NR324 EXAM 1 ACTUAL EXAM QUESTIONS AND ANSWERS 2026/NEWEST
UPDATE!!!
Question 1
A nurse is reviewing the arterial blood gas (ABG) results for a client with a history of COPD.
The results show: pH 7.30, PaCO2 52 mm Hg, and HCO3 24 mEq/L. Which acid-base
imbalance should the nurse identify?
A) Respiratory alkalosis
B) Metabolic acidosis
C) Respiratory acidosis
D) Metabolic alkalosis
E) Normal findings
Correct Answer: C) Respiratory acidosis
Rationale: Respiratory acidosis is characterized by a low pH (below 7.35) and a high PaCO2
(above 45 mm Hg), while the bicarbonate (HCO3) remains within the normal range
initially. This occurs because the lungs are failing to excrete carbon dioxide adequately,
leading to an accumulation of carbonic acid in the blood.
Question 2
Which of the following clinical conditions is a primary cause of respiratory acidosis?
A) Hyperventilation due to anxiety
B) Excessive ingestion of antacids
C) Respiratory depression from opioid overdose
D) Severe diarrhea for three days
E) High-altitude climbing
Correct Answer: C) Respiratory depression from opioid overdose
Rationale: Respiratory acidosis is caused by hypoventilation. Opioid overdoses depress the
central nervous system's drive to breathe, leading to CO2 retention. In contrast, anxiety
causes hyperventilation (respiratory alkalosis), and diarrhea causes loss of bicarbonate
(metabolic acidosis).
Question 3
A nurse is assessing a client with acute respiratory acidosis. Which of the following neurological
findings should the nurse expect?
A) Hyperactivity and tremors
B) Drowsiness, dizziness, and disorientation
C) Seizures and heightened alertness
D) Numbness and tingling in the extremities
E) Improved cognitive focus
Correct Answer: B) Drowsiness, dizziness, and disorientation
Rationale: As CO2 levels rise and the pH drops, the client may experience central nervous
system depression. Common signs include headache, drowsiness, dizziness, and
, 2
disorientation. Numbness and tingling (Option D) are more common in respiratory
alkalosis due to decreased ionized calcium levels.
Question 4
A nurse is caring for a client with chronic respiratory acidosis. Which nursing intervention is the
priority to promote the release of CO2?
A) Administering a sedative to calm the client
B) Placing the client in a supine position
C) Encouraging the client to turn, cough, and deep breathe
D) Restricting fluid intake to 1000 mL/day
E) Administering high-flow oxygen at 10L/min
Correct Answer: C) Encouraging the client to turn, cough, and deep breathe
Rationale: Nursing management for respiratory acidosis focuses on improving ventilation.
Turning, coughing, and deep breathing help clear secretions and expand the alveoli to
promote CO2 exchange. High-flow oxygen (Option E) can be dangerous in chronic COPD
patients as it may suppress their drive to breathe.
Question 5
A nurse identifies a client’s ABG results as: pH 7.50, PaCO2 30 mm Hg, and HCO3 24 mEq/L.
Which condition is most likely responsible for these findings?
A) Diabetic Ketoacidosis
B) Severe Vomiting
C) Pulmonary Embolism (initial stages)
D) Renal Failure
E) Hypoventilation
Correct Answer: C) Pulmonary Embolism (initial stages)
Rationale: These results indicate respiratory alkalosis (high pH, low CO2). In the initial
stages of a pulmonary embolism, the client often hyperventilates due to hypoxia and
anxiety, which blows off CO2, resulting in a respiratory alkalosis.
Question 6
A client is experiencing a severe anxiety attack and is hyperventilating. Which instruction should
the nurse provide to help correct the resulting acid-base imbalance?
A) "Breathe as quickly as possible to get more oxygen."
B) "Hold your breath for one minute."
C) "Breathe into a paper bag or use a rebreather mask."
D) "Drink a large glass of water."
E) "Cough vigorously to clear your airway."
Correct Answer: C) "Breathe into a paper bag or use a rebreather mask."
Rationale: Hyperventilation causes the client to blow off too much CO2, leading to
, 3
respiratory alkalosis. Breathing into a paper bag allows the client to re-breathe the exhaled
CO2, effectively raising the blood's CO2 levels and restoring the pH balance.
Question 7
A nurse is assessing a client with respiratory alkalosis. Which electrolyte imbalance is frequently
associated with this condition?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypercalcemia
E) Hypermagnesemia
Correct Answer: B) Hypokalemia
Rationale: In alkalosis, hydrogen ions (H+) shift out of the cells to help normalize the blood
pH. To maintain electrical neutrality, potassium (K+) shifts into the cells, resulting in a
decreased serum potassium level (hypokalemia).
Question 8
A nurse is reviewing the lab results of a client with Metabolic Acidosis. Which of the following
is a classic compensatory breathing pattern the nurse should observe?
