Acid Base BalanceAcid Base BalanceNCLEX Review Questions

Acid Base Balance

An arterial blood gas (ABG) sample reports the status of oxygenation and acid-base balance in the blood.

An arterial blood gas (ABG) sample reports the status of oxygenation and acid-base balance in the blood.

Acid Base BalanceAcid Base BalanceAn ABG measures:

◦pH – the amount of free hydrogen ions in the (H+)

◦PaO2 – the partial pressure of oxygen◦PaCO2 – the partial pressure of carbon

dioxide◦HCO3 – the concentration of bicarbonate ◦SaO2 – percentage of oxygen bound to

hemoglobin as compared to the total amount that can possible be carried

Acid Base BalanceAcid Base Balance

ABG Measure Normal RangepH 7.35 – 7.45PaO2 80 – 100 mmHgPaCO2 35 - 45 mmHg HCO3 22 – 26 mEq/LSaO2 95 -100%

Acid Base BalanceAcid Base BalanceBlood pH levels may be affected

by any number of disease processes (respiratory, endocrine, or neurologic).

Blood pH levels below 7.35 reflect acidosis, while levels above 7.45 reflect alkalosis.

ABGs can be obtained by an arterial puncture or through an arterial line.

Acid Base BalanceAcid Base BalanceIf you can remember the

following pyramid points and steps, you will be able to analyze any blood gas report.

Pyramid Points ◦In acidosis, the pH is down.◦In alkalosis, the pH is up.◦The respiratory function indicator is

the PCO2 value.◦The metabolic function indicator is

the HCO3 level.

Pyramid StepsPyramid StepsStep 1

◦Look at the pH. Is it up or down? If it is up, it reflects alkalosis. If it is down, it reflects acidosis.

Step 2◦Look at the PCO2 level. Is it up or

down? If it reflects an opposite relationship to the pH, then you know that the condition is a respiratory imbalance. If it does not reflect an opposite relationship to the pH, then move to step 3

Pyramid StepsPyramid StepsStep 3

◦Look at the HCO3 level. Does the HCO3 level reflect a corresponding relationship to the pH? If it does, then the condition is a metabolic imbalance.

Acid Base BalanceAcid Base BalanceRespiratory Acidosis

◦The pH is down.◦The PCO2 is up.

Respiratory alkalosis◦The pH is up.◦The PCO2 is down.

Acid Base BalanceAcid Base BalanceMetabolic acidosis

◦The pH is down.◦The HCO3 is down.

Metabolic Alkalosis◦The pH is up.◦The HCO3 is up.

Acid Base BalanceAcid Base BalanceA client with diabetes mellitus has a

blood glucose on admission of 596 mg/dL. The nurse anticipates that this client would be experiencing which of the following types of acid-base imbalance?

a. Metabolic acidosisb. Metabolic alkalosisc. Respiratory acidosisd. Respiratory alkalosis

Acid Base BalanceAcid Base Balance

A client with diabetes mellitus has a blood glucose on admission of 596 mg/dL. The nurse anticipates that this client would be experiencing which of the following types of acid-base imbalance?

a. Metabolic acidosisb. Metabolic alkalosisc. Respiratory acidosisd. Respiratory alkalosis

Acid Base BalanceAcid Base Balance

A nurse is assisting to admit a client with a diagnosis of Guillain-Barré syndrome. The nurse knows that if the disease is severe enough, the client will be at risk for which of the following acid-base imbalances?

a. Metabolic acidosisb. Metabolic alkalosisc. Respiratory acidosisd. Respiratory alkalosis

Acid Base BalanceAcid Base Balance

A nurse is assisting to admit a client with a diagnosis of Guillain-Barré syndrome. The nurse knows that if the disease is severe enough, the client will be at risk for which of the following acid-base imbalances?

a. Metabolic acidosisb. Metabolic alkalosisc. Respiratory acidosisd. Respiratory alkalosis

Acid Base BalanceAcid Base BalanceA client is determined to be in

respiratory alkalosis by blood gas analysis. The nurse would monitor this client for signs of which of the following electrolyte disorders that could accompany the acid-base imbalance?

a. Hypercalcemiab. Hypochloremiac. Hypernatremiad. Hypokalemia

Acid Base BalanceAcid Base BalanceA client is determined to be in

respiratory alkalosis by blood gas analysis. The nurse would monitor this client for signs of which of the following electrolyte disorders that could accompany the acid-base imbalance?

a. Hypercalcemiab. Hypochloremiac. Hypernatremiad. Hypokalemia

Acid Base BalanceAcid Base Balance

A nurse is caring for a client who is nervous and is hyperventilating. The nurse would monitor the client for signs of which of the following acid-base imbalances?

a. Respiratory acidosisb. Respiratory alkalosisc. Metabolic alkalosisd. Metabolic acidosis

