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1) A client is brought to the Emergency Department after passing out in a local
department store. The client has been fasting and has ketones in the urine. Which acid-
base imbalance would the nurse expect to assess in this client?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Metabolic alkalosis
D) Respiratory acidosis
A
(Explanation: A) A client who is fasting is at risk for development of metabolic acidosis.
The body recognizes fasting as starvation and begins to metabolize its own proteins into
ketones, which are metabolic acids. Starvation would not result in respiratory acidosis or
alkalosis or in metabolic alkalosis.)
2) Which of the following risk factors exhibited by the client presenting in the Emergency
Department would place the client at risk for metabolic acidosis?
Select all that apply.
A) Abdominal fistulas
B) Chronic obstructive pulmonary disease
C) Pneumonia
D) Acute renal failure
E) Hypovolemic shock
ADE
(Explanation: A, D, E Metabolic acidosis is rarely a primary disorder. It usually develops
during the course of another disease; presence of abdominal fistulas; which can cause
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excess bicarbonate loss; and acute renal failure. Chronic obstructive pulmonary disease
and pneumonia place the client at risk for respiratory acidosis with the increased
retention of carbon dioxide in the blood.)
3) A child with acute asthma has a PaCO2 of 48 mmHg, a pH of 7.31, and a normal
HCO3 blood gas value. The nurse interprets this as which of the following?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Respiratory acidosis
D) Metabolic alkalosis
C
(If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is
uncompensated respiratory acidosis. In addition, croup can be a disease process that
causes respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH,
decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a
decreased pH, normal PaCO2, and normal HCO3. Uncompensated metabolic alkalosis
has an increased pH, normal PaCO2, and increased HCO3.)
5) A client has been admitted with chronic obstructive pulmonary disease. Diagnostic
tests have been ordered. Which of the tests will provide the most accurate indicator of
the client's acid-base balance?
A) Arterial blood gases (ABGs)
B) Pulse oximetry
C) Sputum studies
D) Bronchoscopy
A
(ABGs are done to assess alterations in acid-base balance caused by respiratory
disorders, metabolic disorders, or both. A bronchoscopy provides visualization of
internal respiratory structures. Sputum studies can provide specific information about
bacterial organisms. Pulse oximetry is a noninvasive test that evaluates the oxygen
saturation level of blood.)
6) The nurse is instructing a client with a history of acidosis on the use of sodium
bicarbonate. Which client statement indicates that additional teaching is needed?
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A) "I should contact the doctor if I have any gastric discomfort with chest pain."
B) "I need to purchase antacids without salt."
C) "I should use the antacid for at least 2 months."
D) "I should call the doctor if I get short of breath or start to sweat with this medication."
C
( The client should be instructed to immediately contact the primary healthcare provider
if gastric discomfort occurs with chest pain or if dyspnea or diaphoresis occurs. The
client should be instructed to use non-sodium antacids to prevent the absorption of
excess sodium or bicarbonate into systemic circulation and to not use any bicarbonate
antacid for longer than 2 weeks.)
7) A client who was diagnosed with diabetes mellitus 1 year ago is hospitalized in
diabetic ketoacidosis after a religious fast. The client tells the nurse, "I have fasted
during this season every year since I became an adult. I am not going to stop now." The
nurse is not knowledgeable about this particular religion. Which nursing action would be
appropriate?
Select all that apply.
A) Request a consult from a diabetes educator.
B) Tell the client that things are different now because of the diabetes.
C) Ask family members of the same religion to discuss fasting with the client.
D) Assess the meaning and context of fasting in the client's religion.
E) Encourage the client to seek medical care if signs of ketoacidosis occur in the future.
ADE
(Explanation: A,D,E The diabetes educator should be contacted to work with the client
on strategies that might allow the fasting to occur in a safe manner. Assessing the
meaning and context of fasting in the client's religion would be educative for the nurse
and an appropriate action. Stressing the importance of promptly seeking care when
signs of ketoacidosis occur helps to promote the client's health and is appropriate.
Telling the client that life is different now does not support religious beliefs. Asking the
family to talk to the client might help, but the diabetes educator would be able to provide
more direct and helpful information for the client.)
