NUR 443 EXAM 2 QUESTIONS AND ANSWERS
normal pH range - CORRECT ANSWER✅✅7.35 - 7.45
pH < 7.35 - CORRECT ANSWER✅✅acidotic
pH > 7.45 - CORRECT ANSWER✅✅alkalotic
normal pCO2 levels - CORRECT ANSWER✅✅35-45
normal HCO3- levels - CORRECT ANSWER✅✅22-26
normal PaO2 levels - CORRECT ANSWER✅✅80-100
the more H+ ions, the _______ the pH - CORRECT ANSWER✅✅lower
in acidotic states, K+ shifts ______ of the cell - CORRECT ANSWER✅✅out to cause hyperkalemia
in alkalotic states, K+ shifts ______ the cell - CORRECT ANSWER✅✅into to cause hypokalemia
acids - CORRECT ANSWER✅✅CO2 (carbon dioxide) + H+ (found in urine and stomach acid)
base - CORRECT ANSWER✅✅HCO3- (bicarbonate, found in intestines)
blood is slightly ______ at baseline - CORRECT ANSWER✅✅alkaline
describe the bicarbonate buffer system - CORRECT ANSWER✅✅CO2 + H20 ⇄ H2CO3 ⇄ H+ + HCO3
respiratory. metabolic
,- this is the body's first line defense to maintain A/B balance
- primarily operates in extracellular fluid
- minimize changes by neutralizing acids + bases
- works within seconds (is the fastest)
how do the lungs help to control the pH balance? - CORRECT ANSWER✅✅- controls CO2 → a waste
product of metabolism
- this is faster (works within minutes or hours)
when ↓ pH, RR _____ - CORRECT ANSWER✅✅- increases
- a low pH means an acidic state, so excess CO2
- increasing RR increases the speed that CO2 is blown off
when ↑ pH, RR ______ - CORRECT ANSWER✅✅- decreases
- a high pH means an alkalotic state, so low CO2
- decreasing RR helps to retain CO2
how do the kidneys help the pH balance? - CORRECT ANSWER✅✅- controls HCO3- and H+
- kidneys help to filter blood, urine is normally acidic
- slower, works hours to days
when ↓ pH, the kidneys ______ - CORRECT ANSWER✅✅- excrete more H+ and reabsorb more HCO3
(or make more)
when ↑ pH, the kidneys _______ - CORRECT ANSWER✅✅- decreases excretion of H+ or HCO3
- can also produce ammonia (acid) to counteract alkalosis
bicarbonate buffer → when the body is in a state of acidosis, HCO3- will ______ to H+ - CORRECT
ANSWER✅✅bind
,bicarbonate buffer → when the body is in an alkalotic state H2CO3 will ______ H+ - CORRECT
ANSWER✅✅release
respiratory system → when the body is in acidosis CO2 is ______ and our respiratory rate ________ -
CORRECT ANSWER✅✅↑ and ↑
respiratory system → when the body is in alkalosis CO2 is ______ and our respiratory rate ______ -
CORRECT ANSWER✅✅↓ and ↓
when the body is in acidosis the kidneys _______ or _______ HCO3- - CORRECT ANSWER✅✅reabsorb
or produce more
when the body is in alkalosis the kidneys ____ excretion HCO3- in the urine _____ H+ in the urine, or
produce _____ - CORRECT ANSWER✅✅↑ and ↓
produce ammonia
respiratory alkalosis - CORRECT ANSWER✅✅↓ CO2 ↓H+ ↑ pH
- caused be hypocapnia (low CO2 levels) due to *inappropriate hyperventilation*
- does not occur where hyperventilation is appropriate (like strenuous exercise)
- hyperventilation is compensatory → blowing off CO2 to accommodate the building up of lactic acid
from anaerobic metabolism associated with exercise
examples of causes of respiratory alkalosis - CORRECT ANSWER✅✅- panic attack with rapid breathing
- late stages of labor and delivery not assisted by an epidural
nursing interventions for respiratory alkalosis - CORRECT ANSWER✅✅- address underlying cause →
give anti-anxiety meds (lorazepam)
- coach to take slow breaths
- may ask to breath into a paper bag
, metabolic alkalosis - CORRECT ANSWER✅✅↑ HCO3- ↓ H+ ↑pH
- caused by a loss of acid (H+) or excessive accumulation of bicarbonate (HCO3-)
examples of causes of metabolic alkalosis - CORRECT ANSWER✅✅- excessive vomiting → patient losses
stomach acid and is left with excess bicarb (base) in the blood
- NG suctioning
- antacid use → neutralizes stomach acids leaving an excess of bicarb (base) in the body
nursing interventions for respiratory alkalosis - CORRECT ANSWER✅✅- address the underlying cause →
antiemetics, slow suctioning
- IV fluid + electrolyte repletion → potassium and magnesium
- place patient on tele
- give KCl if hypokalemic
alkalosis compensation - CORRECT ANSWER✅✅- lungs → increase CO2 by decreasing RR
- kidneys → excrete HCO3- and retain H+
respiratory acidosis - CORRECT ANSWER✅✅↑ CO2 ↑ H+ ↓ pH
- caused by hypercapnia (elevated CO2) due to hypoventilation
- CO2 accumulates and the patient becomes acidotic
examples of causes of respiratory acidosis - CORRECT ANSWER✅✅- COPD (inconsistent bipap use or
SOB for 2 days)
- chest injuries that impair ventilation
- neurologic conditions that impair ventilation
- neuromuscular conditions that impair ventilation (ALS, myasthenia gravis
