MID-CURRICULAR HES QUESTIONS WITH
CORRECT ANSWERS
The nurse assesses a client with the admitting diagnosis of bipolar affective disorder, mani
xz xz xz xz xz xz xz xz xz xz xz xz xz
a. Which client symptoms require the nurse's immediate action?
xz xz xz xz xz xz xz xz
1-Incessant talking and sexual innuendos xz xz xz xz
2-Grandiose delusions and poor concentration xz xz xz xz
3-Outlandish behaviors and inappropriate dress xz xz xz xz
4-Nonstop physical activity and poor nutritional intake - ans-4- xz xz xz xz xz xz xz xz
Nonstop physical activity and poor nutritional intake
xz xz xz xz xz xz
Rationale:Mania is a mood characterized by excitement, euphoria, hyperactivity, excessiv xz xz xz xz xz xz xz xz xz
e energy, decreased need for sleep, and impaired ability to concentrate or complete a singl
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
e train of thought. The client's mood is predominantly elevated, expansive, or irritable. All of
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
the options reflect a client's possible symptoms. However, the correct option clearly presen
xz xz xz xz xz xz xz xz xz xz xz xz
ts a problem that compromises physiological integrity and needs to be addressed immediat
xz xz xz xz xz xz xz xz xz xz xz xz
ely.
The nurse is caring for a client who was involuntarily hospitalized to a mental health unit and
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
is scheduled for electroconvulsive therapy. The nurse notes that an informed consent has
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
not been obtained for the procedure. Based on this information, what is the nurse's best det
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ermination in planning care? xz xz xz
1-The informed consent does not need to be obtained.
xz xz xz xz xz xz xz xz
2-The informed consent would be obtained from the family.
xz xz xz xz xz xz xz xz
3-The informed consent needs to be obtained from the client.
xz xz xz xz xz xz xz xz xz
4-The primary health care provider will provide the informed consent. - ans-3-
xz xz xz xz xz xz xz xz xz xz xz
The informed consent needs to be obtained from the client.
xz xz xz xz xz xz xz xz xz
Rationale: Clients who are admitted involuntarily to a mental health unit do not lose their rig
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ht to informed consent. Clients must be considered legally competent until they have been
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
declared incompetent through a legal proceeding. The best determination for the nurse to
xz xz xz xz xz xz xz xz xz xz xz xz xz
make is to obtain the informed consent from the client.
xz xz xz xz xz xz xz xz xz
A client presents to the emergency department with upper gastrointestinal bleeding and is i
xz xz xz xz xz xz xz xz xz xz xz xz xz
n moderate distress. In planning care, what is the priority nursing action for this client?
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
1-Assessment of vital signs xz xz xz
2-Completion of abdominal examination xz xz xz
3-Insertion of the prescribed nasogastric tube xz xz xz xz xz
4-Thorough investigation of precipitating events - ans-1-Assessment of vital signs
xz xz xz xz xz xz xz xz xz
Rationale:The priority nursing action is to assess the vital signs. This would provide informa xz xz xz xz xz xz xz xz xz xz xz xz xz
tion about the amount of blood loss that has occurred and provide a baseline by which to mo
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
,nitor the progress of treatment. The client may be unable to provide subjective data until the
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz x
immediate physical needs are met. Although an abdominal examination and an assessme
z xz xz xz xz xz xz xz xz xz xz xz
nt of the precipitating events may be necessary, these actions are not the priority. Insertion
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
of a nasogastric tube is not the priority and will require a primary health care provider's pres
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
cription; in addition, the vital signs would be checked before performing this procedure.
xz xz xz xz xz xz xz xz xz xz xz xz
The nurse provides instructions to a malnourished pregnant client regarding iron suppleme
xz xz xz xz xz xz xz xz xz xz xz
ntation. Which client statement indicates an understanding of the instructions?
