Miami Dade College
2 MAXE · II CDM
★ ★
MDC Medical Campus — School of Nursing
EST. 1960
THE COLLEGE OF THE AMERICAN DREAM.
MDC II — Examination 2
A B G I N T E R P R E TAT I O N · AC I D - B A S E · G I D I S O R D E RS · O N CO LO G Y ·
M U LT I D I M E N S I O N A L C A R E
INSTITUTION Miami Dade College COURSE CODE MDC II
PROGRAM Associate of Science in Nursing — ACADEMIC YEAR
ADN
EXAM TITLE MDC II Examination 2 — ABGs, GI, COURSE TITLE Med-Surg Nursing II
Oncology
TOTAL QUESTIONS 62 Questions FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each multiple-choice question unless otherwise instructed.
▸ Content covers ABG interpretation, acid-base imbalances, upper GI disorders, oncological emergencies,
and multidimensional care.
▸ Normal ABG reference values: pH 7.35–7.45, PaCO₂ 35–45 mm Hg, HCO₃⁻ 21–28 mEq/L.
▸ Correct answers and clinical rationales appear below each question for board review purposes.
, COMPREHENSIVE EXAMINATION Questions 1 – 62
1. What is the first step when interpreting arterial blood gases (ABGs)?
A. Calculate the anion gap
B. Look at the pH
C. Evaluate the PaO₂
D. Check the serum lactate
CORRECT ANSWER B — Look at the pH.
RATIONALE ABG interpretation follows a systematic approach: (1) Look at the pH first — pH <
7.35 = acidosis, pH > 7.45 = alkalosis. (2) Then evaluate PaCO₂ (respiratory
component) — if abnormal in the same direction as pH, the problem is metabolic;
if abnormal in the opposite direction, the problem is respiratory. (3) Check HCO₃⁻
(metabolic component). (4) Determine if compensation is present.
2. What acid-base imbalance would the nurse expect to see in an asthmatic patient
experiencing an acute exacerbation?
A. Metabolic alkalosis
B. Respiratory acidosis
C. Respiratory alkalosis
D. Metabolic acidosis
CORRECT ANSWER B — Respiratory acidosis.
RATIONALE Asthma causes bronchoconstriction and airway obstruction, leading to CO₂
retention (hypercapnia). Elevated CO₂ combines with water to form carbonic acid,
decreasing pH — producing respiratory acidosis. The PaCO₂ will be elevated (>45
mm Hg) and pH will be low (<7.35). Treatment focuses on bronchodilators,
oxygen, and pulmonary hygiene to improve ventilation and eliminate excess CO₂.
,3. Which of the following are common causes of respiratory acidosis? Select all that apply.
A. COPD, asthma, pneumonia, and pulmonary edema
B. Prolonged vomiting and NG suctioning
C. Diabetic ketoacidosis and starvation
D. Excessive antacid use and blood transfusion
CORRECT ANSWER A — COPD, asthma, pneumonia, pulmonary edema, muscle weakness,
inadequate chest expansion, sleep apnea, respiratory depression
(drugs/alcohol/anesthesia/electrolyte imbalance), and high ICP.
RATIONALE Respiratory acidosis results from hypoventilation — anything that impairs gas
exchange or reduces respiratory drive. Pulmonary causes: COPD, asthma,
pneumonia, pulmonary edema, sleep apnea. Neuromuscular causes: muscle
weakness, inadequate chest expansion. CNS causes: respiratory depression from
drugs/alcohol/anesthesia, high ICP, electrolyte imbalances causing respiratory
muscle dysfunction.
4. A patient with respiratory acidosis would exhibit which signs and symptoms? Select all
that apply.
A. Bradycardia, thready weak pulses, hypotension, and hypoxia
B. Tachycardia, hypertension, and hyperreflexia
C. Anxiety, irritability, tetany, and seizures
D. Increased deep tendon reflexes and muscle twitching
CORRECT ANSWER A — Bradycardia, thready weak pulses, hypotension, hypoxia, pale/cyanotic
skin, lethargy, confusion, stupor, coma, headache, hyporeflexia, muscle
weakness, flaccid paralysis, and hyperkalemia with ECG changes (tall T
waves, wide QRS, prolonged PR).
