Nursing: A Concept-Based Approach to Learning Vol. 1 & 2, 3e (Pearson)
Module 1 Acid-Base Balance
The Concept of Acid-Base Balance
1) A client is brought to the emergency department (ED) after passing out in a local
department store. The client has been fasting and has ketones in the urine. 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. Starvation would not result in respiratory
acidosis or alkalosis or in metabolic alkalosis.
B) 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. Starvation would not result in respiratory acidosis or alkalosis
or in metabolic alkalosis.
C) 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. Starvation would not result in respiratory acidosis or alkalosis
or in metabolic alkalosis.
D) 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. Starvation would not result in respiratory acidosis or alkalosis
or in metabolic alkalosis.
Page Ref: 6
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
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) Which risk factors exhibited by the client presenting in the emergency department (ED)
would place the client at risk for metabolic acidosis? Select all that apply.
A) Abdominal fistulas
B) Chronic obstructive pulmonary disease
C) Pneumonia
D) Acute 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 disease; presence of abdominal fistulas, which can cause
excess bicarbonate loss; acute renal failure; and hypovolemic shock. Chronic obstructive
pulmonary disease and pneumonia place the client at risk for respiratory acidosis with the
increased retention of carbon dioxide in the blood.
B) Metabolic acidosis is rarely a primary disorder. It usually develops during the course
of another disease; presence of abdominal fistulas, which can cause excess bicarbonate
loss; acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease
and pneumonia place the client at risk for respiratory acidosis with the increased retention
of carbon dioxide in the blood.
C) Metabolic acidosis is rarely a primary disorder. It usually develops during the course
of another disease; presence of abdominal fistulas, which can cause excess bicarbonate
loss; acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease
and pneumonia place 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 disease; presence of abdominal fistulas, which can cause excess bicarbonate
loss; acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease
and pneumonia place the client at risk for respiratory acidosis with the increased retention
of carbon dioxide in the blood.
E) Metabolic acidosis is rarely a primary disorder. It usually develops during the course
of another disease; presence of abdominal fistulas, which can cause excess bicarbonate
loss; acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease
and pneumonia place the client at risk for respiratory acidosis with the increased retention
of carbon dioxide in the blood.
, Page Ref: 6, 14
Cognitive Level: Applying
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
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.
Module 1 Acid-Base Balance
The Concept of Acid-Base Balance
1) A client is brought to the emergency department (ED) after passing out in a local
department store. The client has been fasting and has ketones in the urine. 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. Starvation would not result in respiratory
acidosis or alkalosis or in metabolic alkalosis.
B) 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. Starvation would not result in respiratory acidosis or alkalosis
or in metabolic alkalosis.
C) 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. Starvation would not result in respiratory acidosis or alkalosis
or in metabolic alkalosis.
D) 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. Starvation would not result in respiratory acidosis or alkalosis
or in metabolic alkalosis.
Page Ref: 6
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
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) Which risk factors exhibited by the client presenting in the emergency department (ED)
would place the client at risk for metabolic acidosis? Select all that apply.
A) Abdominal fistulas
B) Chronic obstructive pulmonary disease
C) Pneumonia
D) Acute 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 disease; presence of abdominal fistulas, which can cause
excess bicarbonate loss; acute renal failure; and hypovolemic shock. Chronic obstructive
pulmonary disease and pneumonia place the client at risk for respiratory acidosis with the
increased retention of carbon dioxide in the blood.
B) Metabolic acidosis is rarely a primary disorder. It usually develops during the course
of another disease; presence of abdominal fistulas, which can cause excess bicarbonate
loss; acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease
and pneumonia place the client at risk for respiratory acidosis with the increased retention
of carbon dioxide in the blood.
C) Metabolic acidosis is rarely a primary disorder. It usually develops during the course
of another disease; presence of abdominal fistulas, which can cause excess bicarbonate
loss; acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease
and pneumonia place 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 disease; presence of abdominal fistulas, which can cause excess bicarbonate
loss; acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease
and pneumonia place the client at risk for respiratory acidosis with the increased retention
of carbon dioxide in the blood.
E) Metabolic acidosis is rarely a primary disorder. It usually develops during the course
of another disease; presence of abdominal fistulas, which can cause excess bicarbonate
loss; acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease
and pneumonia place the client at risk for respiratory acidosis with the increased retention
of carbon dioxide in the blood.
, Page Ref: 6, 14
Cognitive Level: Applying
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
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.
