NUR 2243 Exam 2 (2026-2027 Update Version)
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A nurse assesses a client with diabetes mellitus who is admitted
with an acid-base imbalance. The clients arterial blood gas values
are pH 7.36, PaO2 98 mm Hg, PaCO2 33 mm Hg, and HCO3 18
mEq/L. Which manifestation should the nurse identify as an
example of the clients compensation mechanism?
a. Increased rate and depth of respirations
b. Increased urinary output
c. Increased thirst and hunger
d. Increased release of acids from the kidneys
ANS: A
This client has metabolic acidosis. The respiratory system
compensates by increasing its activity and blowing off excess
carbon dioxide. Increased urinary output, thirst, and hunger are
manifestations of hyperglycemia but are not compensatory
mechanisms for acid-base imbalances. The kidneys do not release
acids
A nurse assesses a client who is experiencing an acid-base
imbalance. The clients arterial blood gas values are pH 7.34, PaO2
88 mm Hg, PaCO2 38 mm Hg, and HCO3 19 mEq/L. Which
assessment should the nurse perform first?
a. Cardiac rate and rhythm
b. Skin and mucous membranes
c. Musculoskeletal strength
d. Level of orientation
ANS: A
Early cardiovascular changes for a client experiencing moderate
acidosis include increased heart rate and cardiac output. As the
,acidosis worsens, the heart rate decreases and
electrocardiographic changes will be present. Central nervous
system and neuromuscular system changes do not occur with mild
acidosis and should be monitored if the acidosis worsens. Skin and
mucous membrane assessment is not a priority now, but will
change as acidosis worsens.
A nurse assesses a client who is prescribed furosemide (Lasix) for
hypertension. For which acid-base imbalance should the nurse
assess to prevent complications of this therapy?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
ANS: D
Many diuretics, especially loop diuretics, increase the excretion of
hydrogen ions, leading to excess acid loss through the renal
system. This situation is an acid deficit of metabolic origin.
A nurse is caring for a client who is experiencing moderate
metabolic alkalosis. Which action should the nurse take?
a. Monitor daily hemoglobin and hematocrit values.
b. Administer furosemide (Lasix) intravenously.
c. Encourage the client to take deep breaths.
d. Teach the client fall prevention measures.
ANS: D
The priority nursing care for a client who is experiencing moderate
metabolic alkalosis is providing client safety. Clients with
metabolic alkalosis have muscle weakness and are at risk for
falling. The other nursing interventions are not appropriate for
metabolic alkalosis
A nurse assesses a client who is admitted with an acid-base
imbalance. The clients arterial blood gas values are pH 7.32, PaO2
85 mm Hg, PaCO2 34 mm Hg, and HCO3 16 mEq/L. What action
should the nurse take next?
a. Assess clients rate, rhythm, and depth of respiration.
b. Measure the clients pulse and blood pressure.
c. Document the findings and continue to monitor.
d. Notify the physician as soon as possible.
ANS: A
Progressive skeletal muscle weakness is associated with
increasing severity of acidosis. Muscle weakness can lead to
,severe respiratory insufficiency. Acidosis does lead to
dysrhythmias (due to hyperkalemia), but these would best be
assessed with cardiac monitoring. Findings should be
documented, but simply continuing to monitor is not sufficient.
Before notifying the physician, the nurse must have more data to
report
A nurse is caring for a client who has the following arterial blood
values: pH 7.12, PaO2 56 mm Hg, PaCO2 65 mm Hg, and HCO3 22
mEq/L. Which clinical situation should the nurse correlate with
these values?
a. Diabetic ketoacidosis in a person with emphysema
b. Bronchial obstruction related to aspiration of a hot dog
c. Anxiety-induced hyperventilation in an adolescent
d. Diarrhea for 36 hours in an older, frail woman
ANS: B
Arterial blood gas values indicate that the client has acidosis with
normal levels of bicarbonate, suggesting that the problem is not
metabolic. Arterial concentrations of oxygen and carbon dioxide
are abnormal, with low oxygen and high carbon dioxide levels.
Thus, this client has respiratory acidosis from inadequate gas
exchange. The fact that the bicarbonate level is normal indicates
that this is an acute respiratory problem rather than a chronic
problem, because no renal compensation has occurred.
A nurse is caring for a client who has just experienced a 90-second
tonic-clonic seizure. The clients arterial blood gas values are pH
6.88, PaO2 50 mm Hg, PaCO2 60 mm Hg, and HCO3 22 mEq/L.
Which action should the nurse take first?
a. Apply oxygen by mask or nasal cannula.
b. Apply a paper bag over the clients nose and mouth.
c. Administer 50 mL of sodium bicarbonate intravenously.
d. Administer 50 mL of 20% glucose and 20 units of regular insulin.
