Test Bank for Nursing: A Concept-Based Approach to Learning, Volume 1, 5th Edition
TEST BANK
Nursing: A Concept-Based Approach
to Learning Volume 1 — Biophysical
Modules
5th Edition (Pearson)
• Coverage: Part I: Biophysical Modules 1–21
• Format: Multiple Choice with Detailed Answer Explanations
• Includes: Cognitive Level · Client Need · Standards · Learning Outcomes · MNL LOs
i
Copyright © 2027, 2020, 2017
, Nursing: A Concept-Based Approach to Learning Vol. 1, 2 & 3, 5e (Pearson)
Module 1 Acid-Base Balance
The Concept of Acid-Base Balance
1) A client who has been fasting and has ketones in the urine is brought to the emergency department (ED)
unconscious. Which acid-base imbalance would the nurse expect to assess in this client?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Metabolic alkalosis
D) Respiratory acidosis
Answer: A
Explanation: A) A client who is fasting is at risk for development of metabolic acidosis. The body recognizes
fasting as starvation and begins to metabolize its own fatty acids into ketones, which are metabolic acids. B)
Respiratory alkalosis involves an imbalance in the respiratory and metabolic processes of the body. It is caused
by hyperventilation. C) Metabolic alkalosis involves an imbalance in the metabolic processes of the body. It is
caused by a decrease in hydrogen ions, a decrease in chloride ions, or an increase in bicarbonate. D)
Respiratory acidosis involves an imbalance in the respiratory and metabolic processes of the body. It is caused
by a decreased respiratory rate, a decreased inhaled and exhaled volume of air, or blockage of the respiratory
passageways.
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity; Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. |
AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical management and nursing management
across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge
and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process:
Assessment | CJMM: 2.3 Integrate assessment skills in practice.
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
1
Copyright © 2027, 2020, 2017
, Nursing: A Concept-Based Approach to Learning Vol. 1, 2 & 3, 5e (Pearson)
2) The nurse is caring for a client in the emergency department. Which health condition will the nurse suspect
that increases the client's risk for metabolic acidosis? Select all that apply.
A) Abdominal fistulas
B) Chronic obstructive pulmonary disease
C) Pneumonia
D) Chronic renal failure
E) Hypovolemic shock
Answer: A, D, E
Explanation: A) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
another condition such as an abdominal fistula which can cause the loss of bicarbonate from the intestine. B)
Chronic obstructive pulmonary disease places the client at risk for respiratory acidosis with the increased
retention of carbon dioxide in the blood. C) Pneumonia places the client at risk for respiratory acidosis with the
increased retention of carbon dioxide in the blood. D) Metabolic acidosis is rarely a primary disorder. It usually
develops during the course of another condition such as chronic renal failure. In this health problem, the
kidneys are unable to excrete a normal amount of hydrogen ions in the urine. This results in an excessive
amount of hydrogen ions in the blood, which produces metabolic acidosis. E) Metabolic acidosis is rarely a
primary disorder. It usually develops during the course of another condition such as hypovolemic shock. With a
severe blood loss, there is a lack of blood flow throughout the body and a lack of oxygen in every cell.
Adenosine triphosphate (ATP) must produce energy anaerobically without the presence of oxygen; lactic acid is
a by-product. This produces systemic lactic acidosis, a type of metabolic acidosis.
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity; Physiological Adaptation
Standards: QSEN: III.A.1 | AACN: IX.3 | NLN: Knowledge and Science | Nursing Process: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
3) A client with acute asthma has a PaCO₂ of 48 mmHg, a pH of 7.31, and a normal HCO₃⁻ arterial blood gas
value. Which condition will the nurse associate with these values?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Respiratory acidosis
D) Metabolic alkalosis
Answer: C
Explanation: A) Uncompensated metabolic acidosis has a decreased pH, normal PaCO₂, and decreased HCO₃⁻.
B) Uncompensated respiratory alkalosis has an increased pH, decreased PaCO₂, and normal HCO₃⁻. C) If the
pH is decreased and the PaCO₂ is increased with a normal HCO₃⁻, it is uncompensated respiratory acidosis. D)
Uncompensated metabolic alkalosis has an increased pH, normal PaCO₂, and increased HCO₃⁻.
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity; Physiological Adaptation
Standards: QSEN: III.A.1 | AACN: IX.3 | NLN: Knowledge and Science | Nursing Process: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
2
Copyright © 2027, 2020, 2017
, Nursing: A Concept-Based Approach to Learning Vol. 1, 2 & 3, 5e (Pearson)
4) The nurse is reviewing the latest arterial blood gas results for a client with metabolic alkalosis. Which result
indicates that the metabolic alkalosis is compensated?
