NUR 2243 EXAM REVIEW 2026
COMPREHENSIVE STUDY GUIDE WITH SOLVED
QUESTIONS
◉A nurse assesses a client who is experiencing an acid-base imbalance.
The clients arterial blood gas values are pH 7.34, PaO2 88 mm Hg,
PaCO2 38 mm Hg, and HCO3 19 mEq/L. Which assessment should the
nurse perform first?
a. Cardiac rate and rhythm
b. Skin and mucous membranes
c. Musculoskeletal strength
d. Level of orientation . ANS: A
Early cardiovascular changes for a client experiencing moderate acidosis
include increased heart rate and cardiac output. As the acidosis worsens,
the heart rate decreases and electrocardiographic changes will be
present. Central nervous system and neuromuscular system changes do
not occur with mild acidosis and should be monitored if the acidosis
worsens. Skin and mucous membrane assessment is not a priority now,
but will change as acidosis worsens.
◉A nurse assesses a client who is prescribed furosemide (Lasix) for
hypertension. For which acid-base imbalance should the nurse assess to
prevent complications of this therapy?
a. Respiratory acidosis
,b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis . ANS: D
Many diuretics, especially loop diuretics, increase the excretion of
hydrogen ions, leading to excess acid loss through the renal system. This
situation is an acid deficit of metabolic origin.
◉A nurse is caring for a client who is experiencing moderate metabolic
alkalosis. Which action should the nurse take?
a. Monitor daily hemoglobin and hematocrit values.
b. Administer furosemide (Lasix) intravenously.
c. Encourage the client to take deep breaths.
d. Teach the client fall prevention measures. . ANS: D
The priority nursing care for a client who is experiencing moderate
metabolic alkalosis is providing client safety. Clients with metabolic
alkalosis have muscle weakness and are at risk for falling. The other
nursing interventions are not appropriate for metabolic alkalosis
◉A nurse assesses a client who is admitted with an acid-base imbalance.
The clients arterial blood gas values are pH 7.32, PaO2 85 mm Hg,
PaCO2 34 mm Hg, and HCO3 16 mEq/L. What action should the nurse
take next?
a. Assess clients rate, rhythm, and depth of respiration.
b. Measure the clients pulse and blood pressure.
,c. Document the findings and continue to monitor.
d. Notify the physician as soon as possible. . ANS: A
Progressive skeletal muscle weakness is associated with increasing
severity of acidosis. Muscle weakness can lead to severe respiratory
insufficiency. Acidosis does lead to dysrhythmias (due to hyperkalemia),
but these would best be assessed with cardiac monitoring. Findings
should be documented, but simply continuing to monitor is not
sufficient. Before notifying the physician, the nurse must have more data
to report
◉A nurse is caring for a client who has the following arterial blood
values: pH 7.12, PaO2 56 mm Hg, PaCO2 65 mm Hg, and HCO3 22
mEq/L. Which clinical situation should the nurse correlate with these
values?
a. Diabetic ketoacidosis in a person with emphysema
b. Bronchial obstruction related to aspiration of a hot dog
c. Anxiety-induced hyperventilation in an adolescent
d. Diarrhea for 36 hours in an older, frail woman . ANS: B
Arterial blood gas values indicate that the client has acidosis with
normal levels of bicarbonate, suggesting that the problem is not
metabolic. Arterial concentrations of oxygen and carbon dioxide are
abnormal, with low oxygen and high carbon dioxide levels. Thus, this
client has respiratory acidosis from inadequate gas exchange. The fact
that the bicarbonate level is normal indicates that this is an acute
respiratory problem rather than a chronic problem, because no renal
compensation has occurred.
, ◉A nurse is caring for a client who has just experienced a 90-second
tonic-clonic seizure. The clients arterial blood gas values are pH 6.88,
PaO2 50 mm Hg, PaCO2 60 mm Hg, and HCO3 22 mEq/L. Which
action should the nurse take first?
a. Apply oxygen by mask or nasal cannula.
b. Apply a paper bag over the clients nose and mouth.
c. Administer 50 mL of sodium bicarbonate intravenously.
d. Administer 50 mL of 20% glucose and 20 units of regular insulin. .
ANS: A
The client has experienced a combination of metabolic and acute
respiratory acidosis through heavy skeletal muscle contractions and no
gas exchange. When the seizures have stopped and the client can breathe
again, the fastest way to return acid-base balance is to administer
oxygen. Applying a paper bag over the clients nose and mouth would
worsen the acidosis. Sodium bicarbonate should not be administered
because the clients arterial bicarbonate level is normal. Glucose and
insulin are administered together to decrease serum potassium levels.
This action is not appropriate based on the information provided
◉After teaching a client who was malnourished and is being discharged,
a nurse assesses the clients understanding. Which statement indicates the
client correctly understood teaching to decrease risk for the development
of metabolic acidosis?
a. I will drink at least three glasses of milk each day.
b. I will eat three well-balanced meals and a snack daily.