ANS: A
The client has experienced a combination of metabolic and acute
respiratory acidosis through heavy skeletal muscle contractions
and no gas exchange. When the seizures have stopped and the
client can breathe again, the fastest way to return acid-base
balance is to administer oxygen. Applying a paper bag over the
clients nose and mouth would worsen the acidosis. Sodium
bicarbonate should not be administered because the clients arterial
bicarbonate level is normal. Glucose and insulin are administered
, together to decrease serum potassium levels. This action is not
appropriate based on the information provided
After teaching a client who was malnourished and is being
discharged, a nurse assesses the clients understanding. Which
statement indicates the client correctly understood teaching to
decrease risk for the development of metabolic acidosis?
a. I will drink at least three glasses of milk each day.
b. I will eat three well-balanced meals and a snack daily.
c. I will not take pain medication and antihistamines together.
d. I will avoid salting my food when cooking or during meals.
ANS: B
Starvation or a diet with too few carbohydrates can lead to
metabolic acidosis by forcing cells to switch to using fats for fuel
and by creating ketoacids as a by-product of excessive fat
metabolism. Eating sufficient calories from all food groups helps
reduce this risk.
A nurse evaluates the following arterial blood gas values in a client:
pH 7.48, PaO2 98 mm Hg, PaCO2 28 mm Hg, and HCO3 22 mEq/L.
Which client condition should the nurse correlate with these
results?
a. Diarrhea and vomiting for 36 hours
b. Anxiety-induced hyperventilation
c. Chronic obstructive pulmonary disease (COPD)
d. Diabetic ketoacidosis and emphysema
ANS: B
The elevated pH level indicates alkalosis. The bicarbonate level is
normal, and so is the oxygen partial pressure. Loss of carbon
dioxide is the cause of the alkalosis, which would occur in
response to hyperventilation. Diarrhea and vomiting would cause
metabolic alterations, COPD would lead to respiratory acidosis, and
the client with emphysema most likely would have combined
metabolic acidosis on top of a mild, chronic respiratory acidosis.
After providing discharge teaching, a nurse assesses the clients
understanding regarding increased risk for metabolic alkalosis.
Which statement indicates the client needs additional teaching?
a. I dont drink milk because it gives me gas and diarrhea.
b. I have been taking digoxin every day for the last 15 years.
c. I take sodium bicarbonate after every meal to prevent heartburn.
d. In hot weather, I sweat so much that I drink six glasses of water
each day.
with Premium Questions Bank & Verified
Solutions / Guaranteed Pass / Fully Solved &
Already Graded A+
A nurse assesses a client with diabetes mellitus who is admitted
with an acid-base imbalance. The clients arterial blood gas values
are pH 7.36, PaO2 98 mm Hg, PaCO2 33 mm Hg, and HCO3 18
mEq/L. Which manifestation should the nurse identify as an
example of the clients compensation mechanism?
a. Increased rate and depth of respirations
b. Increased urinary output
c. Increased thirst and hunger
d. Increased release of acids from the kidneys
ANS: A
This client has metabolic acidosis. The respiratory system
compensates by increasing its activity and blowing off excess
carbon dioxide. Increased urinary output, thirst, and hunger are
manifestations of hyperglycemia but are not compensatory
mechanisms for acid-base imbalances. The kidneys do not release
acids
A nurse assesses a client who is experiencing an acid-base
imbalance. The clients arterial blood gas values are pH 7.34, PaO2
88 mm Hg, PaCO2 38 mm Hg, and HCO3 19 mEq/L. Which
assessment should the nurse perform first?
a. Cardiac rate and rhythm
b. Skin and mucous membranes
c. Musculoskeletal strength
d. Level of orientation
ANS: A
Early cardiovascular changes for a client experiencing moderate
acidosis include increased heart rate and cardiac output. As the
,acidosis worsens, the heart rate decreases and
electrocardiographic changes will be present. Central nervous
system and neuromuscular system changes do not occur with mild
acidosis and should be monitored if the acidosis worsens. Skin and
mucous membrane assessment is not a priority now, but will
change as acidosis worsens.
A nurse assesses a client who is prescribed furosemide (Lasix) for
hypertension. For which acid-base imbalance should the nurse
assess to prevent complications of this therapy?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis
ANS: D
Many diuretics, especially loop diuretics, increase the excretion of
hydrogen ions, leading to excess acid loss through the renal
system. This situation is an acid deficit of metabolic origin.
A nurse is caring for a client who is experiencing moderate
metabolic alkalosis. Which action should the nurse take?
a. Monitor daily hemoglobin and hematocrit values.
b. Administer furosemide (Lasix) intravenously.
c. Encourage the client to take deep breaths.
d. Teach the client fall prevention measures.
