MDC II - Exam 2
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1. Causes of respiratory acidosis (low ph/ high CO2): -Hypoventilation
-Drug overdose
-Pulmonary edema
-Chest trauma/neuromuscular disease
-COPD
-Airway obstruction
2. Causes of Metabolic Acidosis (low pH/low HCO3): -Diabetic ketoacidosis
-Salicylate OD
-Renal failure
-Severe diarrhea
-Sepsis
-Shock
3. How to evaluate that treatment is working for respiratory acidosis?: -Maintains
adequate gas exchange
-Arterial pH above 7.2 and closer to 7.35
-PaO2 level above 90 mmHg or at least 10 mm Hg higher than their admission level
-PaCO2 levels below 45 mmHg or at least 15 mm Hg below their admission level
4. Alkalosis pathophysiology: Alkalosis is a decrease in the free hydrogen ion level of the blood and is
reflected by an arterial blood pH above 7.45.
5. Metabolic Alkalosis: Base excess in what?: Excessive intake bicarbonates, carbonates, acetates,
citrates
6. Cause of acid deficit?: Prolonged vomiting, excess cortisol, hyperaldosteronism, thiazide diuretics, pro-
longed NG suction, loss of gastric fluids.
7. Hallmark of base excess acidosis?: ABG result with ‘pH and ‘bicarbonate level with normal O2 and
CO2 levels
8. What is citrate?: citrate is an anticoagulant used in blood products that is rapidly metabolized in the liver
9. What can happen when blood is rapidly administered?: rapid administration of large
quantities of stored blood can cause hypocalcemia and hypomagnesmia.
10. The nurse is evaluating the laboratory work of a patient who has uncon-
trolled metabolic acidosis. Which outcome would result from this condition?
A.pH 7.40
1/8
, MDC II - Exam 2
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B.Pao2 98 mm Hg
C.Bicarbonate 38 mEq/L
Serum potassium 5.7 mEq/L: ANS: D
Metabolic acidosis is reflected by several changes in ABG values. The pH is low (<7.35). The bicarbonate level is low
(<21 mEq/L). The partial pressure of arterial oxygen (Pao2) is normal because gas exchange is adequate. The serum
potassium level is often high in acidosis as the body attempts to maintain electroneutrality during buffering.
11. The nurse is reviewing the standing orders for a patient who was admitted
for evaluation of chest pain. The patient has a history of chronic obstructive
pulmonary disease (COPD) and his laboratory results and assessment reveal
that he has mild respiratory acidosis. The nurse would question which order?
A.Encourage oral fluids
B.Keep head of bed elevated
C.Oxygen therapy at 4 L/min as needed
Bedrest with bathroom privileges only: ANS: C
The bedrest order will help the patient conserve energy. The upright position (mid-Fowler's to high-Fowler's position)
helps increase lung expansion. Increasing fluid intake may reduce the thickness of lung secretions and assist in their
removal. Oxygen therapy helps promote gas exchange for patients with respiratory acidosis. However, use caution
when giving oxygen to patients with COPD and CO2 retention as evidenced by a high Paco2 level. The only breathing
trigger for these patients is a decreased arterial oxygen level. Giving too much oxygen to these patients decreases their
respiratory drive and may lead to respiratory arrest.
12. What is the third line of defense against pH changes?: Kidneys
13. Acid-base Control Actions and Mechanisms: Kidney: -Stronger for regulation acid-base
balance; takes longer than chemical and respiratory.
-Kidneys move bicarbonate.
-Formation of acids and ammonium
-Kidneys can correct/compensate for pH changes when respiratory system is overwhelmed or unhealthy.
14. Compensation: Body attempts to correct blood pH chan
15. What pH is considered fatal?: <6.9
>7.8
2/8
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1. Causes of respiratory acidosis (low ph/ high CO2): -Hypoventilation
-Drug overdose
-Pulmonary edema
-Chest trauma/neuromuscular disease
-COPD
-Airway obstruction
2. Causes of Metabolic Acidosis (low pH/low HCO3): -Diabetic ketoacidosis
-Salicylate OD
-Renal failure
-Severe diarrhea
-Sepsis
-Shock
3. How to evaluate that treatment is working for respiratory acidosis?: -Maintains
adequate gas exchange
-Arterial pH above 7.2 and closer to 7.35
-PaO2 level above 90 mmHg or at least 10 mm Hg higher than their admission level
-PaCO2 levels below 45 mmHg or at least 15 mm Hg below their admission level
4. Alkalosis pathophysiology: Alkalosis is a decrease in the free hydrogen ion level of the blood and is
reflected by an arterial blood pH above 7.45.
5. Metabolic Alkalosis: Base excess in what?: Excessive intake bicarbonates, carbonates, acetates,
citrates
6. Cause of acid deficit?: Prolonged vomiting, excess cortisol, hyperaldosteronism, thiazide diuretics, pro-
longed NG suction, loss of gastric fluids.
7. Hallmark of base excess acidosis?: ABG result with ‘pH and ‘bicarbonate level with normal O2 and
CO2 levels
8. What is citrate?: citrate is an anticoagulant used in blood products that is rapidly metabolized in the liver
9. What can happen when blood is rapidly administered?: rapid administration of large
quantities of stored blood can cause hypocalcemia and hypomagnesmia.
10. The nurse is evaluating the laboratory work of a patient who has uncon-
trolled metabolic acidosis. Which outcome would result from this condition?
A.pH 7.40
1/8
, MDC II - Exam 2
Study online at https://quizlet.com/_8juq06
B.Pao2 98 mm Hg
C.Bicarbonate 38 mEq/L
Serum potassium 5.7 mEq/L: ANS: D
Metabolic acidosis is reflected by several changes in ABG values. The pH is low (<7.35). The bicarbonate level is low
(<21 mEq/L). The partial pressure of arterial oxygen (Pao2) is normal because gas exchange is adequate. The serum
potassium level is often high in acidosis as the body attempts to maintain electroneutrality during buffering.
11. The nurse is reviewing the standing orders for a patient who was admitted
for evaluation of chest pain. The patient has a history of chronic obstructive
pulmonary disease (COPD) and his laboratory results and assessment reveal
that he has mild respiratory acidosis. The nurse would question which order?
A.Encourage oral fluids
B.Keep head of bed elevated
C.Oxygen therapy at 4 L/min as needed
Bedrest with bathroom privileges only: ANS: C
The bedrest order will help the patient conserve energy. The upright position (mid-Fowler's to high-Fowler's position)
helps increase lung expansion. Increasing fluid intake may reduce the thickness of lung secretions and assist in their
removal. Oxygen therapy helps promote gas exchange for patients with respiratory acidosis. However, use caution
when giving oxygen to patients with COPD and CO2 retention as evidenced by a high Paco2 level. The only breathing
trigger for these patients is a decreased arterial oxygen level. Giving too much oxygen to these patients decreases their
respiratory drive and may lead to respiratory arrest.
12. What is the third line of defense against pH changes?: Kidneys
13. Acid-base Control Actions and Mechanisms: Kidney: -Stronger for regulation acid-base
balance; takes longer than chemical and respiratory.
-Kidneys move bicarbonate.
-Formation of acids and ammonium
-Kidneys can correct/compensate for pH changes when respiratory system is overwhelmed or unhealthy.
14. Compensation: Body attempts to correct blood pH chan
15. What pH is considered fatal?: <6.9
>7.8
2/8
