Chamberlain University
1 MAXE • 423 RN
★ ★
C College of Nursing
J O U R N E Y T O E X T R A O R D I N A R Y CO M PA S S I O N AT E C A R E
EST. 1889
NR 324 — Examination 1
F LU I D , E L E C T R O LYT E & A C I D - B A S E B A L A N C E + R E S P I R ATO R Y D I S O R D E R S
INSTITUTION Chamberlain University COURSE CODE NR 324
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Examination 1 — Adult Health I TOTAL QUESTIONS 30 Questions
COURSE TITLE Adult Health I FORMAT Multiple Choice — Select the Single Best
Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise instructed.
▸ Acid-base balance — respiratory acidosis/alkalosis and metabolic acidosis/alkalosis — with ABG interpretation is a core
competency.
▸ Fluid and electrolyte imbalances — sodium, potassium, calcium, and magnesium — with assessment findings and priority
interventions are emphasized.
▸ Respiratory disorders — COPD, asthma, pneumonia, TB, tracheostomy care, and chest tube management — are testable
content.
▸ Isolation precautions, diagnostic testing, and pharmacological management are integrated throughout.
▸ Correct answers and clinical rationales appear below each question for NCLEX board review purposes.
▸ All content reflects current evidence-based practice and NCLEX/HESI testing blueprints.
SECTION I — ACID-BASE BALANCE & FLUID/ELECTROLYTE DISORDERS Questions 1 – 14
1. What are the primary causes of respiratory acidosis?
A. Hyperventilation, tachypnea, high respiratory rate
B. Hypoventilation, bradypnea, low respiratory rate
C. Diarrhea and loss of bicarbonate
D. Excessive antacid use and vomiting
CORRECT ANSWER B — Hypoventilation, bradypnea, low respiratory rate; alveolar hypoventilation leads to CO2 retention
and decreased pH
RATIONALE Respiratory acidosis results from ALVEOLAR HYPOVENTILATION — when the lungs cannot adequately
eliminate CO2, PaCO2 rises (>45 mmHg) and blood pH falls (<7.35). Primary causes: bradypnea (low
respiratory rate — e.g., opioid overdose, sedation, anesthesia), shallow breathing (e.g., neuromuscular
disorders like Guillain-Barré, myasthenia gravis), COPD exacerbation, and respiratory failure. The kidneys
compensate by retaining bicarbonate, but this takes days. Hyperventilation (A) causes respiratory ALKALOSIS
(PaCO2 <35, pH >7.45). Diarrhea (C) causes metabolic acidosis. Vomiting (D) causes metabolic alkalosis. ABG
interpretation: respiratory acidosis = pH <7.35 with PaCO2 >45. Treatment: improve ventilation — naloxone for
opioid overdose, bronchodilators, BiPAP, or mechanical ventilation.
, 2. What are the primary causes of respiratory alkalosis?
A. Hypoventilation and bradypnea
B. Hyperventilation, tachypnea, high respiratory rate
C. Renal failure and diabetic ketoacidosis
D. Prolonged vomiting and NG suctioning
CORRECT ANSWER B — Hyperventilation, tachypnea, high respiratory rate; excessive CO2 elimination increases pH above
7.45
RATIONALE Respiratory alkalosis occurs when HYPERVENTILATION causes excessive CO2 elimination — PaCO2 drops
below 35 mmHg and blood pH rises above 7.45. Common causes: anxiety/panic attacks, pain, fever,
mechanical ventilation (over-ventilation), salicylate (aspirin) overdose (directly stimulates respiratory center),
high altitude, and pregnancy (progesterone stimulates respiration). Tachypnea (high respiratory rate)
increases alveolar ventilation, "blowing off" CO2. Symptoms include: lightheadedness, paresthesias (perioral
and extremities numbness/tingling), carpopedal spasms, and tetany (due to hypocalcemia from increased
calcium binding to albumin in alkalotic state). Hypoventilation (A) causes respiratory acidosis. Renal
failure/DKA (C) cause metabolic acidosis. Vomiting (D) causes metabolic alkalosis.