xz xz xz xz xz xz xz xz xz
1-"Iron supplements will give me diarrhea." xz xz xz xz xz
2-"Meat does not provide iron and should be avoided." xz xz xz xz xz xz xz xz
3-"The iron is best absorbed if taken on an empty stomach."
xz xz xz xz xz xz xz xz xz xz
4-"On the days that I eat green leafy vegetables or calf liver I can omit taking the iron supple
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ment." - ans-3-"The iron is best absorbed if taken on an empty stomach."
xz xz xz xz xz xz xz xz xz xz xz xz
Rationale:Iron is needed to allow for transfer of adequate iron to the fetus and to permit exp xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ansion of the maternal red blood cell mass. During pregnancy, the relative excess of plasm
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
a causes a decrease in the hemoglobin concentration and hematocrit, known as physiologi
xz xz xz xz xz xz xz xz xz xz xz xz
cal anemia of pregnancy. This is a normal adaptation during pregnancy. Iron is best absorb
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ed if taken on an empty stomach. Taking it with a fluid high in ascorbic acid such as tomato j
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
uice enhances absorption. Iron supplements usually cause constipation. Meats are an exc
xz xz xz xz xz xz xz xz xz xz xz
ellent source of iron. The client needs to take the iron supplements regardless of food intak
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
e.
The nurse is teaching a client with emphysema about positions that help breathing during d
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
yspneic episodes. The nurse instructs the client that which positions alleviate dyspnea?
xz xz xz xz xz xz xz xz xz xz xz
Select all that apply.
xz xz xz xz
1- Sitting up and leaning on a table
xz xz xz xz xz xz xz
2-Standing and leaning against a wall xz xz xz xz xz
3-Lying supine with the feet elevated xz xz xz xz xz
4-Sitting up with the elbows resting on knees xz xz xz xz xz xz xz
5-Lying on the back in a low-Fowler's position - ans-1- Sitting up and leaning on a table
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
2-Standing and leaning against a wall xz xz xz xz xz
4-Sitting up with the elbows resting on knees xz xz xz xz xz xz xz
Rationale:The client would use the positions outlined in options 1, 2, and 4. These allow for xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
maximal chest expansion. The client would not lie on the back because this reduces move
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ment of a large area of the client's chest wall. Sitting is better than standing, whenever possi
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ble. If no chair is available, leaning against a wall while standing allows accessory muscles t
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
o be used for breathing and not posture control.
xz xz xz xz xz xz xz xz
A client is about to undergo a lumbar puncture. The nurse describes to the client that which
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
position will be used during the procedure? xz xz xz xz xz xz
1-Side-lying with a pillow under the hip xz xz xz xz xz xz
2-Prone with a pillow under the abdomen xz xz xz xz xz xz
3-Prone in slight Trendelenburg's position xz xz xz xz
, 4-Side-lying with the legs pulled up and the head bent down onto the chest - ans-4-Side-
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
lying with the legs pulled up and the head bent down onto the chest
xz xz xz xz xz xz xz xz xz xz xz xz xz
Rationale:A client undergoing lumbar puncture is positioned lying on the side, with the legs
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
pulled up to the abdomen and the head bent down onto the chest. This position helps open t
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
he spaces between the vertebrae and allows for easier needle insertion by the primary heal
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
th care provider. The nurse remains with the client during the procedure to help the client m
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
aintain this position. The other options identify incorrect positions for this procedure.
xz xz xz xz xz xz xz xz xz xz xz
The nurse recognizes that which interventions are likely to facilitate effective communicatio
xz xz xz xz xz xz xz xz xz xz xz
n between a dying client and family? Select all that apply.
xz xz xz xz xz xz xz xz xz xz
1-The nurse encourages the client and family to identify and discuss feelings openly.
xz xz xz xz xz xz xz xz xz xz xz xz
2-The nurse assists the client and family in carrying out spiritually meaningful practices.
xz xz xz xz xz xz xz xz xz xz xz xz
3-
The nurse removes autonomy from the client to alleviate any unnecessary stress for the cli
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ent.
