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Week 2 NCLEX Practice
Questions: ABG Interpretation
& Fluid Imbalance
Complex Adult Health (Chamberlain University)
Question 1: Interpreting ABG Values
A patient with diabetic ketoacidosis (DKA) presents with the following ABG results:
● Ph: 7.28
● Paco₂: 30 mm Hg
● HCO₃⁻: 14 meq/L
What is the correct interpretation?
A. Respiratory acidosis with full compensation
B. Metabolic acidosis with partial compensation
C. Metabolic alkalosis with full compensation
D. Respiratory alkalosis with partial compensation
Answer: B. Metabolic acidosis with partial compensation
Rationale: The low ph and low HCO₃⁻ indicate metabolic acidosis. The low paco₂
shows thelungs are compensating by blowing off CO₂, but since the ph is still
abnormal, it is partially compensated.
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Rationale:
🔹 Question 2: Fluid Imbalance Prioritization
A postoperative patient has been receiving hypotonic IV fluids. Assessment reveals
confusion, headache, and muscle weakness. Which lab value is most concerning?
A. Sodium: 127 meq/L
B. Potassium: 4.5 meq/L
C. Chloride: 98 meq/L
D. Hematocrit: 45%
Answer: A. Sodium: 127 meq/L
Rationale: Hyponatremia (<135 meq/L) can cause cerebral edema, leading to
confusion and neurological changes. This is a priority concern in fluid and electrolyte
imbalance.
🔹 Question 3: Acid-Base Imbalance in GI Loss
A patient with prolonged vomiting is admitted with the following ABG results:
● Ph: 7.50
● Paco₂: 47 mm Hg
● HCO₃⁻: 32 meq/L
Which condition is most consistent with these findings?
A. Metabolic alkalosis with partial compensation
B. Respiratory alkalosis with full compensation
C. Metabolic acidosis with no compensation
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D. Uncompensated respiratory acidosis
Answer: A. Metabolic alkalosis with partial compensation
Rationale: High ph and high HCO₃⁻ indicate metabolic alkalosis. Paco₂ is elevated,
indicating the lungs are attempting to compensate by retaining CO₂ (acid). Since ph is
still elevated, it'spartially compensated.
🔹 Question 4: Electrolyte Imbalance & Cardiac Risk
A patient receiving loop diuretics for heart failure reports muscle cramps and palpitations.
Labs show:
● Potassium: 2.9 meq/L
● Magnesium: 1.5 mg/dl
● Sodium: 138 meq/L
What is the most appropriate nursing intervention?
A. Encourage oral fluid intake
B. Administer potassium chloride IV as prescribed
C. Administer sodium bicarbonate
D. Hold all electrolyte replacements until magnesium is corrected
Answer: B. Administer potassium chloride IV as prescribed
Hypokalemia (<3.5) is dangerous due to its impact on cardiac rhythm.
Although magnesium is also low, potassium must be corrected quickly, especially if
ECG changes or symptoms are present.
🔹 Question 5: ABG Compensation Identification
A COPD patient has the following ABG:
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Rationale:
● Ph: 7.35
● Paco₂: 60 mm Hg
● HCO₃⁻: 34 meq/L
What is the correct interpretation?
A. Respiratory alkalosis with partial compensation
B. Fully compensated respiratory acidosis
C. Metabolic acidosis with respiratory compensation
D. Uncompensated respiratory acidosis
Answer: B. Fully compensated respiratory acidosis
Rationale: The paco₂ is high (respiratory acidosis), and HCO₃⁻ is elevated as the
kidneys retain bicarbonate to compensate. Since the ph is within normal, this is fully
compensated.
🔹 Question 6: Fluid Volume Overload
A nurse is assessing a client receiving IV fluids at 200 ml/hr. Which finding requires
immediate action?
