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,Nursing: A Concept-Based Approach to Learning Vol. 1 2 & 3, 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) Respiratoryacidosis
Answer: A
Explanation: A) A client who is fasting is at risk for development of metabolic acidosis. The
bodyrecognizes 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
carethat 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.
MNLLO: Analyze the concept of acid-base balance and its application to nursing care.

,2) Which risk factors exhibited bythe client presenting in the emergencydepartment (ED) would
B B B B B B B B B B B B B




Bplace the client at risk for metabolic acidosis? Select all that apply.
B B B B B B B B B B B




A) Abdominal fistulas B




B) Chronicobstructive pulmonarydisease B B B




C) Pneumonia
D) Acuterenal failure B B




E) Hypovolemicshock B




BAnswer: A, D, E B B




Explanation: A) Metabolic acidosis is rarely a primary disorder. It usually develops during the
B B B B B B B B B B B B B




Bcourse of another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss;
B B B B B B B B B B B B B




Bacute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia
B B B B B B B B B B B




place the client at risk for respiratoryacidosis with the increased retention of carbon dioxide in the
B B B B B B B B B B B B B B B B B




Bblood.
B) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
B B B B B B B B B B B B B




Banotherdisease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute
B B B B B B B B B B B




Brenal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia
B B B B B B B B B B




Bplace the client at risk for respiratory acidosis with the increased retention of carbon dioxide
B B B B B B B B B B B B B B




Bin the blood.
b B




C) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
B B B B B B B B B B B B B




anotherdisease; presence of abdominal fistulas, which can cause excess bicarbonate loss;
B B B B B B B B B B B B




acuterenal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and
B B B B B B B B B B




pneumonia place the client at risk for respiratory acidosis with the increased retention of
B B B B B B B B B B B B B B




carbon dioxide inthe blood.
B B B B




D) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
B B B B B B B B B B B B B




Banotherdisease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute
B B B B B B B B B B B




Brenal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia
B B B B B B B B B B




Bplace the client at risk for respiratory acidosis with the increased retention of carbon dioxide
B B B B B B B B B B B B B B




Bin the blood.
b B




E) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of
B B B B B B B B B B B B B




Banotherdisease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute
B B B B B B B B B B B




Brenal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia
B B B B B B B B B B




Bplace the client at risk for respiratory acidosis with the increased retention of carbon dioxide
B B B B B B B B B B B B B B




Bin the blood.
b B




PageRef: 6, 14
B B B




Cognitive Level: Applying B




Client Need/Sub: Physiological Integrity: Physiological Adaptation
B B B B




Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and
B B B B B B B B B B




Bprocesses. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered carethat
B B B B B B B B B




Breflects an understanding of human growth and development, pathophysiology, pharmacology,
B B B B B B B B B




Bmedical management and nursing management across the health-illness continuum, across
B B B B B B B B B




lifespan, and in all healthcaresettings. |NLN Competencies: Knowledge and Science:
B B B B B B B B B B B




BRelationships between knowledge/science and quality and safe patient care. | Nursing Process:
B B B B B B B B B B B




BAssessment
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
B B B B B B




MNLLO: Analyzethe concept of acid-base balanceand its application to nursingcare.
B B B B B B B B B B B B

, 3) A child with acute asthma has a PaCO2 of 48 mmHg, a pH of 7.31, and a normal HCO3 blood gas
B B B B B B B B B B B B B B B B B B B B




Bvalue. The nurse interprets these findings as indicative of which condition?
B B B B B B B B B B




A) Metabolic acidosis B




B) Respiratory alkalosis B




C) Respiratory acidosis B




D) Metabolicalkalosis B




BAnswer: C
Explanation: A) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is
B B B B B B B B B B B B B B B B B




uncompensated respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH,
B B B B B B B B B B




decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH,
B B B B B B B B B B B B




normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased
B B B B B B B B B B B




pH,normal PaCO2, and increased HCO3.
B B B B B




B) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated
B B B B B B B B B B B B B B B B




Brespiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased
B B B B B B B B B




BPaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal
B B B B B B B B B B B




BPaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH,
B B B B B B B B B B




BnormalPaCO2, and increased HCO3. B B B




C) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated
B B B B B B B B B B B B B B B B




Brespiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased
B B B B B B B B B




BPaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal
B B B B B B B B B B B




BPaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH,
B B B B B B B B B B




BnormalPaCO2, and increased HCO3. B B B




D) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated
B B B B B B B B B B B B B B B B




Brespiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased
B B B B B B B B B




BPaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal
B B B B B B B B B B B




BPaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH,
B B B B B B B B B B




BnormalPaCO2, and increased HCO3. B B B




PageRef: 24
B B




Cognitive Level: Analyzing B




Client Need/Sub: Physiological Integrity:Physiological Adaptation
B B B B




Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and
B B B B B B B B B B




Bprocesses. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered carethat
B B B B B B B B B




Breflects an understanding of human growth and development, pathophysiology, pharmacology,
B B B B B B B B B




Bmedical management and nursing management across the health-illness continuum, across
B B B B B B B B B




lifespan, and in all healthcaresettings. | NLN Competencies: Knowledge and Science:
B B B B B B B B B B B B




BRelationships between knowledge/science and quality and safe patient care. | Nursing Process:
B B B B B B B B B B B




BDiagnosis
Learning Outcome: 1.2. Differentiate alterations in acid-base balance.
B B B B B B




MNLLO: Analyzethe concept of acid-base balanceand its application to nursingcare.
B B B B B B B B B B B B