NCLEX Exam Questions From The 5th Edition Saunders
Book, Acid-Base Balance Exam Questions & Answers
A patient had 5 liters of fluid removed during a paracentesis. What intravenous (IV)
solution may be used to pull fluid into the intravascular space after the paracentesis?
0.9% sodium chloride
25% albumin solution
Lactated Ringer's solution
5% dextrose in 0.45% saline - 25% albumin solution
After a paracentesis of 5 L or greater of ascites fluid, 25% albumin solution may be
used as a volume expander. Normal saline, lactated Ringer's, and 5% dextrose in
0.45% saline will not be effective for this action.
A nurse reviews the arterial blood gas results of a client and notes the following: pH
7.45, Pco2 of 30, and HCO3- of 22. The nurse analyzes these results as indicating
which condition?
1) Metabolic Acidosis, compensated
2) Respiratory Alkalosis, compensated
3) Metabolic Alkalosis, compensated
4) Respiratory Acidosis, compensated - Answer: 2
Rational: The normal pH is 7.3-7.45. In a respiratory condition, an opposite effect will
be seen between the pH and the Pco2. In this condition, the pH is a the high end of
normal and the Pco2 is low. In an alkalotic condition, the pH is elevated. Therefore
the values identified in the question indicated a respiratory alkalosis. When the pH
returns to a normal value, compensation has occurred.
A nurse is caring for a client with a nasogastric tube that is attached to low suction.
The nurse monitors the client, knowing that the client is at risk for which acid-base
disorder?
1) Metabolic Acidosis
,2) Metabolic Alkalosis
3) Respiratory Acidosis
4) Respiratory Alkalosis - Answer: 2
Rational: Metabolic Alkalosis is defined as a deficit or loss of hydrogen ions or acids
or an excess of base (bicarbonate) that results from the accumulation of base or from a
loss of acid without a comparable loss of base in the body fluids. This occurs in
conditions resulting in hypovolemia, the loss of gastric fluid, excessive bicarbonate
intake, the massive transfusion of whole blood, and hyperaldosteronism. Loss of
gastric fluid via nasogastric suction or vomiting causes Metabolic Alkalosis as a result
of the loss of hydrochloric acid. Options 1, 3, & 4 are incorrect interpretations.
A client with a 3-day history of nausea and vomiting presents to the emergency
department. The client is hypoventilating and has a respiratory rate of 10 breaths/min.
Arterial blood gases are drawn and the nurse reviews the results, expecting to note
which of the following?
1) A decreased pH and an increased CO2
2) An increased pH and a decreased Co2
3) A decreased pH and a decreased HCO3-
4) An increased pH with an increased HCO3- - Answer: 4
Rational: Clients experiencing nausea and vomiting would most likely present with
metabolic alkalosis resulting from loss of gastric acid, thus causing the pH and HCO3-
to increase. Symptoms experienced by the client would include hypventilation and
tachycardia. Option 2 reflects a respiratory acidotic condition. Option 2 reflects a
respiratory alkalotic condition. Option 3 reflects a metabolic acidotic condition.
A nurse caring for a client with an ileostomy understands the the client is most at risk
for developing which acid-base disorder?
1) Metabolic Acidosis
2) Metabolic Alkalosis
3) Respiratory Acidosis
4) Respiratory Alkalosis - Answer: 1
Rational: Metabolic Acidosis is defined as total concentration of buffer base that is
lower than normal, with a relative increase in the hydrogen ion concentration. This
results from loss of buffer bases or the retention of too many acids without sufficient
bases, and occurs in conditions such as renal failure, diabetic ketoacidosis, from the
production of lactic acid, from the ingestion of toxins (such as acetylsalicylic acid -
,aka- aspirin), malnutrition, or severe diarrhea. Intestinal secretions are high in
bicarbonate and may e lost through enteric drainage tubes or an ileostomy, or with
diarrhea. These conditions result in metabolic acidosis. Options 2, 3, & 4 are incorrect
interpretations and do not occur in the client with an ileostomy.
**(Base/Bicarbonate is lost through an ileostomy)
A nurse is caring for a client with diabetic ketoacidosis and documents the the client is
experiencing Kussmaul's respirations. Based on this documentation, which of the
following did the nurse observe?
1) Respirations that cease for several seconds
2) Respirations that are regular but abnormally slow
3) Respirations that are labored and increased in depth and rate
4) Respirations that are abnormally deep, regular, and increased in rate - Answer: 4
Rational: Kussmal's respirations are abnormally deep, regular, and increased in rate.
Apnea is described as repirations that cease for several seconds. In bradypnea,
respirations are regular but abnormally slow. In hyperpnea, respirations are labored
and increased in depth and rate.
A client who is found unresponsive has arterial blood gases drawn and the results
indicate dthe following: pH is 7.12, Pco2 is 90, and HCO3- is 22. the nurse interprets
the results as indicating which condition?
