Chapter 9: Acid-Base Balance, NCLEX
Fluids and Electrolytes Chapter 9,
fundamentals Chapter 42: Fluid,
Electrolyte, and Acid-Base Balance, Fluid &
Electrolytes
The nurse is providing care for an adult patient who is admitted to the emergency department
(ED) after passing out. The patient has been fasting and currently has ketones in the urine.
Which acid-based imbalance should the nurse monitor the patient for based on the current
data?
1) Metabolic acidosis
2) Metabolic alkalosis
3) Respiratory acidosis
4) Respiratory alkalosis -
1) Metabolic acidosis
The patient who is fasting is at risk for metabolic acidosis. The body recognized fasting as
starvation and begins to metabolize its own proteins into ketones, which are metabolic acid.
The nurse is providing care to patient with the following laboratory values: pH - 7.31; PaCO2
- 48 mmHg; and a normal HCO3. Which condition should the nurse plan care for based on
the current data?
1) Metabolic acidosis
2) Metabolic alkalosis
3) Respiratory acidosis
4) Respiratory alkalosis -
3) Respiratory acidosis
If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated
respiratory acidosis
The nurse is reviewing the latest arterial blood gas results for a patient with metabolic
alkalosis. Which result indicates that the metabolic alkalosis is compensated?
1) pH 7.32
2) HCO3 8 mEq/L
3) PaCO2 48 mmHg
4) PaCO2 18 mmHg -
3) PaCO2 48 mmHg
To compensate for this imbalance, the rate and depth of respirations decrease, leading to
retention of carbon dioxide. The PaCO2 will be elevated
Which diagnostic test should the nurse anticipate when providing care to a patient diagnosed
with chronic obstructive pulmonary disease (COPD) to monitor acid-base balance?
1) Pulse oximetry
2) Bronchoscopy
3) Sputum studies
1|Page
,4) Arterial blood gases -
4) Arterial blood gases
Arterial blood gas analysis is done to assess alterations in acid-base balance caused by
respiratory disorders, metabolic disorders, or both.
Which patient statement indicates the need for additional education regarding the use of
sodium bicarbonate to treat acidosis?
1) "I need to purchase antacids without salt."
2) "I should use the antacid for at least 2 months."
3) "I should contact the doctor if I have any gastric discomfort with chest pain."
4) "I should call the doctor if I get short of breath or start to sweat with this medication." -
2) "I should use the antacid for at least 2 months."
Bicarbonate antacid should not be used for longer than two weeks. This statement indicates
the need for additional teaching.
The patient is receiving sodium bicarbonate intravenously (IV) for correction of acidosis
secondary to diabetic coma. The nurse assesses the patient to be lethargic, confused, and
breathing rapidly. Which is the nurse's priority response to the current situation?
1) Stop the infusion and notify the provider because the patient is in alkalosis.
2) Increase the rate of the infusion and continue to assess the patient for symptoms of
acidosis.
3) Decrease the rate of the infusion and continue to assess the patient for symptoms of
alkalosis.
4) Continue the infusion, because the patient is still in acidosis, and notify the provider. -
4) Continue the infusion, because the patient is still in acidosis, and notify the
provider.
The client continues to exhibit signs of acidosis; symptoms of acidosis include lethargy,
confusion, CNS depression leading to coma, and a deep, rapid respiration rate that indicates
an attempt by the lungs to rid the body of excess acid, and the provider should be notified.
The nurse is planning care for an older adult patient with respiratory acidosis. Which
intervention should the nurse include in this patient's plan of care?
1) Maintain adequate hydration.
2) Reduce environmental stimuli.
3) Administer intravenous sodium bicarbonate.
4) Administer prescribed intravenous fluids carefully. -
1) Maintain adequate hydration.
In respiratory acidosis, there are a drop in the blood pH, reduced level of oxygen, and
retaining of carbon dioxide. The body needs to be well-hydrated so that pulmonary secretions
can be removed to improve oxygenation.
The results of a patient's arterial blood gas sample indicate an oxygen level of 72 mmHg.
Which should the nurse closely assess when providing care to this patient?
1) Perfusion
2) Cognition
3) Communication
4) Fluid and electrolytes -
2) Cognition
An oxygen level of less than 75 mmHg can be due to hypoventilation. This drop in oxygen
will change the patient's level of responsiveness
2|Page
, The nurse is caring for a comatose patient with respiratory acidosis. For which intervention
will the nurse need to collaborate when caring for this patient?
