• NUR 504 EXAM 09/07/2026
NUR 504 EXAM 4 PREP NEWEST 2026/2027
ACTUAL EXAM COMPLETE EXAM QUESTIONS
AND CORRECT VERIFIED ANSWERS WITH
RATIONALE
A nurse assesses a client who is prescribed furosemide for hypertension. For which acid-base
imbalance does the nurse assess to prevent complications of this therapy?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis - Correct Answer :ANS: D
P 1
, • NUR 504 EXAM 09/07/2026
Many diuretics, especially loop and thiazide diuretics, increase the excretion of hydrogen ions,
leading to excess acid loss through the renal system. This situation is an actual acid deficit.
A nurse is caring for a client who is experiencing moderate metabolic alkalosis. What action
would the nurse take?
a. Monitor daily hemoglobin and hematocrit values.
b. Administer furosemide intravenously.
c. Encourage the client to take deep breaths.
d. Teach the client fall prevention measures. - Correct Answer :ANS: D
The most important nursing care for a client who is experiencing moderate metabolic alkalosis
is providing client safety. Client's with metabolic alkalosis have muscle weakness and are at
risk for falling. The other nursing interventions are not appropriate for metabolic alkalosis.
A nurse is assessing a client who has acute pancreatitis and is at risk for an acid-base imbalance. For which
manifestation of this acid-base imbalance would the nurse assess?
a. Agitation
b. Kussmaul respirations
c. Seizures
d. Positive Chvostek sign - Correct Answer :ANS: B
The pancreas is a major site of bicarbonate production. Pancreatitis can cause metabolic
acidosis through underproduction of bicarbonate ions. Signs and symptoms of acidosis
include lethargy and Kussmaul respirations. Agitation, seizures, and a positive Chvostek sign
are signs and symptoms of the electrolyte imbalances that accompany alkalosis.
A nurse assesses a client who is admitted with an acid-base imbalance. The client's arterial
blood gas values were pH 7.32, PaO2 85 mm Hg, PaCO2 34 mm Hg, and HCO3 16 mEq/L
(16 mmol/L). The most recent blood gasses show a drop in the pH. What action does the nurse
take next?
a. Assess client's rate, rhythm, and depth of respiration.
P 2
, • NUR 504 EXAM 09/07/2026
b. Measure the client's pulse and blood pressure.
c. Document the findings and continue to monitor.
d. Notify the primary health care provider. - Correct Answer :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 would be documented, but simply continuing to monitor is not
sufficient. Before notifying the primary care provider, 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 (22 mmol/L). Which clinical situation does
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 - Correct Answer :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. The client who would have these ABG
values is the one with the new onset of airway obstruction.
A nurse is caring for a client who has just experienced a 90-second tonic-clonic seizure. The
client's arterial blood gas values are pH 6.88, PaO2 50 mm Hg, PaCO2 60 mm Hg, and HCO3
22 mEq/L (22 mmol/L). What action would the nurse take first?
a. Apply oxygen by mask or nasal cannula.
P 3
, • NUR 504 EXAM 09/07/2026
b. Apply a paper bag over the client's nose and mouth.
c. Administer 50 mL of sodium bicarbonate intravenously.
d. Administer 50 mL of 20% glucose and 20 units of regular insulin. - Correct Answer :ANS: A
This client is severely hypoxic and needs oxygen. Now that the seizure has ended, the client
can breathe again normally, so oxygen administration will rapidly increase the PaO2.
Rebreathing carbon dioxide with a paper bag would make the acidosis worse. Bicarbonate is
only indicated with extremely low pH and serum bicarbonate levels. Glucose and insulin are
administered to decrease the high potassium levels associated with acidosis, but this situation
should reverse itself with oxygen and breathing.
After teaching a client who was malnourished and is being discharged, a nurse assesses the
client's understanding. Which statement indicates that 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."
c. "I will not take pain medication and antihistamines together."
d. "I will avoid salting my food when cooking or during meals." - Correct Answer :ANS: B
Starvation or a diet with too few carbohydrates can lead to metabolic acidosis by forcing cells
to switch to using fats for fuel and by creating ketoacids as a by-product of excessive fat
metabolism. Eating sufficient calories from all food groups helps reduce this risk. Milk, taking
pain medications with antihistamines, and salting food are not related.
