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Verified, A+ Rated, Updated NGN NCLEX-RN
2025/2026 | Saunders Ch. 9 Acid-Base Imbalance
(ABG) – 160 Select-All-That-Apply Questions with
Detailed Rationales":
1. A client with COPD has the following ABG results: pH 7.32, PaCO₂ 55 mm
Hg, HCO₃ 26 mEq/L. How should the nurse interpret this?
Select all that apply.
A. Respiratory acidosis
B. Metabolic alkalosis
C. Uncompensated
D. Partially compensated
E. Normal acid-base balance
Correct Answers: A, C
Rationale:
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A pH of 7.32 indicates acidosis. The elevated PaCO₂ confirms a respiratory cause,
and since the HCO₃ is within normal limits, the kidneys have not compensated yet.
Therefore, the condition is classified as uncompensated respiratory acidosis.
2. A nurse is caring for a client with metabolic alkalosis. Which clinical
manifestations might the nurse expect?
Select all that apply.
A. Hypoventilation
B. Muscle cramps
C. Hyperkalemia
D. Confusion
E. Tachycardia
Correct Answers: A, B, D, E
Rationale:
Metabolic alkalosis leads to compensatory hypoventilation to retain CO₂, which
increases acidity. Symptoms include muscle cramps from electrolyte imbalances,
mental status changes like confusion, and tachycardia as the body tries to
compensate.
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3. A client has an ABG with pH 7.48, PaCO₂ 40 mm Hg, HCO₃ 30 mEq/L.
What is the interpretation?
Select all that apply.
A. Metabolic alkalosis
B. Respiratory alkalosis
C. Uncompensated
D. Fully compensated
E. Partially compensated
Correct Answers: A, C
Rationale:
The pH is high, indicating alkalosis. Since PaCO₂ is normal and HCO₃ is elevated,
the issue is metabolic. No compensation is observed, making this an
uncompensated metabolic alkalosis.
4. Which findings indicate respiratory alkalosis?
Select all that apply.
A. pH 7.49
B. PaCO₂ 28 mm Hg
C. HCO₃ 22 mEq/L
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D. pH 7.35
E. PaCO₂ 50 mm Hg
Correct Answers: A, B
Rationale:
A high pH and low PaCO₂ indicate respiratory alkalosis due to excessive
exhalation of CO₂. Normal HCO₃ suggests no metabolic compensation. PaCO₂ of
50 and pH 7.35 are within or trending toward acidosis, not alkalosis.
5. Which clients are at risk for metabolic acidosis?
Select all that apply.
A. A client with severe diarrhea
B. A client in diabetic ketoacidosis
C. A client with prolonged vomiting
D. A client with renal failure
E. A client taking excessive antacids
Correct Answers: A, B, D
Rationale:
Loss of bicarbonate via diarrhea, accumulation of ketones in DKA, and failure of
Verified, A+ Rated, Updated NGN NCLEX-RN
2025/2026 | Saunders Ch. 9 Acid-Base Imbalance
(ABG) – 160 Select-All-That-Apply Questions with
Detailed Rationales":
1. A client with COPD has the following ABG results: pH 7.32, PaCO₂ 55 mm
Hg, HCO₃ 26 mEq/L. How should the nurse interpret this?
Select all that apply.
A. Respiratory acidosis
B. Metabolic alkalosis
C. Uncompensated
D. Partially compensated
E. Normal acid-base balance
Correct Answers: A, C
Rationale:
, 2
A pH of 7.32 indicates acidosis. The elevated PaCO₂ confirms a respiratory cause,
and since the HCO₃ is within normal limits, the kidneys have not compensated yet.
Therefore, the condition is classified as uncompensated respiratory acidosis.
2. A nurse is caring for a client with metabolic alkalosis. Which clinical
manifestations might the nurse expect?
Select all that apply.
A. Hypoventilation
B. Muscle cramps
C. Hyperkalemia
D. Confusion
E. Tachycardia
Correct Answers: A, B, D, E
Rationale:
Metabolic alkalosis leads to compensatory hypoventilation to retain CO₂, which
increases acidity. Symptoms include muscle cramps from electrolyte imbalances,
mental status changes like confusion, and tachycardia as the body tries to
compensate.
, 3
3. A client has an ABG with pH 7.48, PaCO₂ 40 mm Hg, HCO₃ 30 mEq/L.
What is the interpretation?
Select all that apply.
A. Metabolic alkalosis
B. Respiratory alkalosis
C. Uncompensated
D. Fully compensated
E. Partially compensated
Correct Answers: A, C
Rationale:
The pH is high, indicating alkalosis. Since PaCO₂ is normal and HCO₃ is elevated,
the issue is metabolic. No compensation is observed, making this an
uncompensated metabolic alkalosis.
4. Which findings indicate respiratory alkalosis?
Select all that apply.
A. pH 7.49
B. PaCO₂ 28 mm Hg
C. HCO₃ 22 mEq/L
, 4
D. pH 7.35
E. PaCO₂ 50 mm Hg
Correct Answers: A, B
Rationale:
A high pH and low PaCO₂ indicate respiratory alkalosis due to excessive
exhalation of CO₂. Normal HCO₃ suggests no metabolic compensation. PaCO₂ of
50 and pH 7.35 are within or trending toward acidosis, not alkalosis.
5. Which clients are at risk for metabolic acidosis?
Select all that apply.
A. A client with severe diarrhea
B. A client in diabetic ketoacidosis
C. A client with prolonged vomiting
D. A client with renal failure
E. A client taking excessive antacids
Correct Answers: A, B, D
Rationale:
Loss of bicarbonate via diarrhea, accumulation of ketones in DKA, and failure of