1) Metabolic Acidosis with compensation
2) Respiratory Acidosis with compensation
3) Metabolic Acidosis without compensation
4) Respiratory Acidosis without compensation - Answer: 4
Rational: The acid-base disturbance is respiratory acidosis without compensation. The
normal pH is 7.35-7.45. The normal Pco2 is 32-48. In respiratory acidosis the pH is
decreased and the pco2 is elevated. The normal bicarbonate (HCO3-) level is 22-27.
Because the bicarbonate is still within normal limits, the kidneys have not had time to
adjust for this acid-base disturbance. Additionally, the pH is not within normal limits.
Therefore the condition is without compensation. Options 1, 2, & 3 are incorrect
interpretations.
The nurse plans care for a client with chronic obstructive pulmonary disease (COPD),
understanding that the client is most likely to experience what type of acid-bases
imbalance:
, 1) Metabolic Acidosis
2) Metabolic Alkalosis
3) Respiratory Acidosis
4) Respiratory Alkalosis - Answer: 3
Rational: Respiratory Acidosis is most often caused by hypoventilation in a client
with COPD. Other acid-base disturbances can occur in a client with COPD during
exacerbation of the disease but the most likely imabalance is respiratory acidosis.
Option 1, 2,& 4 are incorrect options.
A nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes
the results and determines that the client is experiencing respiratory acidosis. Which
of the following validates the nurse's findings?
1) pH 7.25, Pco2 50,
2) pH 7.35, Pco2 40
3) pH 7.50, Pco2 52
4) pH 7.52, Pco2 28 - Answer: 1
Rational: Atelectasis is a condition characterized by the collapse of alveoli, preventing
the respiratory exchange of oxygen and carbon dioxide in a part of the lungs. The
normal pH is 7.35-7.45. The normal Pco2 is 32-48. In respiratory acidosis, the pH is
decreased and the Pco2 is elevated. Option 2 identifies normal values. Option 3
identifies an alkalotic condition. Option 4 identifies respiratory alkalosis.
A nurse is caring for a client who is on a mechanical ventilator. Blood gas results
indicated a pH of 7.50 and a Pco2 of 30. The nurse has determines that the client is
experience respiratory alkalosis. Which laboratory value would most likely be noted
in this condition?
1) Sodium level of 145
2) Potassium level of 3
3) Magnesium level of 2
4) Phosphorus level of 4 - Answer: 2
Rational: Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in
hydrogen ion concentrations that results from the accumulations of base or from a loss
of acid without a comparable loss of base in the body fluids. This occurs in conditions
that cause overstimulation of the respiratory system. Clinical manifestations of
repiratory alkalosis include headache, tachypnea, paresthesias, tetany, vertigo,
Book, Acid-Base Balance Exam Questions & Answers
A patient had 5 liters of fluid removed during a paracentesis. What intravenous (IV)
solution may be used to pull fluid into the intravascular space after the paracentesis?
0.9% sodium chloride
25% albumin solution
Lactated Ringer's solution
5% dextrose in 0.45% saline - 25% albumin solution
After a paracentesis of 5 L or greater of ascites fluid, 25% albumin solution may be
used as a volume expander. Normal saline, lactated Ringer's, and 5% dextrose in
0.45% saline will not be effective for this action.
A nurse reviews the arterial blood gas results of a client and notes the following: pH
7.45, Pco2 of 30, and HCO3- of 22. The nurse analyzes these results as indicating
which condition?
1) Metabolic Acidosis, compensated
2) Respiratory Alkalosis, compensated
3) Metabolic Alkalosis, compensated
4) Respiratory Acidosis, compensated - Answer: 2
Rational: The normal pH is 7.3-7.45. In a respiratory condition, an opposite effect will
be seen between the pH and the Pco2. In this condition, the pH is a the high end of
normal and the Pco2 is low. In an alkalotic condition, the pH is elevated. Therefore
the values identified in the question indicated a respiratory alkalosis. When the pH
returns to a normal value, compensation has occurred.
A nurse is caring for a client with a nasogastric tube that is attached to low suction.
The nurse monitors the client, knowing that the client is at risk for which acid-base
disorder?
1) Metabolic Acidosis
,2) Metabolic Alkalosis
3) Respiratory Acidosis
4) Respiratory Alkalosis - Answer: 2
Rational: Metabolic Alkalosis is defined as a deficit or loss of hydrogen ions or acids
or an excess of base (bicarbonate) that results from the accumulation of base or from a
loss of acid without a comparable loss of base in the body fluids. This occurs in
conditions resulting in hypovolemia, the loss of gastric fluid, excessive bicarbonate
intake, the massive transfusion of whole blood, and hyperaldosteronism. Loss of
gastric fluid via nasogastric suction or vomiting causes Metabolic Alkalosis as a result
of the loss of hydrochloric acid. Options 1, 3, & 4 are incorrect interpretations.
A client with a 3-day history of nausea and vomiting presents to the emergency
department. The client is hypoventilating and has a respiratory rate of 10 breaths/min.
Arterial blood gases are drawn and the nurse reviews the results, expecting to note
which of the following?
