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Module 1 Acid-Base Balance
The Concept of Acid-Base Balance
1) A client is brought to the emergency department (ED) 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
Answer: 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 fatty acids into ketones,
which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in
metabolic alkalosis.
B) 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 fatty acids into ketones, which are
metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic
alkalosis.
C) 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 fatty acids into ketones, which are
metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic
alkalosis.
D) 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 fatty acids into ketones, which are
metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic
alkalosis.
Page Ref: 6
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care
that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical management and nursing management across the health-illness
continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. | Nursing
Process: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
1
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2) Which risk factors exhibited by the client presenting in the emergency department (ED) 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
Answer: A, D, E
Explanation: A) Metabolic acidosis is rarely a primary disorder. It usually develops during the
course of another disease; presence of abdominal fistulas, which can cause excess bicarbonate
loss; acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and
pneumonia place the client at risk for respiratory acidosis with the increased retention of carbon
dioxide in the blood.
B) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute
renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia
place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in
the blood.
C) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute
renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia
place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in
the blood.
D) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute
renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia
place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in
the blood.
E) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute
renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia
place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in
the blood.
Page Ref: 6, 14
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care
that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical management and nursing management across the health-illness
continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. | Nursing
Process: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
2
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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 these findings as indicative of which condition?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Respiratory acidosis
D) Metabolic alkalosis
Answer: C
Explanation: A) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is
uncompensated respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH,
decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH,
normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH,
normal PaCO2, and increased HCO3.
B) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated
respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased
PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal
PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH, normal
PaCO2, and increased HCO3.
C) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated
respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased
PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal
PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH, normal
PaCO2, and increased HCO3.
D) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated
respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased
PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal
PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH, normal
PaCO2, and increased HCO3.
Page Ref: 24
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care
that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical management and nursing management across the health-illness
continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. | Nursing
Process: Diagnosis
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
3
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4) The nurse is reviewing the latest arterial blood gas results for a client with metabolic alkalosis.
Which result indicates that the metabolic alkalosis is compensated?
A) pH 7.32
B) PaCO2 18 mmHg
C) HCO3 8 mEq/L
D) PaCO2 48 mmHg
Answer: D
Explanation: A) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2
level of 18 mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low
and is most likely associated with metabolic acidosis. In metabolic alkalosis, there is an excess of
bicarbonate. To compensate for this imbalance, the rate and depth of respirations decrease,
leading to retention of carbon dioxide. The PaCO2 will be elevated.
B) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2 level of 18
mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low and is most
likely associated with metabolic acidosis. In metabolic alkalosis, there is an excess of
bicarbonate. To compensate for this imbalance, the rate and depth of respirations decrease,
leading to retention of carbon dioxide. The PaCO2 will be elevated.
C) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2 level of 18
mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low and is most
likely associated with metabolic acidosis. In metabolic alkalosis, there is an excess of
bicarbonate. To compensate for this imbalance, the rate and depth of respirations decrease,
leading to retention of carbon dioxide. The PaCO2 will be elevated.
D) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2 level of 18
mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low and is most
likely associated with metabolic acidosis. In metabolic alkalosis, there is an excess of
bicarbonate. To compensate for this imbalance, the rate and depth of respirations decrease,
leading to retention of carbon dioxide. The PaCO2 will be elevated.
Page Ref: 8
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care
that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical management and nursing management across the health-illness
continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. | Nursing
Process: Evaluation
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
4
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3eConcept-Based
(Pearson).pdf Approach to Learning Vol. 1 & 2, 3e (Pearson)
Nursing: A Concept-Based Approach to Learning Vol. 1 & 2, 3e (Pearson)
Module 1 Acid-Base Balance
The Concept of Acid-Base Balance
1) A client is brought to the emergency department (ED) 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
Answer: 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 fatty acids into ketones,
which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in
metabolic alkalosis.
B) 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 fatty acids into ketones, which are
metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic
alkalosis.
C) 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 fatty acids into ketones, which are
metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic
alkalosis.
D) 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 fatty acids into ketones, which are
metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic
alkalosis.
Page Ref: 6
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care
that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical management and nursing management across the health-illness
continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. | Nursing
Process: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
1
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2) Which risk factors exhibited by the client presenting in the emergency department (ED) 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
Answer: A, D, E
Explanation: A) Metabolic acidosis is rarely a primary disorder. It usually develops during the
course of another disease; presence of abdominal fistulas, which can cause excess bicarbonate
loss; acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and
pneumonia place the client at risk for respiratory acidosis with the increased retention of carbon
dioxide in the blood.
B) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute
renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia
place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in
the blood.
C) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute
renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia
place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in
the blood.
D) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute
renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia
place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in
the blood.
E) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute
renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia
place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in
the blood.
Page Ref: 6, 14
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care
that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical management and nursing management across the health-illness
continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. | Nursing
Process: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
2
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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 these findings as indicative of which condition?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Respiratory acidosis
D) Metabolic alkalosis
Answer: C
Explanation: A) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is
uncompensated respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH,
decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH,
normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH,
normal PaCO2, and increased HCO3.
B) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated
respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased
PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal
PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH, normal
PaCO2, and increased HCO3.
C) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated
respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased
PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal
PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH, normal
PaCO2, and increased HCO3.
D) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated
respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased
PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal
PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH, normal
PaCO2, and increased HCO3.
Page Ref: 24
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care
that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical management and nursing management across the health-illness
continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. | Nursing
Process: Diagnosis
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
3
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4) The nurse is reviewing the latest arterial blood gas results for a client with metabolic alkalosis.
Which result indicates that the metabolic alkalosis is compensated?
A) pH 7.32
B) PaCO2 18 mmHg
C) HCO3 8 mEq/L
D) PaCO2 48 mmHg
Answer: D
Explanation: A) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2
level of 18 mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low
and is most likely associated with metabolic acidosis. In metabolic alkalosis, there is an excess of
bicarbonate. To compensate for this imbalance, the rate and depth of respirations decrease,
leading to retention of carbon dioxide. The PaCO2 will be elevated.
B) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2 level of 18
mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low and is most
likely associated with metabolic acidosis. In metabolic alkalosis, there is an excess of
bicarbonate. To compensate for this imbalance, the rate and depth of respirations decrease,
leading to retention of carbon dioxide. The PaCO2 will be elevated.
C) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2 level of 18
mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low and is most
likely associated with metabolic acidosis. In metabolic alkalosis, there is an excess of
bicarbonate. To compensate for this imbalance, the rate and depth of respirations decrease,
leading to retention of carbon dioxide. The PaCO2 will be elevated.
D) A normal pH level is 7.35-7.45. A pH of less than 7.35 is acidosis. A PaCO2 level of 18
mmHg is low and is seen in respiratory alkalosis. A HCO3 level of 8 mEq/L is low and is most
likely associated with metabolic acidosis. In metabolic alkalosis, there is an excess of
bicarbonate. To compensate for this imbalance, the rate and depth of respirations decrease,
leading to retention of carbon dioxide. The PaCO2 will be elevated.
Page Ref: 8
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods
and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care
that reflects an understanding of human growth and development, pathophysiology,
pharmacology, medical management and nursing management across the health-illness
continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and
Science: Relationships between knowledge/science and quality and safe patient care. | Nursing
Process: Evaluation
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
4
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