3. What is a common cause of metabolic acidosis?
A. Hyperventilation and anxiety
B. Diarrhea
C. Nausea and vomiting
D. Excessive antacid use
CORRECT ANSWER B — Diarrhea; causes loss of bicarbonate-rich intestinal fluids, leading to non-anion gap metabolic
acidosis
RATIONALE Metabolic acidosis (pH <7.35, HCO3 <22) has many causes. Diarrhea causes loss of bicarbonate-rich intestinal
secretions — the pancreas and intestinal mucosa secrete large amounts of bicarbonate into the GI tract that is
normally reabsorbed; diarrhea causes net loss. Other causes: (1) Diabetic ketoacidosis — accumulation of
ketone bodies. (2) Lactic acidosis — tissue hypoperfusion (shock, sepsis). (3) Renal failure — inability to
excrete acid and reabsorb bicarbonate. (4) Salicylate poisoning — mixed respiratory alkalosis + metabolic
acidosis. Hyperventilation (A) causes respiratory alkalosis. Vomiting (C) causes metabolic ALKALOSIS (loss of
gastric HCl). Excessive antacids (D) cause metabolic alkalosis. The anion gap (Na - [Cl + HCO3]) distinguishes
between anion gap (MUDPILES) and non-anion gap metabolic acidosis.
4. What is a common cause of metabolic alkalosis?
A. Diarrhea and renal failure
B. Nausea, vomiting
C. Lactic acidosis and DKA
D. Bradypnea and hypoventilation
CORRECT ANSWER B — Nausea and vomiting; loss of hydrochloric acid from the stomach leads to increased blood
bicarbonate
RATIONALE Metabolic alkalosis (pH >7.45, HCO3 >26) results from loss of acid (H+) or gain of base (HCO3). Vomiting is the
classic cause — the stomach secretes HCl into gastric fluid; when vomiting occurs, H+ is lost, and the gastric
parietal cells continue producing bicarbonate (which enters the blood) to replace the lost acid. Other causes:
NG suctioning (removes gastric acid), excessive antacid or bicarbonate ingestion, loop/thiazide diuretics
(increase renal H+ and K+ loss), and hyperaldosteronism. The kidneys compensate by excreting bicarbonate,
but this is often incomplete if hypokalemia or hypovolemia are present (both stimulate bicarbonate
reabsorption). Diarrhea (A) causes metabolic acidosis. Lactic acidosis/DKA (C) cause metabolic acidosis.
Bradypnea (D) causes respiratory acidosis.
1 MAXE • 423 RN
★ ★
C College of Nursing
J O U R N E Y T O E X T R A O R D I N A R Y CO M PA S S I O N AT E C A R E
EST. 1889
NR 324 — Examination 1
F LU I D , E L E C T R O LYT E & A C I D - B A S E B A L A N C E + R E S P I R ATO R Y D I S O R D E R S
INSTITUTION Chamberlain University COURSE CODE NR 324
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Examination 1 — Adult Health I TOTAL QUESTIONS 30 Questions
COURSE TITLE Adult Health I FORMAT Multiple Choice — Select the Single Best
Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise instructed.
▸ Acid-base balance — respiratory acidosis/alkalosis and metabolic acidosis/alkalosis — with ABG interpretation is a core
competency.
▸ Fluid and electrolyte imbalances — sodium, potassium, calcium, and magnesium — with assessment findings and priority
interventions are emphasized.
▸ Respiratory disorders — COPD, asthma, pneumonia, TB, tracheostomy care, and chest tube management — are testable
content.
▸ Isolation precautions, diagnostic testing, and pharmacological management are integrated throughout.
▸ Correct answers and clinical rationales appear below each question for NCLEX board review purposes.
▸ All content reflects current evidence-based practice and NCLEX/HESI testing blueprints.
SECTION I — ACID-BASE BALANCE & FLUID/ELECTROLYTE DISORDERS Questions 1 – 14
1. What are the primary causes of respiratory acidosis?
A. Hyperventilation, tachypnea, high respiratory rate
B. Hypoventilation, bradypnea, low respiratory rate
C. Diarrhea and loss of bicarbonate
D. Excessive antacid use and vomiting
CORRECT ANSWER B — Hypoventilation, bradypnea, low respiratory rate; alveolar hypoventilation leads to CO2 retention
and decreased pH
RATIONALE Respiratory acidosis results from ALVEOLAR HYPOVENTILATION — when the lungs cannot adequately
eliminate CO2, PaCO2 rises (>45 mmHg) and blood pH falls (<7.35). Primary causes: bradypnea (low
respiratory rate — e.g., opioid overdose, sedation, anesthesia), shallow breathing (e.g., neuromuscular
disorders like Guillain-Barré, myasthenia gravis), COPD exacerbation, and respiratory failure. The kidneys
compensate by retaining bicarbonate, but this takes days. Hyperventilation (A) causes respiratory ALKALOSIS
(PaCO2 <35, pH >7.45). Diarrhea (C) causes metabolic acidosis. Vomiting (D) causes metabolic alkalosis. ABG
interpretation: respiratory acidosis = pH <7.35 with PaCO2 >45. Treatment: improve ventilation — naloxone for
opioid overdose, bronchodilators, BiPAP, or mechanical ventilation.