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Acid Base NCLEX Questions and
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1) A client is brought to the Emergency Department after passing out in a local
department store. The client has been fasting and has ketones in the urine. Which acid-
base imbalance would the nurse expect to assess in this client?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Metabolic alkalosis
D) Respiratory acidosis
A
(Explanation: A) A client who is fasting is at risk for development of metabolic acidosis.
The body recognizes fasting as starvation and begins to metabolize its own proteins into
ketones, which are metabolic acids. Starvation would not result in respiratory acidosis or
alkalosis or in metabolic alkalosis.)
2) Which of the following risk factors exhibited by the client presenting in the Emergency
Department would place the client at risk for metabolic acidosis?
Select all that apply.
A) Abdominal fistulas
B) Chronic obstructive pulmonary disease
C) Pneumonia
D) Acute renal failure
E) Hypovolemic shock
ADE
(Explanation: A, D, E Metabolic acidosis is rarely a primary disorder. It usually develops
during the course of another disease; presence of abdominal fistulas; which can cause
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excess bicarbonate loss; and acute renal failure. Chronic obstructive pulmonary disease
and pneumonia place the client at risk for respiratory acidosis with the increased
retention of carbon dioxide in the blood.)
3) A child with acute asthma has a PaCO2 of 48 mmHg, a pH of 7.31, and a normal
HCO3 blood gas value. The nurse interprets this as which of the following?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Respiratory acidosis
D) Metabolic alkalosis
C
(If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is
uncompensated respiratory acidosis. In addition, croup can be a disease process that
causes respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH,
decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a
decreased pH, normal PaCO2, and normal HCO3. Uncompensated metabolic alkalosis
has an increased pH, normal PaCO2, and increased HCO3.)
5) A client has been admitted with chronic obstructive pulmonary disease. Diagnostic
tests have been ordered. Which of the tests will provide the most accurate indicator of
the client's acid-base balance?
A) Arterial blood gases (ABGs)
B) Pulse oximetry
C) Sputum studies
D) Bronchoscopy
A
(ABGs are done to assess alterations in acid-base balance caused by respiratory
disorders, metabolic disorders, or both. A bronchoscopy provides visualization of
internal respiratory structures. Sputum studies can provide specific information about
bacterial organisms. Pulse oximetry is a noninvasive test that evaluates the oxygen
saturation level of blood.)
6) The nurse is instructing a client with a history of acidosis on the use of sodium
bicarbonate. Which client statement indicates that additional teaching is needed?
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A) "I should contact the doctor if I have any gastric discomfort with chest pain."
B) "I need to purchase antacids without salt."
C) "I should use the antacid for at least 2 months."
D) "I should call the doctor if I get short of breath or start to sweat with this medication."
C
( The client should be instructed to immediately contact the primary healthcare provider
if gastric discomfort occurs with chest pain or if dyspnea or diaphoresis occurs. The
client should be instructed to use non-sodium antacids to prevent the absorption of
excess sodium or bicarbonate into systemic circulation and to not use any bicarbonate
antacid for longer than 2 weeks.)
7) A client who was diagnosed with diabetes mellitus 1 year ago is hospitalized in
diabetic ketoacidosis after a religious fast. The client tells the nurse, "I have fasted
during this season every year since I became an adult. I am not going to stop now." The
nurse is not knowledgeable about this particular religion. Which nursing action would be
appropriate?
Select all that apply.
A) Request a consult from a diabetes educator.
B) Tell the client that things are different now because of the diabetes.
C) Ask family members of the same religion to discuss fasting with the client.
D) Assess the meaning and context of fasting in the client's religion.
E) Encourage the client to seek medical care if signs of ketoacidosis occur in the future.
ADE
(Explanation: A,D,E The diabetes educator should be contacted to work with the client
on strategies that might allow the fasting to occur in a safe manner. Assessing the
meaning and context of fasting in the client's religion would be educative for the nurse
and an appropriate action. Stressing the importance of promptly seeking care when
signs of ketoacidosis occur helps to promote the client's health and is appropriate.
Telling the client that life is different now does not support religious beliefs. Asking the
family to talk to the client might help, but the diabetes educator would be able to provide
more direct and helpful information for the client.)
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