A) Shallow, slow respirations
B) Periods of apnea
C) Deep, rapid hyperventilation (Kussmaul respirations)
D) Musical wheezing on expiration
E) Cheyne-Stokes breathing
Correct Answer: C) Deep, rapid hyperventilation (Kussmaul respirations)
Rationale: The body compensates for metabolic acidosis by attempting to "blow off" CO2
(an acid) to raise the pH. This manifests as Kussmaul respirations, which are deep and
rapid. This is commonly seen in patients with Diabetic Ketoacidosis (DKA).
Question 9
Which of the following conditions is a primary cause of Metabolic Acidosis?
A) Excessive nasogastric suctioning
B) Severe diarrhea
C) Prolonged use of diuretics
D) Hypoventilation
E) High-altitude sickness
Correct Answer: B) Severe diarrhea
Rationale: The lower GI tract is rich in bicarbonate. Severe diarrhea causes an excessive
loss of bicarbonate, leading to a relative increase in acid in the blood (metabolic acidosis).
NG suctioning (Option A) causes loss of gastric acid, leading to metabolic alkalosis.
, 4
Question 10
In a client with metabolic acidosis, which of the following electrolytes should the nurse monitor
for an increase?
A) Sodium
B) Calcium
C) Potassium
D) Magnesium
E) Phosphorus
Correct Answer: C) Potassium
Rationale: In acidic states (acidosis), the body attempts to buffer the excess H+ ions by
moving them into the cells. As H+ enters the cells, potassium (K+) leaves the cells to
maintain electrical balance, leading to hyperkalemia.
Question 11
A client presents with: pH 7.55, PaCO2 40 mm Hg, and HCO3 34 mEq/L. Which cause should
the nurse investigate?
A) Sepsis and shock
B) Excessive gastric suctioning or vomiting
C) Chronic Obstructive Pulmonary Disease
D) Salicylate poisoning
E) Acute Pneumonia
Correct Answer: B) Excessive gastric suctioning or vomiting
Rationale: These results indicate metabolic alkalosis (high pH, high HCO3). Vomiting or
gastric suctioning removes hydrochloric acid (HCl) from the stomach, which leads to an
excess of bicarbonate in the ECF.
Question 12
Which finding is a clinical manifestation of metabolic alkalosis?
A) Warm, flushed skin
B) Kussmaul respirations
C) Numbness and tingling of fingers and toes
D) Hypotension and bradycardia
E) Hyperreflexia and tall T-waves
Correct Answer: C) Numbness and tingling of fingers and toes
Rationale: Metabolic alkalosis can cause a decrease in ionized calcium, leading to
neuromuscular excitability. This manifests as tingling in the extremities (paresthesia),
muscle cramps, and tremors. Option B is characteristic of acidosis, not alkalosis.
Question 13
How does the respiratory system compensate for metabolic alkalosis?
A) By increasing the rate and depth of breathing
UPDATE!!!
Question 1
A nurse is reviewing the arterial blood gas (ABG) results for a client with a history of COPD.
The results show: pH 7.30, PaCO2 52 mm Hg, and HCO3 24 mEq/L. Which acid-base
imbalance should the nurse identify?
A) Respiratory alkalosis
B) Metabolic acidosis
C) Respiratory acidosis
D) Metabolic alkalosis
E) Normal findings
Correct Answer: C) Respiratory acidosis
Rationale: Respiratory acidosis is characterized by a low pH (below 7.35) and a high PaCO2
(above 45 mm Hg), while the bicarbonate (HCO3) remains within the normal range
initially. This occurs because the lungs are failing to excrete carbon dioxide adequately,
leading to an accumulation of carbonic acid in the blood.
Question 2
Which of the following clinical conditions is a primary cause of respiratory acidosis?
A) Hyperventilation due to anxiety
B) Excessive ingestion of antacids
C) Respiratory depression from opioid overdose
D) Severe diarrhea for three days
E) High-altitude climbing
Correct Answer: C) Respiratory depression from opioid overdose
Rationale: Respiratory acidosis is caused by hypoventilation. Opioid overdoses depress the
central nervous system's drive to breathe, leading to CO2 retention. In contrast, anxiety
causes hyperventilation (respiratory alkalosis), and diarrhea causes loss of bicarbonate
(metabolic acidosis).
Question 3
A nurse is assessing a client with acute respiratory acidosis. Which of the following neurological
findings should the nurse expect?
A) Hyperactivity and tremors
B) Drowsiness, dizziness, and disorientation
C) Seizures and heightened alertness
D) Numbness and tingling in the extremities
E) Improved cognitive focus
Correct Answer: B) Drowsiness, dizziness, and disorientation
Rationale: As CO2 levels rise and the pH drops, the client may experience central nervous
system depression. Common signs include headache, drowsiness, dizziness, and
, 2
disorientation. Numbness and tingling (Option D) are more common in respiratory
alkalosis due to decreased ionized calcium levels.
Question 4
A nurse is caring for a client with chronic respiratory acidosis. Which nursing intervention is the
priority to promote the release of CO2?
A) Administering a sedative to calm the client
B) Placing the client in a supine position
C) Encouraging the client to turn, cough, and deep breathe
D) Restricting fluid intake to 1000 mL/day
E) Administering high-flow oxygen at 10L/min
Correct Answer: C) Encouraging the client to turn, cough, and deep breathe
Rationale: Nursing management for respiratory acidosis focuses on improving ventilation.