4-
The nurse makes decisions for the client and family to relieve them of unnecessary demand
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
s.
5-
The nurse maintains a calm attitude and one of acceptance when the family or client expres
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ses anger. - ans-1- xz xz xz
The nurse encourages the client and family to identify and discuss feelings openly.
xz xz xz xz xz xz xz xz xz xz xz xz
2-The nurse assists the client and family in carrying out spiritually meaningful practices.5-
xz xz xz xz xz xz xz xz xz xz xz xz
The nurse maintains a calm attitude and one of acceptance when the family or client expres
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ses anger. xz
Rationale: Maintaining effective and open communication among family members affected
xz xz xz xz xz xz xz xz xz x
by death and grief is of the greatest importance. Option 1 describes encouraging discussio
z xz xz xz xz xz xz xz xz xz xz xz xz xz
n of feelings and is likely to enhance communication. Option 2 is also an effective interventi
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
on because spiritual practices give meaning to life and have an impact on how people react
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
to crisis. Option 5 is also an effective technique because the client and family need to know t
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
hat someone will be there who is supportive and nonjudgmental. The remaining options de
xz xz xz xz xz xz xz xz xz xz xz xz xz
scribe the nurse removing autonomy and decision making from the client and family, who ar
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
e already experiencing feelings of loss of control in that they cannot change the process of d
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ying. These are ineffective interventions that could impair communication further.
xz xz xz xz xz xz xz xz xz
The nurse reviews the arterial blood gas results of a client with emphysema and notes that t
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
he laboratory report indicates a pH of 7.30, Paco2 of 58 mm Hg, Pao2 of 80 mm Hg, and Hc
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
o3 of 27 mEq/L. The nurse interprets that the client has which acid-base disturbance?
xz xz xz xz xz xz xz xz xz xz xz xz xz
1-Metabolic acidosis xz
2-Metabolic alkalosis xz
3-Respiratory acidosis xz
4-Respiratory alkalosis - ans-3-Respiratory acidosis xz xz xz xz
CORRECT ANSWERS
The nurse assesses a client with the admitting diagnosis of bipolar affective disorder, mani
xz xz xz xz xz xz xz xz xz xz xz xz xz
a. Which client symptoms require the nurse's immediate action?
xz xz xz xz xz xz xz xz
1-Incessant talking and sexual innuendos xz xz xz xz
2-Grandiose delusions and poor concentration xz xz xz xz
3-Outlandish behaviors and inappropriate dress xz xz xz xz
4-Nonstop physical activity and poor nutritional intake - ans-4- xz xz xz xz xz xz xz xz
Nonstop physical activity and poor nutritional intake
xz xz xz xz xz xz
Rationale:Mania is a mood characterized by excitement, euphoria, hyperactivity, excessiv xz xz xz xz xz xz xz xz xz
e energy, decreased need for sleep, and impaired ability to concentrate or complete a singl
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
e train of thought. The client's mood is predominantly elevated, expansive, or irritable. All of
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
the options reflect a client's possible symptoms. However, the correct option clearly presen
xz xz xz xz xz xz xz xz xz xz xz xz
ts a problem that compromises physiological integrity and needs to be addressed immediat
xz xz xz xz xz xz xz xz xz xz xz xz
ely.
The nurse is caring for a client who was involuntarily hospitalized to a mental health unit and
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
is scheduled for electroconvulsive therapy. The nurse notes that an informed consent has
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
not been obtained for the procedure. Based on this information, what is the nurse's best det
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ermination in planning care? xz xz xz
1-The informed consent does not need to be obtained.
xz xz xz xz xz xz xz xz
2-The informed consent would be obtained from the family.
xz xz xz xz xz xz xz xz
3-The informed consent needs to be obtained from the client.
xz xz xz xz xz xz xz xz xz
4-The primary health care provider will provide the informed consent. - ans-3-
xz xz xz xz xz xz xz xz xz xz xz
The informed consent needs to be obtained from the client.