COMPREHENSIVE STUDY GUIDE WITH SOLVED
QUESTIONS
◉A nurse assesses a client who is experiencing an acid-base imbalance.
The clients arterial blood gas values are pH 7.34, PaO2 88 mm Hg,
PaCO2 38 mm Hg, and HCO3 19 mEq/L. Which assessment should the
nurse perform first?
a. Cardiac rate and rhythm
b. Skin and mucous membranes
c. Musculoskeletal strength
d. Level of orientation . ANS: A
Early cardiovascular changes for a client experiencing moderate acidosis
include increased heart rate and cardiac output. As the acidosis worsens,
the heart rate decreases and electrocardiographic changes will be
present. Central nervous system and neuromuscular system changes do
not occur with mild acidosis and should be monitored if the acidosis
worsens. Skin and mucous membrane assessment is not a priority now,
but will change as acidosis worsens.
◉A nurse assesses a client who is prescribed furosemide (Lasix) for
hypertension. For which acid-base imbalance should the nurse assess to
prevent complications of this therapy?
a. Respiratory acidosis
,b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis . ANS: D
Many diuretics, especially loop diuretics, increase the excretion of
hydrogen ions, leading to excess acid loss through the renal system. This
situation is an acid deficit of metabolic origin.
◉A nurse is caring for a client who is experiencing moderate metabolic
alkalosis. Which action should the nurse take?
a. Monitor daily hemoglobin and hematocrit values.
b. Administer furosemide (Lasix) intravenously.
c. Encourage the client to take deep breaths.
d. Teach the client fall prevention measures. . ANS: D
The priority nursing care for a client who is experiencing moderate
metabolic alkalosis is providing client safety. Clients with metabolic
alkalosis have muscle weakness and are at risk for falling. The other
nursing interventions are not appropriate for metabolic alkalosis
◉A nurse assesses a client who is admitted with an acid-base imbalance.
The clients arterial blood gas values are pH 7.32, PaO2 85 mm Hg,
PaCO2 34 mm Hg, and HCO3 16 mEq/L. What action should the nurse
take next?
a. Assess clients rate, rhythm, and depth of respiration.
b. Measure the clients pulse and blood pressure.
,c. Document the findings and continue to monitor.
d. Notify the physician as soon as possible. . ANS: A
Progressive skeletal muscle weakness is associated with increasing
severity of acidosis. Muscle weakness can lead to severe respiratory
insufficiency. Acidosis does lead to dysrhythmias (due to hyperkalemia),
but these would best be assessed with cardiac monitoring. Findings
should be documented, but simply continuing to monitor is not
sufficient. Before notifying the physician, the nurse must have more data
to report
◉A nurse is caring for a client who has the following arterial blood
values: pH 7.12, PaO2 56 mm Hg, PaCO2 65 mm Hg, and HCO3 22
mEq/L. Which clinical situation should the nurse correlate with these
values?
a. Diabetic ketoacidosis in a person with emphysema
b. Bronchial obstruction related to aspiration of a hot dog
c. Anxiety-induced hyperventilation in an adolescent
d. Diarrhea for 36 hours in an older, frail woman . ANS: B
Arterial blood gas values indicate that the client has acidosis with
normal levels of bicarbonate, suggesting that the problem is not
metabolic. Arterial concentrations of oxygen and carbon dioxide are
abnormal, with low oxygen and high carbon dioxide levels. Thus, this
client has respiratory acidosis from inadequate gas exchange. The fact
that the bicarbonate level is normal indicates that this is an acute
respiratory problem rather than a chronic problem, because no renal
compensation has occurred.
, ◉A nurse is caring for a client who has just experienced a 90-second
tonic-clonic seizure. The clients arterial blood gas values are pH 6.88,
PaO2 50 mm Hg, PaCO2 60 mm Hg, and HCO3 22 mEq/L. Which
action should the nurse take first?
a. Apply oxygen by mask or nasal cannula.
b. Apply a paper bag over the clients nose and mouth.
c. Administer 50 mL of sodium bicarbonate intravenously.
d. Administer 50 mL of 20% glucose and 20 units of regular insulin. .
ANS: A
The client has experienced a combination of metabolic and acute
respiratory acidosis through heavy skeletal muscle contractions and no
gas exchange. When the seizures have stopped and the client can breathe
again, the fastest way to return acid-base balance is to administer
oxygen. Applying a paper bag over the clients nose and mouth would
worsen the acidosis. Sodium bicarbonate should not be administered
because the clients arterial bicarbonate level is normal. Glucose and
insulin are administered together to decrease serum potassium levels.
This action is not appropriate based on the information provided
◉After teaching a client who was malnourished and is being discharged,
a nurse assesses the clients understanding. Which statement indicates the
client correctly understood teaching to decrease risk for the development
of metabolic acidosis?
a. I will drink at least three glasses of milk each day.
b. I will eat three well-balanced meals and a snack daily.