1) Monitoring vital signs
2) Measuring intake and output
3) Determining recent eating behaviors
4) Identifying current oxygen saturation level -
3) Determining recent eating behaviors
For patients in severe distress, family members may need to be consulted for critical
information such as recent eating habits and history of vomiting.
The nurse is analyzing the patient's arterial blood gas report, which reveals a pH of 7.15. The
patient has just suffered a cardiac arrest. Which consequences of this pH value does the nurse
consider for this patient?
1) Decreased cardiac output
2) Decreased potassium levels
3) Increased magnesium levels
4) Decreased free calcium in the ECF -
1) Decreased cardiac output
The nurse knows that severe acidosis depresses myocardial contractility, which leads to
decreased cardiac output.
The nurse is caring for a patient admitted with renal failure and metabolic acidosis. Which
clinical manifestation would indicate to the nurse that planned interventions to relieve the
metabolic acidosis have been effective?
1) Tachypnea
2) Palpitations
3) Increased deep tendon reflexes
4) Decreased depth of respirations -
4) Decreased depth of respirations
The patient with metabolic acidosis will have an increased respiratory rate and depth. Signs
that care has been effective would include a decrease in the rate and depth of respirations.
A patient with metabolic acidosis has been admitted to the unit from the emergency
department (ED). The patient is experiencing confusion and weakness. Which independent
nursing intervention is the priority?
1) Protecting the patient from injury
2) Placing the patient in a high-Fowler's position
3) Administering sodium bicarbonate to the patient
4) Providing the patient with appropriate skin care -
1) Protecting the patient from injury
The patient with metabolic acidosis may have symptoms of drowsiness, lethargy, confusion,
and weakness. A priority of care would be preventing injury.
The nurse is reviewing new orders provided by the health-care provider for a critical care
patient with metabolic acidosis. Which prescription should the nurse question?
1) Draw serum potassium levels every two hours.
2) Draw arterial blood gas samples every two hours.
3) Administer one ampule of sodium bicarbonate now.
4) Begin intravenous infusion of 0.9% normal saline. -
3|Page
Fluids and Electrolytes Chapter 9,
fundamentals Chapter 42: Fluid,
Electrolyte, and Acid-Base Balance, Fluid &
Electrolytes
The nurse is providing care for an adult patient who is admitted to the emergency department
(ED) after passing out. The patient has been fasting and currently has ketones in the urine.
Which acid-based imbalance should the nurse monitor the patient for based on the current
data?
1) Metabolic acidosis
2) Metabolic alkalosis
3) Respiratory acidosis
4) Respiratory alkalosis -
1) Metabolic acidosis
The patient who is fasting is at risk for metabolic acidosis. The body recognized fasting as
starvation and begins to metabolize its own proteins into ketones, which are metabolic acid.
The nurse is providing care to patient with the following laboratory values: pH - 7.31; PaCO2
- 48 mmHg; and a normal HCO3. Which condition should the nurse plan care for based on
the current data?
1) Metabolic acidosis
2) Metabolic alkalosis
3) Respiratory acidosis
4) Respiratory alkalosis -
3) Respiratory acidosis
If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated
respiratory acidosis
The nurse is reviewing the latest arterial blood gas results for a patient with metabolic
alkalosis. Which result indicates that the metabolic alkalosis is compensated?
1) pH 7.32
2) HCO3 8 mEq/L
3) PaCO2 48 mmHg
4) PaCO2 18 mmHg -
3) PaCO2 48 mmHg
To compensate for this imbalance, the rate and depth of respirations decrease, leading to
retention of carbon dioxide. The PaCO2 will be elevated
Which diagnostic test should the nurse anticipate when providing care to a patient diagnosed
with chronic obstructive pulmonary disease (COPD) to monitor acid-base balance?
1) Pulse oximetry
2) Bronchoscopy
3) Sputum studies
1|Page
,4) Arterial blood gases -
4) Arterial blood gases
Arterial blood gas analysis is done to assess alterations in acid-base balance caused by
respiratory disorders, metabolic disorders, or both.
Which patient statement indicates the need for additional education regarding the use of
sodium bicarbonate to treat acidosis?
1) "I need to purchase antacids without salt."
