Chapter 14: Concepts of Acid–Base Balance
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. 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.
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.
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.
DIF: Applying TOP: Integrated Process: Nursing Process:
Implementation KEY: Acid-base imbalance, Critical rescue MSC:
Client Needs Category: Safe and Effective Care Environment: Management of
Care
, 2. 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.”
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.
DIF: Analyzing TOP: Integrated Process: Teaching/Learning KEY:
Acid-base imbalances, Health teaching MSC: Client Needs Category:
Physiological Integrity: Physiological Adaptation
3. 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
ANS: B
The elevated pH level indicates alkalosis. The bicarbonate level is normal, and so is
the oxygen partial pressure. Loss of carbon dioxide is the cause of the alkalosis, which
would occur in response to hyperventilation. Diarrhea and vomiting would cause
metabolic acidosis and COPD would lead to respiratory acidosis. The client with
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. 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.
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.
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.
DIF: Applying TOP: Integrated Process: Nursing Process:
Implementation KEY: Acid-base imbalance, Critical rescue MSC:
Client Needs Category: Safe and Effective Care Environment: Management of
Care
, 2. 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.”
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.
DIF: Analyzing TOP: Integrated Process: Teaching/Learning KEY:
Acid-base imbalances, Health teaching MSC: Client Needs Category:
Physiological Integrity: Physiological Adaptation
3. 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
ANS: B
The elevated pH level indicates alkalosis. The bicarbonate level is normal, and so is
the oxygen partial pressure. Loss of carbon dioxide is the cause of the alkalosis, which
would occur in response to hyperventilation. Diarrhea and vomiting would cause
metabolic acidosis and COPD would lead to respiratory acidosis. The client with