Turning, coughing, and deep breathing help clear secretions and expand the alveoli to
promote CO2 exchange. High-flow oxygen (Option E) can be dangerous in chronic COPD
patients as it may suppress their drive to breathe.
Question 5
A nurse identifies a client’s ABG results as: pH 7.50, PaCO2 30 mm Hg, and HCO3 24 mEq/L.
Which condition is most likely responsible for these findings?
A) Diabetic Ketoacidosis
B) Severe Vomiting
C) Pulmonary Embolism (initial stages)
D) Renal Failure
E) Hypoventilation
Correct Answer: C) Pulmonary Embolism (initial stages)
Rationale: These results indicate respiratory alkalosis (high pH, low CO2). In the initial
stages of a pulmonary embolism, the client often hyperventilates due to hypoxia and
anxiety, which blows off CO2, resulting in a respiratory alkalosis.
Question 6
A client is experiencing a severe anxiety attack and is hyperventilating. Which instruction should
the nurse provide to help correct the resulting acid-base imbalance?
A) "Breathe as quickly as possible to get more oxygen."
B) "Hold your breath for one minute."
C) "Breathe into a paper bag or use a rebreather mask."
D) "Drink a large glass of water."
E) "Cough vigorously to clear your airway."
Correct Answer: C) "Breathe into a paper bag or use a rebreather mask."
Rationale: Hyperventilation causes the client to blow off too much CO2, leading to
, 3
respiratory alkalosis. Breathing into a paper bag allows the client to re-breathe the exhaled
CO2, effectively raising the blood's CO2 levels and restoring the pH balance.
Question 7
A nurse is assessing a client with respiratory alkalosis. Which electrolyte imbalance is frequently
associated with this condition?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypercalcemia
E) Hypermagnesemia
Correct Answer: B) Hypokalemia
Rationale: In alkalosis, hydrogen ions (H+) shift out of the cells to help normalize the blood
pH. To maintain electrical neutrality, potassium (K+) shifts into the cells, resulting in a
decreased serum potassium level (hypokalemia).
Question 8
A nurse is reviewing the lab results of a client with Metabolic Acidosis. Which of the following
is a classic compensatory breathing pattern the nurse should observe?
A) Shallow, slow respirations
B) Periods of apnea
C) Deep, rapid hyperventilation (Kussmaul respirations)
D) Musical wheezing on expiration
E) Cheyne-Stokes breathing
Correct Answer: C) Deep, rapid hyperventilation (Kussmaul respirations)
Rationale: The body compensates for metabolic acidosis by attempting to "blow off" CO2
(an acid) to raise the pH. This manifests as Kussmaul respirations, which are deep and
rapid. This is commonly seen in patients with Diabetic Ketoacidosis (DKA).
Question 9
Which of the following conditions is a primary cause of Metabolic Acidosis?
A) Excessive nasogastric suctioning
B) Severe diarrhea
C) Prolonged use of diuretics
D) Hypoventilation
E) High-altitude sickness
Correct Answer: B) Severe diarrhea
Rationale: The lower GI tract is rich in bicarbonate. Severe diarrhea causes an excessive
loss of bicarbonate, leading to a relative increase in acid in the blood (metabolic acidosis).
NG suctioning (Option A) causes loss of gastric acid, leading to metabolic alkalosis.
, 4
Question 10
In a client with metabolic acidosis, which of the following electrolytes should the nurse monitor
for an increase?
A) Sodium
B) Calcium
C) Potassium
D) Magnesium
E) Phosphorus
Correct Answer: C) Potassium
Rationale: In acidic states (acidosis), the body attempts to buffer the excess H+ ions by
moving them into the cells. As H+ enters the cells, potassium (K+) leaves the cells to
maintain electrical balance, leading to hyperkalemia.
Question 11
A client presents with: pH 7.55, PaCO2 40 mm Hg, and HCO3 34 mEq/L. Which cause should
the nurse investigate?
A) Sepsis and shock
B) Excessive gastric suctioning or vomiting
C) Chronic Obstructive Pulmonary Disease
D) Salicylate poisoning
E) Acute Pneumonia
Correct Answer: B) Excessive gastric suctioning or vomiting
Rationale: These results indicate metabolic alkalosis (high pH, high HCO3). Vomiting or
gastric suctioning removes hydrochloric acid (HCl) from the stomach, which leads to an
excess of bicarbonate in the ECF.
Question 12
Which finding is a clinical manifestation of metabolic alkalosis?
A) Warm, flushed skin
B) Kussmaul respirations
C) Numbness and tingling of fingers and toes
D) Hypotension and bradycardia
E) Hyperreflexia and tall T-waves
Correct Answer: C) Numbness and tingling of fingers and toes
Rationale: Metabolic alkalosis can cause a decrease in ionized calcium, leading to
neuromuscular excitability. This manifests as tingling in the extremities (paresthesia),
muscle cramps, and tremors. Option B is characteristic of acidosis, not alkalosis.
Question 13
How does the respiratory system compensate for metabolic alkalosis?
A) By increasing the rate and depth of breathing