Acid Base BalanceAcid Base Balance

A nurse is caring for a client who is nervous and is hyperventilating. The nurse would monitor the client for signs of which of the following acid-base imbalances?

a. Respiratory acidosisb. Respiratory alkalosisc. Metabolic alkalosisd. Metabolic acidosis

Acid Base BalanceAcid Base BalanceA nurse is assisting in the care of a

client for whom an arterial blood gas (ABG) must be drawn. The nurse notes that the person who draws the blood sample from the radial artery performs Allen’s test first. The nurse understands that this is being done to determine the adequacy of the:

a. Carotid circulationb. Ulnar circulationc. Femoral circulationd.Brachial circulation

Acid Base BalanceAcid Base BalanceA nurse is assisting in the care of a

client for whom an arterial blood gas (ABG) must be drawn. The nurse notes that the person who draws the blood sample from the radial artery performs Allen’s test first. The nurse understands that this is being done to determine the adequacy of the:

a. Carotid circulationb. Ulnar circulationc. Femoral circulationd.Brachial circulation

Acid Base BalanceAcid Base Balance

A nurse is assisting in the care of a client who had an ileostomy created a few days ago. Owing to the normally high output of drainage from this type of ostomy, the nurse monitors the client for signs of:

A. Metabolic acidosisB. Metabolic alkalosisC. Respiratory acidosisD. Respiratory alkalosis

Acid Base BalanceAcid Base Balance

A nurse is assisting in the care of a client who had an ileostomy created a few days ago. Owing to the normally high output of drainage from this type of ostomy, the nurse monitors the client for signs of:

A. Metabolic acidosisB. Metabolic alkalosisC. Respiratory acidosisD. Respiratory alkalosis

Acid Base BalanceAcid Base BalanceA client with a chronic airflow limitation

is experiencing respiratory acidosis as a complication. The nurse who is trying to enhance the client’s respiratory status would avoid doing which of the following?

a. Keeping the head of the bed elevatedb. Monitoring the flow rate of

supplemental oxygenc. Assisting the client to turn, cough,

and deep breathed. Encouraging the client to breathe

slowly and shallowly

Acid Base BalanceAcid Base BalanceA client with a chronic airflow limitation

is experiencing respiratory acidosis as a complication. The nurse who is trying to enhance the client’s respiratory status would avoid doing which of the following?

a. Keeping the head of the bed elevatedb. Monitoring the flow rate of

supplemental oxygenc. Assisting the client to turn, cough,

and deep breathed. Encouraging the client to breathe

slowly and shallowly

Acid Base BalanceAcid Base BalanceAn anxious client is experiencing

respiratory alkalosis from hyperventilation due to anxiety. The nurse would do which of the following to help the client experiencing this acid-base disorder?

A. Withhold all sedative or antianxiety medications.

B. Provide emotional support and reassurance.

C. Tell the client to breathe very deeply but more slowly.

D. Put the client in a supine position.

Acid Base BalanceAcid Base BalanceAn anxious client is experiencing

respiratory alkalosis from hyperventilation due to anxiety. The nurse would do which of the following to help the client experiencing this acid-base disorder?

A. Withhold all sedative or antianxiety medications.

B. Provide emotional support and reassurance.

C. Tell the client to breathe very deeply but more slowly.

D. Put the client in a supine position.

Acid Base BalanceAcid Base BalanceA client is being treated for metabolic

acidosis with medication therapy and other measures. The nurse would plan to most carefully note the levels of which of the following electrolytes, which could dramatically decline with effective treatment of the acidosis?

A. SodiumB. PotassiumC. MagnesiumD. Phosphorus

Acid Base BalanceAcid Base BalanceA client is being treated for metabolic

acidosis with medication therapy and other measures. The nurse would plan to most carefully note the levels of which of the following electrolytes, which could dramatically decline with effective treatment of the acidosis?

A. SodiumB. PotassiumC. MagnesiumD. Phosphorus

Acid Base BalanceAcid Base BalanceA licensed practical nurse (LPN) is

assisting in the care of a client who overdosed on aspirin 24 hours ago. The LPN would report to the registered nurse (RN) which of the following findings associated with an anticipated acid-base disturbance?

a. Drowsiness, headache, and tachypneab. Decreased respiratory rate and depth,

cardiac irregularitiesc. Disorientation and dyspnead. Tachypnea, dizziness, and

paresthesias

Acid Base BalanceAcid Base BalanceA licensed practical nurse (LPN) is

assisting in the care of a client who overdosed on aspirin 24 hours ago. The LPN would report to the registered nurse (RN) which of the following findings associated with an anticipated acid-base disturbance?

a. Drowsiness, headache, and tachypneab. Decreased respiratory rate and depth,

cardiac irregularitiesc. Disorientation and dyspnead. Tachypnea, dizziness, and

paresthesias