, 2. What are the primary causes of respiratory alkalosis?
A. Hypoventilation and bradypnea
B. Hyperventilation, tachypnea, high respiratory rate
C. Renal failure and diabetic ketoacidosis
D. Prolonged vomiting and NG suctioning
CORRECT ANSWER B — Hyperventilation, tachypnea, high respiratory rate; excessive CO2 elimination increases pH above
7.45
RATIONALE Respiratory alkalosis occurs when HYPERVENTILATION causes excessive CO2 elimination — PaCO2 drops
below 35 mmHg and blood pH rises above 7.45. Common causes: anxiety/panic attacks, pain, fever,
mechanical ventilation (over-ventilation), salicylate (aspirin) overdose (directly stimulates respiratory center),
high altitude, and pregnancy (progesterone stimulates respiration). Tachypnea (high respiratory rate)
increases alveolar ventilation, "blowing off" CO2. Symptoms include: lightheadedness, paresthesias (perioral
and extremities numbness/tingling), carpopedal spasms, and tetany (due to hypocalcemia from increased
calcium binding to albumin in alkalotic state). Hypoventilation (A) causes respiratory acidosis. Renal
failure/DKA (C) cause metabolic acidosis. Vomiting (D) causes metabolic alkalosis.
3. What is a common cause of metabolic acidosis?
A. Hyperventilation and anxiety
B. Diarrhea
C. Nausea and vomiting
D. Excessive antacid use
CORRECT ANSWER B — Diarrhea; causes loss of bicarbonate-rich intestinal fluids, leading to non-anion gap metabolic
acidosis
RATIONALE Metabolic acidosis (pH <7.35, HCO3 <22) has many causes. Diarrhea causes loss of bicarbonate-rich intestinal
secretions — the pancreas and intestinal mucosa secrete large amounts of bicarbonate into the GI tract that is
normally reabsorbed; diarrhea causes net loss. Other causes: (1) Diabetic ketoacidosis — accumulation of
ketone bodies. (2) Lactic acidosis — tissue hypoperfusion (shock, sepsis). (3) Renal failure — inability to
excrete acid and reabsorb bicarbonate. (4) Salicylate poisoning — mixed respiratory alkalosis + metabolic
acidosis. Hyperventilation (A) causes respiratory alkalosis. Vomiting (C) causes metabolic ALKALOSIS (loss of
gastric HCl). Excessive antacids (D) cause metabolic alkalosis. The anion gap (Na - [Cl + HCO3]) distinguishes
between anion gap (MUDPILES) and non-anion gap metabolic acidosis.
4. What is a common cause of metabolic alkalosis?
A. Diarrhea and renal failure
B. Nausea, vomiting
C. Lactic acidosis and DKA
D. Bradypnea and hypoventilation
CORRECT ANSWER B — Nausea and vomiting; loss of hydrochloric acid from the stomach leads to increased blood
bicarbonate
RATIONALE Metabolic alkalosis (pH >7.45, HCO3 >26) results from loss of acid (H+) or gain of base (HCO3). Vomiting is the
classic cause — the stomach secretes HCl into gastric fluid; when vomiting occurs, H+ is lost, and the gastric
parietal cells continue producing bicarbonate (which enters the blood) to replace the lost acid. Other causes:
NG suctioning (removes gastric acid), excessive antacid or bicarbonate ingestion, loop/thiazide diuretics
(increase renal H+ and K+ loss), and hyperaldosteronism. The kidneys compensate by excreting bicarbonate,
but this is often incomplete if hypokalemia or hypovolemia are present (both stimulate bicarbonate
reabsorption). Diarrhea (A) causes metabolic acidosis. Lactic acidosis/DKA (C) cause metabolic acidosis.
Bradypnea (D) causes respiratory acidosis.
