Test Bank For Nursing A Concept Based Approach to Learning 3rd Edition Pearson Education | 9780134616803 | All Chapters with Answers and Rationals

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,Nursing:A Concept-Based Approach toLearning Vol. 1 2 & 3, 3e(Pearson) Module 1
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u Acid-Base Balance u




TheConcept ofAcid-BaseBalance
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1) A client is brought to the emergency department (ED) after passing out in a local department
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ustore. The client has been fasting and has ketones in the urine. Which acid-base imbalance would the
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unurse expect to assess in this client?
u u u u u u




A) Metabolicacidosis u




B) Respiratory alkalosis u




C) Metabolic alkalosis u




D) Respiratoryacidosis
uAnswer: A
Explanation: A) A client who is fasting is at risk for development of metabolic acidosis. The
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ubodyrecognizes fastingas starvation and begins to metabolize its own fattyacids into ketones, which u u u u u u u u u u u u u u




aremetabolic acids. Starvation wouldnot result in respiratory acidosis oralkalosis orin metabolic
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ualkalosis.
B) Aclient who is fastingisat risk fordevelopment of metabolicacidosis. Thebodyrecognizes
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ufasting as starvation and begins to metabolize its own fatty acids into ketones, which are
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umetabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic
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ualkalosis.
C) Aclient who is fastingis at risk fordevelopment of metabolicacidosis. Thebodyrecognizes
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ufasting as starvation and begins to metabolize its own fatty acids into ketones, which are
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umetabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic
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ualkalosis.
D) Aclient who is fastingisat risk fordevelopment of metabolicacidosis. The bodyrecognizes
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ufasting as starvation and begins to metabolize its own fatty acids into ketones, which are
u u u u u u u u u u u u u u




umetabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic
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ualkalosis.
PageRef: 6 u u




Cognitive Level: Analyzing u




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




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




uprocesses. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered carethat
u u u u u u u u u




ureflects an understanding of human growth and development, pathophysiology, pharmacology,
u u u u u u u u u




umedical management and nursing management across the health-illness continuum, across
u u u u u u u u u




lifespan, andin all healthcaresettings. |NLNCompetencies: Knowledgeand Science: Relationships
u u u u u u u u u u u u




between knowledge/science and quality and safe patient care. |Nursing Process: Assessment
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Learning Outcome: 1.2.Differentiate alterations inacid-basebalance.
u u u u u u




MNLLO: Analyzetheconcept of acid-base balanceand its application to nursingcare.
u u u u u u u u u u u u

,2) Which risk factors exhibited bythe client presenting in the emergencydepartment (ED)
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uwould place the client at risk for metabolic acidosis? Select all that apply.
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A) Abdominal fistulas u




B) Chronicobstructive pulmonarydisease u u




C) Pneumonia
D) Acuterenal failure u u




E) Hypovolemic
ushock Answer: A, u




D, E
u u




Explanation: A) Metabolic acidosis is rarely a primary disorder. It usually develops during the
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ucourse of another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss;
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uacute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and
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upneumoniaplacetheclientat risk forrespiratoryacidosis with theincreased retention ofcarbon
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udioxide in the blood. u u u




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




uanotherdisease; presenceofabdominal fistulas,which can causeexcess bicarbonate loss; acute u u u u u u u u u u u




urenal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia
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uplace the client at risk for respiratory acidosis with the increased retention of carbon dioxide
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uin the blood.
b u




C) Metabolicacidosis is rarely aprimarydisorder. It usually develops duringthe course of u u u u u u u u u u u u u




anotherdisease; presence of abdominal fistulas, which can cause excess bicarbonate loss;
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acuterenal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and
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pneumonia place the client at risk for respiratory acidosis with the increased retention of
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carbon dioxide inthe blood.
u u u u




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




uanotherdisease; presenceofabdominal fistulas,which can causeexcess bicarbonate loss; acute u u u u u u u u u u u




urenal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia
u u u u u u u u u u




uplace the client at risk for respiratory acidosis with the increased retention of carbon dioxide
u u u u u u u u u u u u u u




uin the blood.
b u




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




uanotherdisease; presenceofabdominal fistulas,which can causeexcess bicarbonateloss; acute u u u u u u u u u u u




urenal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia
u u u u u u u u u u




uplace the client at risk for respiratory acidosis with the increased retention of carbon dioxide
u u u u u u u u u u u u u u




uin the blood.
b u




PageRef: 6, 14 u u u




CognitiveLevel: Applying u




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




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




uprocesses. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered carethat
u u u u u u u u u




ureflects an understanding of human growth and development, pathophysiology, pharmacology,
u u u u u u u u u




umedical management and nursing management across the health-illness continuum, across
u u u u u u u u u




lifespan, and in all healthcaresettings. |NLNCompetencies: Knowledgeand Science: Relationships
u u u u u u u u u u u u




between knowledge/science and quality and safe patient care. | Nursing Process: Assessment
u u u u u u u u u u u u




Learning Outcome: 1.2.Differentiate alterations inacid-basebalance.
u u u u u u




MNLLO: Analyzetheconcept of acid-base balanceand its application to nursingcare.
u u u u u u u u u u u u

, 3) A child with acute asthma has a PaCO2 of 48 mmHg, a pH of 7.31, and a normal HCO3
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ublood gas value. The nurse interprets these findings as indicative of which condition?
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A) Metabolicacidosis u




B) Respiratory alkalosis u




C) Respiratory acidosis u




D) Metabolicalkalosis
uAnswer: C
Explanation: A) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is
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uncompensatedrespiratoryacidosis. Uncompensatedrespiratoryalkalosishas anincreased pH,
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decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH,
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normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased
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pH,normal PaCO2, and increased HCO3.
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B) IfthepHis decreased and thePaCO2is increased with anormal HCO3, it is uncompensated
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urespiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased
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uPaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal
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uPaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH,
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unormalPaCO2, and increased HCO3. u u u




C) IfthepHis decreased and thePaCO2 is increased with anormal HCO3, it is uncompensated
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urespiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased
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uPaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal
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uPaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH,
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unormalPaCO2, and increased HCO3. u u u




D) IfthepHis decreased and thePaCO2is increased with anormal HCO3, it is uncompensated
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urespiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased
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uPaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal
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uPaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH,
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unormalPaCO2, and increased HCO3. u u u




PageRef: 24
u u




Cognitive Level: Analyzing u




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




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




uprocesses. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered carethat
u u u u u u u u u




ureflects an understanding of human growth and development, pathophysiology, pharmacology,
u u u u u u u u u




umedical management and nursing management across the health-illness continuum,across
u u u u u u u u u




lifespan, andinallhealthcaresettings. |NLNCompetencies: Knowledgeand Science: Relationships
u u u u u u u u u u u u u




between knowledge/science and quality and safe patient care. | Nursing Process: Diagnosis
u u u u u u u u u u u u




Learning Outcome: 1.2.Differentiate alterations inacid-basebalance.
u u u u u u




MNLLO: Analyzetheconcept of acid-base balanceand its application to nursingcare.
u u u u u u u u u u u u