1) A decreased pH and an increased CO2
2) An increased pH and a decreased Co2
3) A decreased pH and a decreased HCO3-
4) An increased pH with an increased HCO3- - Answer: 4
Rational: Clients experiencing nausea and vomiting would most likely present with
metabolic alkalosis resulting from loss of gastric acid, thus causing the pH and HCO3-
to increase. Symptoms experienced by the client would include hypventilation and
tachycardia. Option 2 reflects a respiratory acidotic condition. Option 2 reflects a
respiratory alkalotic condition. Option 3 reflects a metabolic acidotic condition.
A nurse caring for a client with an ileostomy understands the the client is most at risk
for developing which acid-base disorder?
1) Metabolic Acidosis
2) Metabolic Alkalosis
3) Respiratory Acidosis
4) Respiratory Alkalosis - Answer: 1
Rational: Metabolic Acidosis is defined as total concentration of buffer base that is
lower than normal, with a relative increase in the hydrogen ion concentration. This
results from loss of buffer bases or the retention of too many acids without sufficient
bases, and occurs in conditions such as renal failure, diabetic ketoacidosis, from the
production of lactic acid, from the ingestion of toxins (such as acetylsalicylic acid -
,aka- aspirin), malnutrition, or severe diarrhea. Intestinal secretions are high in
bicarbonate and may e lost through enteric drainage tubes or an ileostomy, or with
diarrhea. These conditions result in metabolic acidosis. Options 2, 3, & 4 are incorrect
interpretations and do not occur in the client with an ileostomy.
**(Base/Bicarbonate is lost through an ileostomy)
A nurse is caring for a client with diabetic ketoacidosis and documents the the client is
experiencing Kussmaul's respirations. Based on this documentation, which of the
following did the nurse observe?
1) Respirations that cease for several seconds
2) Respirations that are regular but abnormally slow
3) Respirations that are labored and increased in depth and rate
4) Respirations that are abnormally deep, regular, and increased in rate - Answer: 4
Rational: Kussmal's respirations are abnormally deep, regular, and increased in rate.
Apnea is described as repirations that cease for several seconds. In bradypnea,
respirations are regular but abnormally slow. In hyperpnea, respirations are labored
and increased in depth and rate.
A client who is found unresponsive has arterial blood gases drawn and the results
indicate dthe following: pH is 7.12, Pco2 is 90, and HCO3- is 22. the nurse interprets
the results as indicating which condition?
1) Metabolic Acidosis with compensation
2) Respiratory Acidosis with compensation
3) Metabolic Acidosis without compensation
4) Respiratory Acidosis without compensation - Answer: 4
Rational: The acid-base disturbance is respiratory acidosis without compensation. The
normal pH is 7.35-7.45. The normal Pco2 is 32-48. In respiratory acidosis the pH is
decreased and the pco2 is elevated. The normal bicarbonate (HCO3-) level is 22-27.
Because the bicarbonate is still within normal limits, the kidneys have not had time to
adjust for this acid-base disturbance. Additionally, the pH is not within normal limits.
Therefore the condition is without compensation. Options 1, 2, & 3 are incorrect
interpretations.
The nurse plans care for a client with chronic obstructive pulmonary disease (COPD),
understanding that the client is most likely to experience what type of acid-bases
imbalance:
, 1) Metabolic Acidosis
2) Metabolic Alkalosis
3) Respiratory Acidosis
4) Respiratory Alkalosis - Answer: 3
Rational: Respiratory Acidosis is most often caused by hypoventilation in a client
with COPD. Other acid-base disturbances can occur in a client with COPD during
exacerbation of the disease but the most likely imabalance is respiratory acidosis.
Option 1, 2,& 4 are incorrect options.
A nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes
the results and determines that the client is experiencing respiratory acidosis. Which
of the following validates the nurse's findings?
1) pH 7.25, Pco2 50,
2) pH 7.35, Pco2 40
3) pH 7.50, Pco2 52
4) pH 7.52, Pco2 28 - Answer: 1
Rational: Atelectasis is a condition characterized by the collapse of alveoli, preventing
the respiratory exchange of oxygen and carbon dioxide in a part of the lungs. The
normal pH is 7.35-7.45. The normal Pco2 is 32-48. In respiratory acidosis, the pH is
decreased and the Pco2 is elevated. Option 2 identifies normal values. Option 3
identifies an alkalotic condition. Option 4 identifies respiratory alkalosis.
A nurse is caring for a client who is on a mechanical ventilator. Blood gas results
indicated a pH of 7.50 and a Pco2 of 30. The nurse has determines that the client is
experience respiratory alkalosis. Which laboratory value would most likely be noted
in this condition?
1) Sodium level of 145
2) Potassium level of 3
3) Magnesium level of 2
4) Phosphorus level of 4 - Answer: 2
Rational: Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in
hydrogen ion concentrations that results from the accumulations of base or from a loss
of acid without a comparable loss of base in the body fluids. This occurs in conditions
that cause overstimulation of the respiratory system. Clinical manifestations of
repiratory alkalosis include headache, tachypnea, paresthesias, tetany, vertigo,