xz xz xz xz xz xz xz xz xz
Rationale: Clients who are admitted involuntarily to a mental health unit do not lose their rig
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ht to informed consent. Clients must be considered legally competent until they have been
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
declared incompetent through a legal proceeding. The best determination for the nurse to
xz xz xz xz xz xz xz xz xz xz xz xz xz
make is to obtain the informed consent from the client.
xz xz xz xz xz xz xz xz xz
A client presents to the emergency department with upper gastrointestinal bleeding and is i
xz xz xz xz xz xz xz xz xz xz xz xz xz
n moderate distress. In planning care, what is the priority nursing action for this client?
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
1-Assessment of vital signs xz xz xz
2-Completion of abdominal examination xz xz xz
3-Insertion of the prescribed nasogastric tube xz xz xz xz xz
4-Thorough investigation of precipitating events - ans-1-Assessment of vital signs
xz xz xz xz xz xz xz xz xz
Rationale:The priority nursing action is to assess the vital signs. This would provide informa xz xz xz xz xz xz xz xz xz xz xz xz xz
tion about the amount of blood loss that has occurred and provide a baseline by which to mo
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
,nitor the progress of treatment. The client may be unable to provide subjective data until the
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz x
immediate physical needs are met. Although an abdominal examination and an assessme
z xz xz xz xz xz xz xz xz xz xz xz
nt of the precipitating events may be necessary, these actions are not the priority. Insertion
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
of a nasogastric tube is not the priority and will require a primary health care provider's pres
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
cription; in addition, the vital signs would be checked before performing this procedure.
xz xz xz xz xz xz xz xz xz xz xz xz
The nurse provides instructions to a malnourished pregnant client regarding iron suppleme
xz xz xz xz xz xz xz xz xz xz xz
ntation. Which client statement indicates an understanding of the instructions?
xz xz xz xz xz xz xz xz xz
1-"Iron supplements will give me diarrhea." xz xz xz xz xz
2-"Meat does not provide iron and should be avoided." xz xz xz xz xz xz xz xz
3-"The iron is best absorbed if taken on an empty stomach."
xz xz xz xz xz xz xz xz xz xz
4-"On the days that I eat green leafy vegetables or calf liver I can omit taking the iron supple
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ment." - ans-3-"The iron is best absorbed if taken on an empty stomach."
xz xz xz xz xz xz xz xz xz xz xz xz
Rationale:Iron is needed to allow for transfer of adequate iron to the fetus and to permit exp xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ansion of the maternal red blood cell mass. During pregnancy, the relative excess of plasm
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
a causes a decrease in the hemoglobin concentration and hematocrit, known as physiologi
xz xz xz xz xz xz xz xz xz xz xz xz
cal anemia of pregnancy. This is a normal adaptation during pregnancy. Iron is best absorb
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ed if taken on an empty stomach. Taking it with a fluid high in ascorbic acid such as tomato j
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
uice enhances absorption. Iron supplements usually cause constipation. Meats are an exc
xz xz xz xz xz xz xz xz xz xz xz
ellent source of iron. The client needs to take the iron supplements regardless of food intak
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
e.
The nurse is teaching a client with emphysema about positions that help breathing during d
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
yspneic episodes. The nurse instructs the client that which positions alleviate dyspnea?
xz xz xz xz xz xz xz xz xz xz xz
Select all that apply.
xz xz xz xz
1- Sitting up and leaning on a table
xz xz xz xz xz xz xz
2-Standing and leaning against a wall xz xz xz xz xz
3-Lying supine with the feet elevated xz xz xz xz xz
4-Sitting up with the elbows resting on knees xz xz xz xz xz xz xz
5-Lying on the back in a low-Fowler's position - ans-1- Sitting up and leaning on a table
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
2-Standing and leaning against a wall xz xz xz xz xz
4-Sitting up with the elbows resting on knees xz xz xz xz xz xz xz
Rationale:The client would use the positions outlined in options 1, 2, and 4. These allow for xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
maximal chest expansion. The client would not lie on the back because this reduces move
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ment of a large area of the client's chest wall. Sitting is better than standing, whenever possi
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ble. If no chair is available, leaning against a wall while standing allows accessory muscles t
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
o be used for breathing and not posture control.