A) pH 7.32
B) PaCO₂ 18 mmHg
C) HCO₃⁻ 8 mEq/L
D) PaCO₂ 48 mmHg
Answer: D
Explanation: A) A normal pH level is 7.35–7.45. A pH of less than 7.35 is acidosis. B) A PaCO₂ level of 18
mmHg is low and is seen in respiratory alkalosis. C) A HCO₃⁻ level of 8 mEq/L is low and is most likely
associated with metabolic acidosis. D) In metabolic alkalosis, there is an excess of bicarbonate. To compensate
for this imbalance, the rate and depth of respirations decrease, leading to retention of carbon dioxide. The
PaCO₂ will be elevated.
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity; Physiological Adaptation
Standards: QSEN: III.A.1 | AACN: IX.3 | NLN: Knowledge and Science | Nursing Process: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
5) A client has been admitted with chronic obstructive pulmonary disease. Diagnostic tests have been ordered.
Which of the tests will provide the most accurate indicator of the client's acid-base balance?
A) Arterial blood gases (ABGs)
B) Pulse oximetry
C) Sputum studies
D) Bronchoscopy
Answer: A
Explanation: A) Acid-base balance is assessed primarily by measuring arterial blood gases (ABGs). Arterial
blood is most often used because it reflects acid-base balance throughout the entire body better than venous or
capillary blood that has dispersed oxygen into the tissues and has collected carbon dioxide. B) Pulse oximetry is
a noninvasive test that evaluates the oxygen saturation level of blood. C) Sputum studies can provide specific
information about organisms in the sputum. D) A bronchoscopy provides visualization of internal respiratory
structures.
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity; Reduction of Risk Potential
Standards: QSEN: III.A.1 | AACN: IX.3 | NLN: Knowledge and Science | Nursing Process: Assessment
Learning Outcome: 1.5. Differentiate common assessment procedures and tests used to examine acid-base balance.
MNL LO: Differentiate common assessment procedures and tests used to examine acid-base balance.
3
Copyright © 2027, 2020, 2017
TEST BANK
Nursing: A Concept-Based Approach
to Learning Volume 1 — Biophysical
Modules
5th Edition (Pearson)
• Coverage: Part I: Biophysical Modules 1–21
• Format: Multiple Choice with Detailed Answer Explanations
• Includes: Cognitive Level · Client Need · Standards · Learning Outcomes · MNL LOs
i
Copyright © 2027, 2020, 2017
, Nursing: A Concept-Based Approach to Learning Vol. 1, 2 & 3, 5e (Pearson)
Module 1 Acid-Base Balance
The Concept of Acid-Base Balance
1) A client who has been fasting and has ketones in the urine is brought to the emergency department (ED)
unconscious. Which acid-base imbalance would the nurse expect to assess in this client?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Metabolic alkalosis
D) Respiratory acidosis
Answer: A
Explanation: A) A client who is fasting is at risk for development of metabolic acidosis. The body recognizes
fasting as starvation and begins to metabolize its own fatty acids into ketones, which are metabolic acids. B)
Respiratory alkalosis involves an imbalance in the respiratory and metabolic processes of the body. It is caused
by hyperventilation. C) Metabolic alkalosis involves an imbalance in the metabolic processes of the body. It is
caused by a decrease in hydrogen ions, a decrease in chloride ions, or an increase in bicarbonate. D)
Respiratory acidosis involves an imbalance in the respiratory and metabolic processes of the body. It is caused
by a decreased respiratory rate, a decreased inhaled and exhaled volume of air, or blockage of the respiratory
passageways.
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity; Physiological Adaptation
Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. |
AACN Essential Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of
human growth and development, pathophysiology, pharmacology, medical management and nursing management
across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge
and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing Process:
Assessment | CJMM: 2.3 Integrate assessment skills in practice.
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
1
Copyright © 2027, 2020, 2017
, Nursing: A Concept-Based Approach to Learning Vol. 1, 2 & 3, 5e (Pearson)
2) The nurse is caring for a client in the emergency department. Which health condition will the nurse suspect
that increases the client's risk for metabolic acidosis? Select all that apply.