A nurse evaluates the following arterial blood gas values in a client: pH 7.48, PaO2 98 mm
Hg, PaCO2 28 mm Hg, and HCO3 22 mEq/L (22 mmol/L). Which client condition does the
nurse correlate with these results?
a. Diarrhea and vomiting for 36 hours
b. Anxiety-induced hyperventilation
c. Chronic obstructive pulmonary disease (COPD)
d. Diabetic ketoacidosis and emphysema - Correct Answer :ANS: B
P 4
NUR 504 EXAM 4 PREP NEWEST 2026/2027
ACTUAL EXAM COMPLETE EXAM QUESTIONS
AND CORRECT VERIFIED ANSWERS WITH
RATIONALE
A nurse assesses a client who is prescribed furosemide for hypertension. For which acid-base
imbalance does the nurse assess to prevent complications of this therapy?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Metabolic alkalosis - Correct Answer :ANS: D
P 1
, • NUR 504 EXAM 09/07/2026
Many diuretics, especially loop and thiazide diuretics, increase the excretion of hydrogen ions,
leading to excess acid loss through the renal system. This situation is an actual acid deficit.
A nurse is caring for a client who is experiencing moderate metabolic alkalosis. What action
would the nurse take?
a. Monitor daily hemoglobin and hematocrit values.
b. Administer furosemide intravenously.
c. Encourage the client to take deep breaths.
d. Teach the client fall prevention measures. - Correct Answer :ANS: D
The most important nursing care for a client who is experiencing moderate metabolic alkalosis
is providing client safety. Client's with metabolic alkalosis have muscle weakness and are at
risk for falling. The other nursing interventions are not appropriate for metabolic alkalosis.
A nurse is assessing a client who has acute pancreatitis and is at risk for an acid-base imbalance. For which
manifestation of this acid-base imbalance would the nurse assess?
a. Agitation
b. Kussmaul respirations
c. Seizures
d. Positive Chvostek sign - Correct Answer :ANS: B
The pancreas is a major site of bicarbonate production. Pancreatitis can cause metabolic
acidosis through underproduction of bicarbonate ions. Signs and symptoms of acidosis
include lethargy and Kussmaul respirations. Agitation, seizures, and a positive Chvostek sign
are signs and symptoms of the electrolyte imbalances that accompany alkalosis.
A nurse assesses a client who is admitted with an acid-base imbalance. The client's arterial
blood gas values were pH 7.32, PaO2 85 mm Hg, PaCO2 34 mm Hg, and HCO3 16 mEq/L
(16 mmol/L). The most recent blood gasses show a drop in the pH. What action does the nurse
take next?
a. Assess client's rate, rhythm, and depth of respiration.
P 2
, • NUR 504 EXAM 09/07/2026
b. Measure the client's pulse and blood pressure.
c. Document the findings and continue to monitor.
d. Notify the primary health care provider. - Correct Answer :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 would be documented, but simply continuing to monitor is not
sufficient. Before notifying the primary care provider, 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 (22 mmol/L). Which clinical situation does
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 - Correct Answer :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. The client who would have these ABG
values is the one with the new onset of airway obstruction.
A nurse is caring for a client who has just experienced a 90-second tonic-clonic seizure. The
client's arterial blood gas values are pH 6.88, PaO2 50 mm Hg, PaCO2 60 mm Hg, and HCO3
22 mEq/L (22 mmol/L). What action would the nurse take first?
a. Apply oxygen by mask or nasal cannula.
P 3
, • NUR 504 EXAM 09/07/2026
b. Apply a paper bag over the client's nose and mouth.
c. Administer 50 mL of sodium bicarbonate intravenously.
d. Administer 50 mL of 20% glucose and 20 units of regular insulin. - Correct Answer :ANS: A
This client is severely hypoxic and needs oxygen. Now that the seizure has ended, the client
can breathe again normally, so oxygen administration will rapidly increase the PaO2.
Rebreathing carbon dioxide with a paper bag would make the acidosis worse. Bicarbonate is
only indicated with extremely low pH and serum bicarbonate levels. Glucose and insulin are
administered to decrease the high potassium levels associated with acidosis, but this situation
should reverse itself with oxygen and breathing.
After teaching a client who was malnourished and is being discharged, a nurse assesses the
client's understanding. Which statement indicates that 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."
c. "I will not take pain medication and antihistamines together."
d. "I will avoid salting my food when cooking or during meals." - Correct Answer :ANS: B
Starvation or a diet with too few carbohydrates can lead to metabolic acidosis by forcing cells
to switch to using fats for fuel and by creating ketoacids as a by-product of excessive fat
metabolism. Eating sufficient calories from all food groups helps reduce this risk. Milk, taking
pain medications with antihistamines, and salting food are not related.
A nurse evaluates the following arterial blood gas values in a client: pH 7.48, PaO2 98 mm
Hg, PaCO2 28 mm Hg, and HCO3 22 mEq/L (22 mmol/L). Which client condition does the
nurse correlate with these results?
a. Diarrhea and vomiting for 36 hours
b. Anxiety-induced hyperventilation
c. Chronic obstructive pulmonary disease (COPD)
d. Diabetic ketoacidosis and emphysema - Correct Answer :ANS: B
P 4