xz xz xz xz xz xz xz xz
A client is about to undergo a lumbar puncture. The nurse describes to the client that which
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
position will be used during the procedure? xz xz xz xz xz xz
1-Side-lying with a pillow under the hip xz xz xz xz xz xz
2-Prone with a pillow under the abdomen xz xz xz xz xz xz
3-Prone in slight Trendelenburg's position xz xz xz xz
, 4-Side-lying with the legs pulled up and the head bent down onto the chest - ans-4-Side-
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
lying with the legs pulled up and the head bent down onto the chest
xz xz xz xz xz xz xz xz xz xz xz xz xz
Rationale:A client undergoing lumbar puncture is positioned lying on the side, with the legs
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
pulled up to the abdomen and the head bent down onto the chest. This position helps open t
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
he spaces between the vertebrae and allows for easier needle insertion by the primary heal
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
th care provider. The nurse remains with the client during the procedure to help the client m
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
aintain this position. The other options identify incorrect positions for this procedure.
xz xz xz xz xz xz xz xz xz xz xz
The nurse recognizes that which interventions are likely to facilitate effective communicatio
xz xz xz xz xz xz xz xz xz xz xz
n between a dying client and family? Select all that apply.
xz xz xz xz xz xz xz xz xz xz
1-The nurse encourages the client and family to identify and discuss feelings openly.
xz xz xz xz xz xz xz xz xz xz xz xz
2-The nurse assists the client and family in carrying out spiritually meaningful practices.
xz xz xz xz xz xz xz xz xz xz xz xz
3-
The nurse removes autonomy from the client to alleviate any unnecessary stress for the cli
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ent.
4-
The nurse makes decisions for the client and family to relieve them of unnecessary demand
xz xz xz xz xz xz xz xz xz xz xz xz xz xz
s.
5-
The nurse maintains a calm attitude and one of acceptance when the family or client expres
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ses anger. - ans-1- xz xz xz
The nurse encourages the client and family to identify and discuss feelings openly.
xz xz xz xz xz xz xz xz xz xz xz xz
2-The nurse assists the client and family in carrying out spiritually meaningful practices.5-
xz xz xz xz xz xz xz xz xz xz xz xz
The nurse maintains a calm attitude and one of acceptance when the family or client expres
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
ses anger. xz
Rationale: Maintaining effective and open communication among family members affected
xz xz xz xz xz xz xz xz xz x
by death and grief is of the greatest importance. Option 1 describes encouraging discussio
z xz xz xz xz xz xz xz xz xz xz xz xz xz
n of feelings and is likely to enhance communication. Option 2 is also an effective interventi
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
on because spiritual practices give meaning to life and have an impact on how people react
xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
to crisis. Option 5 is also an effective technique because the client and family need to know t
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hat someone will be there who is supportive and nonjudgmental. The remaining options de
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scribe the nurse removing autonomy and decision making from the client and family, who ar
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e already experiencing feelings of loss of control in that they cannot change the process of d
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ying. These are ineffective interventions that could impair communication further.
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The nurse reviews the arterial blood gas results of a client with emphysema and notes that t
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he laboratory report indicates a pH of 7.30, Paco2 of 58 mm Hg, Pao2 of 80 mm Hg, and Hc
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o3 of 27 mEq/L. The nurse interprets that the client has which acid-base disturbance?
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1-Metabolic acidosis xz
2-Metabolic alkalosis xz
3-Respiratory acidosis xz
4-Respiratory alkalosis - ans-3-Respiratory acidosis xz xz xz xz