A) Abdominal fistulas
B) Chronic obstructive pulmonary disease
C) Pneumonia
D) Chronic renal failure
E) Hypovolemic shock
Answer: A, D, E
Explanation: A) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
another condition such as an abdominal fistula which can cause the loss of bicarbonate from the intestine. B)
Chronic obstructive pulmonary disease places the client at risk for respiratory acidosis with the increased
retention of carbon dioxide in the blood. C) Pneumonia places the client at risk for respiratory acidosis with the
increased retention of carbon dioxide in the blood. D) Metabolic acidosis is rarely a primary disorder. It usually
develops during the course of another condition such as chronic renal failure. In this health problem, the
kidneys are unable to excrete a normal amount of hydrogen ions in the urine. This results in an excessive
amount of hydrogen ions in the blood, which produces metabolic acidosis. E) Metabolic acidosis is rarely a
primary disorder. It usually develops during the course of another condition such as hypovolemic shock. With a
severe blood loss, there is a lack of blood flow throughout the body and a lack of oxygen in every cell.
Adenosine triphosphate (ATP) must produce energy anaerobically without the presence of oxygen; lactic acid is
a by-product. This produces systemic lactic acidosis, a type of metabolic acidosis.
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity; Physiological Adaptation
Standards: QSEN: III.A.1 | AACN: IX.3 | NLN: Knowledge and Science | Nursing Process: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
3) A client with acute asthma has a PaCO₂ of 48 mmHg, a pH of 7.31, and a normal HCO₃⁻ arterial blood gas
value. Which condition will the nurse associate with these values?
A) Metabolic acidosis
B) Respiratory alkalosis
C) Respiratory acidosis
D) Metabolic alkalosis
Answer: C
Explanation: A) Uncompensated metabolic acidosis has a decreased pH, normal PaCO₂, and decreased HCO₃⁻.
B) Uncompensated respiratory alkalosis has an increased pH, decreased PaCO₂, and normal HCO₃⁻. C) If the
pH is decreased and the PaCO₂ is increased with a normal HCO₃⁻, it is uncompensated respiratory acidosis. D)
Uncompensated metabolic alkalosis has an increased pH, normal PaCO₂, and increased HCO₃⁻.
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity; Physiological Adaptation
Standards: QSEN: III.A.1 | AACN: IX.3 | NLN: Knowledge and Science | Nursing Process: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
2
Copyright © 2027, 2020, 2017
, Nursing: A Concept-Based Approach to Learning Vol. 1, 2 & 3, 5e (Pearson)
4) The nurse is reviewing the latest arterial blood gas results for a client with metabolic alkalosis. Which result
indicates that the metabolic alkalosis is compensated?
A) pH 7.32
B) PaCO₂ 18 mmHg
C) HCO₃⁻ 8 mEq/L
D) PaCO₂ 48 mmHg
Answer: D
Explanation: A) A normal pH level is 7.35–7.45. A pH of less than 7.35 is acidosis. B) A PaCO₂ level of 18
mmHg is low and is seen in respiratory alkalosis. C) A HCO₃⁻ level of 8 mEq/L is low and is most likely
associated with metabolic acidosis. D) In metabolic alkalosis, there is an excess of bicarbonate. To compensate
for this imbalance, the rate and depth of respirations decrease, leading to retention of carbon dioxide. The
PaCO₂ will be elevated.
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity; Physiological Adaptation
Standards: QSEN: III.A.1 | AACN: IX.3 | NLN: Knowledge and Science | Nursing Process: Assessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
MNL LO: Analyze the concept of acid-base balance and its application to nursing care.
5) A client has been admitted with chronic obstructive pulmonary disease. Diagnostic tests have been ordered.
Which of the tests will provide the most accurate indicator of the client's acid-base balance?
A) Arterial blood gases (ABGs)
B) Pulse oximetry
C) Sputum studies
D) Bronchoscopy
Answer: A
Explanation: A) Acid-base balance is assessed primarily by measuring arterial blood gases (ABGs). Arterial
blood is most often used because it reflects acid-base balance throughout the entire body better than venous or
capillary blood that has dispersed oxygen into the tissues and has collected carbon dioxide. B) Pulse oximetry is
a noninvasive test that evaluates the oxygen saturation level of blood. C) Sputum studies can provide specific
information about organisms in the sputum. D) A bronchoscopy provides visualization of internal respiratory
structures.
Cognitive Level: Analyzing
Client Need/Sub: Physiological Integrity; Reduction of Risk Potential
Standards: QSEN: III.A.1 | AACN: IX.3 | NLN: Knowledge and Science | Nursing Process: Assessment
Learning Outcome: 1.5. Differentiate common assessment procedures and tests used to examine acid-base balance.
MNL LO: Differentiate common assessment procedures and tests used to examine acid-base balance.
3
Copyright © 2027, 2020, 2017
