Nursing 121 Concept of Acid-Base Balance Questions With
Complete Solutions
A client has been admitted for dehydration after fasting for 5
days. For which of the following acid-base imbalances would
the nurse anticipate that this client is at risk? Correct Answers
metabolic acidosis
During fasting, the body reverts to cellular breakdown to
maintain energy, and lactic and pyruvic acids build up in the
body, leading to metabolic acidosis.
A client in cardiac arrest develops a Correct Answers mixed
respiratory and metabolic acidosis due to lack of ventilation (and
retained CO2) and hypoxia of body tissues that leads to
anaerobic metabolism and acid by-products (excess nonvolatile
acids).
A client is admitted to the hospital with a diagnosis of
respiratory acidosis secondary to overdose of barbiturates.
Which of the following assessments would the nurse make?
1. Slow, shallow respirations
2. Symptoms of tetany
3. Increased deep tendon reflexes
4. Palpitations Correct Answers 1. Slow, shallow respirations
Rationale:
Clients with respiratory acidosis from ingestion of barbiturates
would have slow and shallow respirations, leading to
hypoventilation. Palpitations are a subjective complaint reported
by the client; the nurse cannot directly assess this symptom. In
addition, palpitations are associated with respiratory alkalosis.
,Tetany symptoms and increased deep tendon reflexes are
associated with metabolic alkalosis.
A client's blood gas results are pH 7.48, PaCO2 30 mmHg,
HCO3 23 mEq/L. What will the nurse suspect that the client is
at risk for?
1. Respiratory alkalosis, compensated
2. Metabolic alkalosis, uncompensated
3. Respiratory alkalosis, uncompensated
4. Metabolic alkalosis, compensated Correct Answers 3.
Respiratory alkalosis, uncompensated
The client's pH is high, indicating alkalosis. The PaCO2 is
abnormal, indicating a respiratory basis. The HCO3 is normal,
indicating that compensation has not started. The HCO3 level
would decrease with compensation. The primary disturbance is
respiratory, as indicated by the decrease in the PaCO2
parameter.
A PaCO2 of less than 35 mmHg is known as Correct Answers
HYPOcapnia. (Hypocapnia or hypocapnea is a state of reduced
carbon dioxide in the blood. Hypocapnia usually results from
deep or rapid breathing, known as hyperventilation).
A PaCO2 of less than 80 mmHg indicates Correct Answers
hypoxemia (Hypoxemia is an abnormally low level of oxygen in
the blood. More specifically, it is oxygen deficiency in arterial
blood. Hypoxemia has many causes, often respiratory disorders,
and can cause tissue hypoxia as the blood is not supplying
enough oxygen to the body).
,A PaCO2 that is greater than 45 mmHg is known as Correct
Answers HYPERcapnia. Hypercapnia, also known as CO2
retention, hypercapnea, and hypercarbia, is a condition of
abnormally elevated carbon dioxide levels in the blood. Carbon
dioxide is a gaseous product of the body's metabolism and is
normally expelled through the lungs).
Acidosis occurs when Correct Answers the hydrogen ion
concentration increases above normal (pH below 7.35).
Acute increases in carbon dioxide or hydrogen ions in the blood
stimulate the brain's respiratory center, increasing both Correct
Answers the rate and depth of respiration.
*As a result, carbon dioxide is eliminated and carbonic acid
levels fall, bringing the pH to a more normal range.
**i.e., Patients with chronic lung disease (COPD) may have
consistently high carbon dioxide levels in their blood.
Acute Respiratory Acidosis Correct Answers Results from
sudden failure of ventilation
-Chest trauma
-Aspiration of foreign body
-Acute pneumonia
-Overdose of sedatives or narcotics
•PaCO2 rises rapidly
•pH falls markedly
•pH of 7 or lower can occur within minutes •Hypercapnia
, Adding a strong acid to extracellular fluid (ECF) depletes
bicarbonate, changing the 20:1 ratio and causing the pH to drop
below 7.35, this is a condition known as Correct Answers
Acidosis
Adding a strong base depletes carbonic acid as it combines with
the base, disrupting the 20:1 ratio. The pH rises above 7.45, this
is a condition known as Correct Answers Alkalosis
ADPIE for respiratory alkalosis Correct Answers Assessment
• Health history
-History of anxiety disorders -Triggering event -Mental health
disorders -Available support systems
• Physical examination
-Breath sounds -Neurological function -Respiratory status
-Cardiac status -Changes in LOC
Diagnosis
•Possible nursing diagnoses include
Ineffective Breathing Pattern Anxiety Risk for Injury
(NANDA-I ©2012)
Planning
•Appropriate outcomes might include
-Identify and treat underlying cause
-Restore acid-base balance -Manifest normal respiratory rate and
rhythm -Maintain safety -Maintain appropriate fluid status
Implementation
• Nursing interventions will include
-Assess respiratory rate, depth, and
Complete Solutions
A client has been admitted for dehydration after fasting for 5
days. For which of the following acid-base imbalances would
the nurse anticipate that this client is at risk? Correct Answers
metabolic acidosis
During fasting, the body reverts to cellular breakdown to
maintain energy, and lactic and pyruvic acids build up in the
body, leading to metabolic acidosis.