ANS: D
The priority nursing care for a client who is experiencing moderate
metabolic alkalosis is providing client safety. Clients with
metabolic alkalosis have muscle weakness and are at risk for
falling. The other nursing interventions are not appropriate for
metabolic alkalosis
A nurse assesses a client who is admitted with an acid-base
imbalance. The clients arterial blood gas values are pH 7.32, PaO2
85 mm Hg, PaCO2 34 mm Hg, and HCO3 16 mEq/L. What action
should the nurse take next?
a. Assess clients rate, rhythm, and depth of respiration.
b. Measure the clients pulse and blood pressure.
c. Document the findings and continue to monitor.
d. Notify the physician as soon as possible.
ANS: A
Progressive skeletal muscle weakness is associated with
increasing severity of acidosis. Muscle weakness can lead to
,severe respiratory insufficiency. Acidosis does lead to
dysrhythmias (due to hyperkalemia), but these would best be
assessed with cardiac monitoring. Findings should be
documented, but simply continuing to monitor is not sufficient.
Before notifying the physician, the nurse must have more data to
report
A nurse is caring for a client who has the following arterial blood
values: pH 7.12, PaO2 56 mm Hg, PaCO2 65 mm Hg, and HCO3 22
mEq/L. Which clinical situation should the nurse correlate with
these values?
a. Diabetic ketoacidosis in a person with emphysema
b. Bronchial obstruction related to aspiration of a hot dog
c. Anxiety-induced hyperventilation in an adolescent
d. Diarrhea for 36 hours in an older, frail woman
ANS: B
Arterial blood gas values indicate that the client has acidosis with
normal levels of bicarbonate, suggesting that the problem is not
metabolic. Arterial concentrations of oxygen and carbon dioxide
are abnormal, with low oxygen and high carbon dioxide levels.
Thus, this client has respiratory acidosis from inadequate gas
exchange. The fact that the bicarbonate level is normal indicates
that this is an acute respiratory problem rather than a chronic
problem, because no renal compensation has occurred.
A nurse is caring for a client who has just experienced a 90-second
tonic-clonic seizure. The clients arterial blood gas values are pH
6.88, PaO2 50 mm Hg, PaCO2 60 mm Hg, and HCO3 22 mEq/L.
Which action should the nurse take first?
a. Apply oxygen by mask or nasal cannula.
b. Apply a paper bag over the clients nose and mouth.
c. Administer 50 mL of sodium bicarbonate intravenously.
d. Administer 50 mL of 20% glucose and 20 units of regular insulin.
ANS: A
The client has experienced a combination of metabolic and acute
respiratory acidosis through heavy skeletal muscle contractions
and no gas exchange. When the seizures have stopped and the
client can breathe again, the fastest way to return acid-base
balance is to administer oxygen. Applying a paper bag over the
clients nose and mouth would worsen the acidosis. Sodium
bicarbonate should not be administered because the clients arterial
bicarbonate level is normal. Glucose and insulin are administered
, together to decrease serum potassium levels. This action is not
appropriate based on the information provided
After teaching a client who was malnourished and is being
discharged, a nurse assesses the clients understanding. Which
statement indicates the client correctly understood teaching to
decrease risk for the development of metabolic acidosis?
a. I will drink at least three glasses of milk each day.
b. I will eat three well-balanced meals and a snack daily.
c. I will not take pain medication and antihistamines together.
d. I will avoid salting my food when cooking or during meals.
ANS: B
Starvation or a diet with too few carbohydrates can lead to
metabolic acidosis by forcing cells to switch to using fats for fuel
and by creating ketoacids as a by-product of excessive fat
metabolism. Eating sufficient calories from all food groups helps
reduce this risk.
A nurse evaluates the following arterial blood gas values in a client:
pH 7.48, PaO2 98 mm Hg, PaCO2 28 mm Hg, and HCO3 22 mEq/L.
Which client condition should the nurse correlate with these
results?
a. Diarrhea and vomiting for 36 hours
b. Anxiety-induced hyperventilation
c. Chronic obstructive pulmonary disease (COPD)
d. Diabetic ketoacidosis and emphysema
ANS: B
The elevated pH level indicates alkalosis. The bicarbonate level is
normal, and so is the oxygen partial pressure. Loss of carbon
dioxide is the cause of the alkalosis, which would occur in
response to hyperventilation. Diarrhea and vomiting would cause
metabolic alterations, COPD would lead to respiratory acidosis, and
the client with emphysema most likely would have combined
metabolic acidosis on top of a mild, chronic respiratory acidosis.
After providing discharge teaching, a nurse assesses the clients
understanding regarding increased risk for metabolic alkalosis.
Which statement indicates the client needs additional teaching?
a. I dont drink milk because it gives me gas and diarrhea.
b. I have been taking digoxin every day for the last 15 years.
c. I take sodium bicarbonate after every meal to prevent heartburn.
d. In hot weather, I sweat so much that I drink six glasses of water
each day.