2) "I should use the antacid for at least 2 months."
3) "I should contact the doctor if I have any gastric discomfort with chest pain."
4) "I should call the doctor if I get short of breath or start to sweat with this medication." -
2) "I should use the antacid for at least 2 months."
Bicarbonate antacid should not be used for longer than two weeks. This statement indicates
the need for additional teaching.
The patient is receiving sodium bicarbonate intravenously (IV) for correction of acidosis
secondary to diabetic coma. The nurse assesses the patient to be lethargic, confused, and
breathing rapidly. Which is the nurse's priority response to the current situation?
1) Stop the infusion and notify the provider because the patient is in alkalosis.
2) Increase the rate of the infusion and continue to assess the patient for symptoms of
acidosis.
3) Decrease the rate of the infusion and continue to assess the patient for symptoms of
alkalosis.
4) Continue the infusion, because the patient is still in acidosis, and notify the provider. -
4) Continue the infusion, because the patient is still in acidosis, and notify the
provider.
The client continues to exhibit signs of acidosis; symptoms of acidosis include lethargy,
confusion, CNS depression leading to coma, and a deep, rapid respiration rate that indicates
an attempt by the lungs to rid the body of excess acid, and the provider should be notified.
The nurse is planning care for an older adult patient with respiratory acidosis. Which
intervention should the nurse include in this patient's plan of care?
1) Maintain adequate hydration.
2) Reduce environmental stimuli.
3) Administer intravenous sodium bicarbonate.
4) Administer prescribed intravenous fluids carefully. -
1) Maintain adequate hydration.
In respiratory acidosis, there are a drop in the blood pH, reduced level of oxygen, and
retaining of carbon dioxide. The body needs to be well-hydrated so that pulmonary secretions
can be removed to improve oxygenation.
The results of a patient's arterial blood gas sample indicate an oxygen level of 72 mmHg.
Which should the nurse closely assess when providing care to this patient?
1) Perfusion
2) Cognition
3) Communication
4) Fluid and electrolytes -
2) Cognition
An oxygen level of less than 75 mmHg can be due to hypoventilation. This drop in oxygen
will change the patient's level of responsiveness
2|Page
, The nurse is caring for a comatose patient with respiratory acidosis. For which intervention
will the nurse need to collaborate when caring for this patient?
1) Monitoring vital signs
2) Measuring intake and output
3) Determining recent eating behaviors
4) Identifying current oxygen saturation level -
3) Determining recent eating behaviors
For patients in severe distress, family members may need to be consulted for critical
information such as recent eating habits and history of vomiting.
The nurse is analyzing the patient's arterial blood gas report, which reveals a pH of 7.15. The
patient has just suffered a cardiac arrest. Which consequences of this pH value does the nurse
consider for this patient?
1) Decreased cardiac output
2) Decreased potassium levels
3) Increased magnesium levels
4) Decreased free calcium in the ECF -
1) Decreased cardiac output
The nurse knows that severe acidosis depresses myocardial contractility, which leads to
decreased cardiac output.
The nurse is caring for a patient admitted with renal failure and metabolic acidosis. Which
clinical manifestation would indicate to the nurse that planned interventions to relieve the
metabolic acidosis have been effective?
1) Tachypnea
2) Palpitations
3) Increased deep tendon reflexes
4) Decreased depth of respirations -
4) Decreased depth of respirations
The patient with metabolic acidosis will have an increased respiratory rate and depth. Signs
that care has been effective would include a decrease in the rate and depth of respirations.
A patient with metabolic acidosis has been admitted to the unit from the emergency
department (ED). The patient is experiencing confusion and weakness. Which independent
nursing intervention is the priority?
1) Protecting the patient from injury
2) Placing the patient in a high-Fowler's position
3) Administering sodium bicarbonate to the patient
4) Providing the patient with appropriate skin care -
1) Protecting the patient from injury
The patient with metabolic acidosis may have symptoms of drowsiness, lethargy, confusion,
and weakness. A priority of care would be preventing injury.
The nurse is reviewing new orders provided by the health-care provider for a critical care
patient with metabolic acidosis. Which prescription should the nurse question?
1) Draw serum potassium levels every two hours.
2) Draw arterial blood gas samples every two hours.
3) Administer one ampule of sodium bicarbonate now.
4) Begin intravenous infusion of 0.9% normal saline. -
3|Page