A client in cardiac arrest develops a Correct Answers mixed
respiratory and metabolic acidosis due to lack of ventilation (and
retained CO2) and hypoxia of body tissues that leads to
anaerobic metabolism and acid by-products (excess nonvolatile
acids).
A client is admitted to the hospital with a diagnosis of
respiratory acidosis secondary to overdose of barbiturates.
Which of the following assessments would the nurse make?
1. Slow, shallow respirations
2. Symptoms of tetany
3. Increased deep tendon reflexes
4. Palpitations Correct Answers 1. Slow, shallow respirations
Rationale:
Clients with respiratory acidosis from ingestion of barbiturates
would have slow and shallow respirations, leading to
hypoventilation. Palpitations are a subjective complaint reported
by the client; the nurse cannot directly assess this symptom. In
addition, palpitations are associated with respiratory alkalosis.
,Tetany symptoms and increased deep tendon reflexes are
associated with metabolic alkalosis.
A client's blood gas results are pH 7.48, PaCO2 30 mmHg,
HCO3 23 mEq/L. What will the nurse suspect that the client is
at risk for?
1. Respiratory alkalosis, compensated
2. Metabolic alkalosis, uncompensated
3. Respiratory alkalosis, uncompensated
4. Metabolic alkalosis, compensated Correct Answers 3.
Respiratory alkalosis, uncompensated
The client's pH is high, indicating alkalosis. The PaCO2 is
abnormal, indicating a respiratory basis. The HCO3 is normal,
indicating that compensation has not started. The HCO3 level
would decrease with compensation. The primary disturbance is
respiratory, as indicated by the decrease in the PaCO2
parameter.
A PaCO2 of less than 35 mmHg is known as Correct Answers
HYPOcapnia. (Hypocapnia or hypocapnea is a state of reduced
carbon dioxide in the blood. Hypocapnia usually results from
deep or rapid breathing, known as hyperventilation).
A PaCO2 of less than 80 mmHg indicates Correct Answers
hypoxemia (Hypoxemia is an abnormally low level of oxygen in
the blood. More specifically, it is oxygen deficiency in arterial
blood. Hypoxemia has many causes, often respiratory disorders,
and can cause tissue hypoxia as the blood is not supplying
enough oxygen to the body).
,A PaCO2 that is greater than 45 mmHg is known as Correct
Answers HYPERcapnia. Hypercapnia, also known as CO2
retention, hypercapnea, and hypercarbia, is a condition of
abnormally elevated carbon dioxide levels in the blood. Carbon
dioxide is a gaseous product of the body's metabolism and is
normally expelled through the lungs).
Acidosis occurs when Correct Answers the hydrogen ion
concentration increases above normal (pH below 7.35).
Acute increases in carbon dioxide or hydrogen ions in the blood
stimulate the brain's respiratory center, increasing both Correct
Answers the rate and depth of respiration.
*As a result, carbon dioxide is eliminated and carbonic acid
levels fall, bringing the pH to a more normal range.
**i.e., Patients with chronic lung disease (COPD) may have
consistently high carbon dioxide levels in their blood.
Acute Respiratory Acidosis Correct Answers Results from
sudden failure of ventilation
-Chest trauma
-Aspiration of foreign body
-Acute pneumonia
-Overdose of sedatives or narcotics
•PaCO2 rises rapidly
•pH falls markedly
•pH of 7 or lower can occur within minutes •Hypercapnia
, Adding a strong acid to extracellular fluid (ECF) depletes
bicarbonate, changing the 20:1 ratio and causing the pH to drop
below 7.35, this is a condition known as Correct Answers
Acidosis
Adding a strong base depletes carbonic acid as it combines with
the base, disrupting the 20:1 ratio. The pH rises above 7.45, this
is a condition known as Correct Answers Alkalosis
ADPIE for respiratory alkalosis Correct Answers Assessment
• Health history
-History of anxiety disorders -Triggering event -Mental health
disorders -Available support systems
• Physical examination
-Breath sounds -Neurological function -Respiratory status
-Cardiac status -Changes in LOC
Diagnosis
•Possible nursing diagnoses include
Ineffective Breathing Pattern Anxiety Risk for Injury
(NANDA-I ©2012)
Planning
•Appropriate outcomes might include
-Identify and treat underlying cause
-Restore acid-base balance -Manifest normal respiratory rate and
rhythm -Maintain safety -Maintain appropriate fluid status
Implementation
• Nursing interventions will include
-Assess respiratory rate, depth, and