normal pH range - CORRECT ANSWER✅✅7.35 - 7.45
pH < 7.35 - CORRECT ANSWER✅✅acidotic
pH > 7.45 - CORRECT ANSWER✅✅alkalotic
normal pCO2 levels - CORRECT ANSWER✅✅35-45
normal HCO3- levels - CORRECT ANSWER✅✅22-26
normal PaO2 levels - CORRECT ANSWER✅✅80-100
the more H+ ions, the _______ the pH - CORRECT ANSWER✅✅lower
in acidotic states, K+ shifts ______ of the cell - CORRECT ANSWER✅✅out to cause hyperkalemia
in alkalotic states, K+ shifts ______ the cell - CORRECT ANSWER✅✅into to cause hypokalemia
acids - CORRECT ANSWER✅✅CO2 (carbon dioxide) + H+ (found in urine and stomach acid)
base - CORRECT ANSWER✅✅HCO3- (bicarbonate, found in intestines)
blood is slightly ______ at baseline - CORRECT ANSWER✅✅alkaline
describe the bicarbonate buffer system - CORRECT ANSWER✅✅CO2 + H20 ⇄ H2CO3 ⇄ H+ + HCO3
respiratory. metabolic
,- this is the body's first line defense to maintain A/B balance
- primarily operates in extracellular fluid
- minimize changes by neutralizing acids + bases
- works within seconds (is the fastest)
how do the lungs help to control the pH balance? - CORRECT ANSWER✅✅- controls CO2 → a waste
product of metabolism
- this is faster (works within minutes or hours)
when ↓ pH, RR _____ - CORRECT ANSWER✅✅- increases
- a low pH means an acidic state, so excess CO2
- increasing RR increases the speed that CO2 is blown off
when ↑ pH, RR ______ - CORRECT ANSWER✅✅- decreases
- a high pH means an alkalotic state, so low CO2
- decreasing RR helps to retain CO2
how do the kidneys help the pH balance? - CORRECT ANSWER✅✅- controls HCO3- and H+
- kidneys help to filter blood, urine is normally acidic
- slower, works hours to days
when ↓ pH, the kidneys ______ - CORRECT ANSWER✅✅- excrete more H+ and reabsorb more HCO3
(or make more)
when ↑ pH, the kidneys _______ - CORRECT ANSWER✅✅- decreases excretion of H+ or HCO3
- can also produce ammonia (acid) to counteract alkalosis
bicarbonate buffer → when the body is in a state of acidosis, HCO3- will ______ to H+ - CORRECT
ANSWER✅✅bind
,bicarbonate buffer → when the body is in an alkalotic state H2CO3 will ______ H+ - CORRECT
ANSWER✅✅release
respiratory system → when the body is in acidosis CO2 is ______ and our respiratory rate ________ -
CORRECT ANSWER✅✅↑ and ↑
respiratory system → when the body is in alkalosis CO2 is ______ and our respiratory rate ______ -
CORRECT ANSWER✅✅↓ and ↓
when the body is in acidosis the kidneys _______ or _______ HCO3- - CORRECT ANSWER✅✅reabsorb
or produce more
when the body is in alkalosis the kidneys ____ excretion HCO3- in the urine _____ H+ in the urine, or
produce _____ - CORRECT ANSWER✅✅↑ and ↓
produce ammonia
respiratory alkalosis - CORRECT ANSWER✅✅↓ CO2 ↓H+ ↑ pH
- caused be hypocapnia (low CO2 levels) due to *inappropriate hyperventilation*
- does not occur where hyperventilation is appropriate (like strenuous exercise)
- hyperventilation is compensatory → blowing off CO2 to accommodate the building up of lactic acid
from anaerobic metabolism associated with exercise
examples of causes of respiratory alkalosis - CORRECT ANSWER✅✅- panic attack with rapid breathing
- late stages of labor and delivery not assisted by an epidural
nursing interventions for respiratory alkalosis - CORRECT ANSWER✅✅- address underlying cause →
give anti-anxiety meds (lorazepam)
- coach to take slow breaths
- may ask to breath into a paper bag
, metabolic alkalosis - CORRECT ANSWER✅✅↑ HCO3- ↓ H+ ↑pH
- caused by a loss of acid (H+) or excessive accumulation of bicarbonate (HCO3-)
examples of causes of metabolic alkalosis - CORRECT ANSWER✅✅- excessive vomiting → patient losses
stomach acid and is left with excess bicarb (base) in the blood
- NG suctioning
- antacid use → neutralizes stomach acids leaving an excess of bicarb (base) in the body
nursing interventions for respiratory alkalosis - CORRECT ANSWER✅✅- address the underlying cause →
antiemetics, slow suctioning
- IV fluid + electrolyte repletion → potassium and magnesium
- place patient on tele
- give KCl if hypokalemic
alkalosis compensation - CORRECT ANSWER✅✅- lungs → increase CO2 by decreasing RR
- kidneys → excrete HCO3- and retain H+
respiratory acidosis - CORRECT ANSWER✅✅↑ CO2 ↑ H+ ↓ pH
- caused by hypercapnia (elevated CO2) due to hypoventilation
- CO2 accumulates and the patient becomes acidotic
examples of causes of respiratory acidosis - CORRECT ANSWER✅✅- COPD (inconsistent bipap use or
SOB for 2 days)
- chest injuries that impair ventilation
- neurologic conditions that impair ventilation
- neuromuscular conditions that impair ventilation (ALS, myasthenia gravis
