NURB 3040: Acid-Base Balance Questions with
Verified Correct Answers
A client with severe burns has massive fluid shifts from the intravascular to the
interstitial space. Which IV fluid is indicated?
Isotonic solution (e.g., Lactated Ringer's) to expand extracellular fluid volume.
A client's peripheral IV site is cool, swollen, with a slowed infusion. What is the priority
nursing action?
Stop the infusion, remove the IV catheter, and elevate the extremity.
ABG: pH 7.33, PaCO2 55 mm Hg, HCO3 30 mEq/L. What is the interpretation?
Partially compensated respiratory acidosis.
A client with potassium 2.8 mEq/L is prescribed IV potassium. Which method is strictly
contraindicated?
IV bolus or push; it must be diluted and infused slowly via pump.
A client has a 6 mm deep indentation upon pretibial pressure. How should this edema
be graded?
3+ pitting edema.
A client in DKA has deep, rapid (Kussmaul) respirations. What is the physiological
purpose?
Lungs hyperventilate to blow off CO2 and decrease carbonic acid levels.
ABG: pH 7.48, PaCO2 40 mm Hg, HCO3 29 mEq/L. What is the interpretation?
Uncompensated metabolic alkalosis.
, A client is receiving 3% NaCl. Which assessment finding requires immediate
intervention?
Crackles in lungs, indicating fluid volume excess and circulatory overload.
A hyperventilating, anxious client has pH 7.49 and PaCO2 28. What is the primary
intervention?
Encourage slow, deep breathing or breathing into a paper bag to retain CO2.
Why is 0.45% NaCl contraindicated or used with extreme caution in head injury
clients?
It is hypotonic and can cause cellular swelling, worsening cerebral edema.
Which transport mechanism does the sodium-potassium pump use to move ions against
a gradient?
Active transport, which requires ATP energy.
An adolescent is admitted with an acute salicylate (aspirin) overdose. Which initial
imbalance is expected?
Respiratory alkalosis due to direct stimulation of the respiratory center.
A client has had continuous nasogastric suctioning for 48 hours. Which imbalance is
expected?
Metabolic alkalosis due to loss of gastric hydrochloric acid.
Why does renal compensation for respiratory acidosis take longer than respiratory
compensation?
Kidneys require hours to days to excrete hydrogen and reabsorb bicarbonate.
Verified Correct Answers
A client with severe burns has massive fluid shifts from the intravascular to the
interstitial space. Which IV fluid is indicated?
Isotonic solution (e.g., Lactated Ringer's) to expand extracellular fluid volume.
A client's peripheral IV site is cool, swollen, with a slowed infusion. What is the priority
nursing action?
Stop the infusion, remove the IV catheter, and elevate the extremity.
ABG: pH 7.33, PaCO2 55 mm Hg, HCO3 30 mEq/L. What is the interpretation?
Partially compensated respiratory acidosis.
A client with potassium 2.8 mEq/L is prescribed IV potassium. Which method is strictly
contraindicated?
IV bolus or push; it must be diluted and infused slowly via pump.
A client has a 6 mm deep indentation upon pretibial pressure. How should this edema
be graded?
3+ pitting edema.
A client in DKA has deep, rapid (Kussmaul) respirations. What is the physiological
purpose?
Lungs hyperventilate to blow off CO2 and decrease carbonic acid levels.
ABG: pH 7.48, PaCO2 40 mm Hg, HCO3 29 mEq/L. What is the interpretation?
Uncompensated metabolic alkalosis.
, A client is receiving 3% NaCl. Which assessment finding requires immediate
intervention?
Crackles in lungs, indicating fluid volume excess and circulatory overload.
A hyperventilating, anxious client has pH 7.49 and PaCO2 28. What is the primary
intervention?
Encourage slow, deep breathing or breathing into a paper bag to retain CO2.
Why is 0.45% NaCl contraindicated or used with extreme caution in head injury
clients?
It is hypotonic and can cause cellular swelling, worsening cerebral edema.
Which transport mechanism does the sodium-potassium pump use to move ions against
a gradient?
Active transport, which requires ATP energy.
An adolescent is admitted with an acute salicylate (aspirin) overdose. Which initial
imbalance is expected?
Respiratory alkalosis due to direct stimulation of the respiratory center.
A client has had continuous nasogastric suctioning for 48 hours. Which imbalance is
expected?
Metabolic alkalosis due to loss of gastric hydrochloric acid.
Why does renal compensation for respiratory acidosis take longer than respiratory
compensation?
Kidneys require hours to days to excrete hydrogen and reabsorb bicarbonate.