A. BP 144/88
B. Oxygen saturation 90%
C. Crackles in the bilateral lower lobes
D. Output of 40 ml/hr
Answer: C. Crackles in the bilateral lower lobes
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Week 2 NCLEX Practice
Questions: ABG Interpretation
& Fluid Imbalance
Complex Adult Health (Chamberlain University)
Question 1: Interpreting ABG Values
A patient with diabetic ketoacidosis (DKA) presents with the following ABG results:
● Ph: 7.28
● Paco₂: 30 mm Hg
● HCO₃⁻: 14 meq/L
What is the correct interpretation?
A. Respiratory acidosis with full compensation
B. Metabolic acidosis with partial compensation
C. Metabolic alkalosis with full compensation
D. Respiratory alkalosis with partial compensation
Answer: B. Metabolic acidosis with partial compensation
Rationale: The low ph and low HCO₃⁻ indicate metabolic acidosis. The low paco₂
shows thelungs are compensating by blowing off CO₂, but since the ph is still
abnormal, it is partially compensated.
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Rationale:
🔹 Question 2: Fluid Imbalance Prioritization
A postoperative patient has been receiving hypotonic IV fluids. Assessment reveals
confusion, headache, and muscle weakness. Which lab value is most concerning?
A. Sodium: 127 meq/L
B. Potassium: 4.5 meq/L
C. Chloride: 98 meq/L
D. Hematocrit: 45%
Answer: A. Sodium: 127 meq/L
Rationale: Hyponatremia (<135 meq/L) can cause cerebral edema, leading to
confusion and neurological changes. This is a priority concern in fluid and electrolyte
imbalance.
🔹 Question 3: Acid-Base Imbalance in GI Loss
A patient with prolonged vomiting is admitted with the following ABG results:
● Ph: 7.50
● Paco₂: 47 mm Hg
● HCO₃⁻: 32 meq/L
Which condition is most consistent with these findings?
A. Metabolic alkalosis with partial compensation
B. Respiratory alkalosis with full compensation
C. Metabolic acidosis with no compensation
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D. Uncompensated respiratory acidosis
Answer: A. Metabolic alkalosis with partial compensation
Rationale: High ph and high HCO₃⁻ indicate metabolic alkalosis. Paco₂ is elevated,
indicating the lungs are attempting to compensate by retaining CO₂ (acid). Since ph is
still elevated, it'spartially compensated.
🔹 Question 4: Electrolyte Imbalance & Cardiac Risk
A patient receiving loop diuretics for heart failure reports muscle cramps and palpitations.
Labs show:
● Potassium: 2.9 meq/L
● Magnesium: 1.5 mg/dl
● Sodium: 138 meq/L
What is the most appropriate nursing intervention?
A. Encourage oral fluid intake
B. Administer potassium chloride IV as prescribed
C. Administer sodium bicarbonate
D. Hold all electrolyte replacements until magnesium is corrected
Answer: B. Administer potassium chloride IV as prescribed
Hypokalemia (<3.5) is dangerous due to its impact on cardiac rhythm.
Although magnesium is also low, potassium must be corrected quickly, especially if
ECG changes or symptoms are present.
🔹 Question 5: ABG Compensation Identification
A COPD patient has the following ABG:
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Rationale:
● Ph: 7.35
● Paco₂: 60 mm Hg
● HCO₃⁻: 34 meq/L
What is the correct interpretation?
A. Respiratory alkalosis with partial compensation
B. Fully compensated respiratory acidosis
C. Metabolic acidosis with respiratory compensation
D. Uncompensated respiratory acidosis
Answer: B. Fully compensated respiratory acidosis
Rationale: The paco₂ is high (respiratory acidosis), and HCO₃⁻ is elevated as the
kidneys retain bicarbonate to compensate. Since the ph is within normal, this is fully
compensated.
🔹 Question 6: Fluid Volume Overload
A nurse is assessing a client receiving IV fluids at 200 ml/hr. Which finding requires
immediate action?
A. BP 144/88
B. Oxygen saturation 90%
C. Crackles in the bilateral lower lobes
D. Output of 40 ml/hr
Answer: C. Crackles in the bilateral lower lobes
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