RATIONALE Acidosis (both respiratory and metabolic) produces CNS depression — think "LOW
and SLOW." Vital signs: bradycardia, weak pulses, hypotension. CNS: lethargy →
confusion → stupor → coma. Musculoskeletal: hyporeflexia, weakness, flaccid
paralysis. Cardiac: dysrhythmias from hyperkalemia — tall T waves, wide QRS,
prolonged PR interval. Skin is pale and cyanotic.
, 5. Which interventions are appropriate for the treatment of respiratory acidosis?
A. Administer sodium bicarbonate IV push
B. Stabilize the airway, administer bronchodilators and oxygen, perform pulmonary hygiene,
suction PRN, and increase ventilation rate if on a ventilator
C. Administer ammonium chloride and discontinue suctioning
D. Encourage the patient to breathe into a paper bag
CORRECT ANSWER B — Stabilize airway, bronchodilators, O₂, pulmonary hygiene, suction PRN,
increase ventilation rate if on ventilator; for underlying causes: correct
electrolyte imbalance, antibiotics if infection.
RATIONALE Respiratory acidosis treatment focuses on improving ventilation to eliminate
excess CO₂. Priority: patent airway, bronchodilators, oxygen, positioning and
breathing/coughing techniques, suctioning, and mechanical ventilation with
increased rate if intubated. Treat underlying causes: correct hyperkalemia,
administer antibiotics for infection. Endotracheal intubation may be necessary for
severe cases. Sodium bicarbonate is for metabolic acidosis.
6. How does the body compensate for respiratory acidosis?
A. Decrease respirations to retain CO₂
B. Increase respirations to increase pH
C. Increase renal excretion of bicarbonate
D. Decrease renal reabsorption of H⁺ ions
CORRECT ANSWER B — Increase respirations to increase pH.
RATIONALE The body's immediate compensation for respiratory acidosis is to increase the
respiratory rate and depth — "blowing off" excess CO₂ raises pH toward normal.
This is why tachypnea and Kussmaul respirations are seen in metabolic acidosis
(the lungs compensate for a metabolic problem). Renal compensation (retaining
HCO₃⁻ and excreting H⁺) occurs more slowly over hours to days.
2 MAXE · II CDM
★ ★
MDC Medical Campus — School of Nursing
EST. 1960
THE COLLEGE OF THE AMERICAN DREAM.
MDC II — Examination 2
A B G I N T E R P R E TAT I O N · AC I D - B A S E · G I D I S O R D E RS · O N CO LO G Y ·
M U LT I D I M E N S I O N A L C A R E
INSTITUTION Miami Dade College COURSE CODE MDC II
PROGRAM Associate of Science in Nursing — ACADEMIC YEAR
ADN
EXAM TITLE MDC II Examination 2 — ABGs, GI, COURSE TITLE Med-Surg Nursing II
Oncology
TOTAL QUESTIONS 62 Questions FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each multiple-choice question unless otherwise instructed.
▸ Content covers ABG interpretation, acid-base imbalances, upper GI disorders, oncological emergencies,
and multidimensional care.
▸ Normal ABG reference values: pH 7.35–7.45, PaCO₂ 35–45 mm Hg, HCO₃⁻ 21–28 mEq/L.
▸ Correct answers and clinical rationales appear below each question for board review purposes.
, COMPREHENSIVE EXAMINATION Questions 1 – 62
1. What is the first step when interpreting arterial blood gases (ABGs)?
A. Calculate the anion gap
B. Look at the pH
C. Evaluate the PaO₂
D. Check the serum lactate
CORRECT ANSWER B — Look at the pH.
RATIONALE ABG interpretation follows a systematic approach: (1) Look at the pH first — pH <
7.35 = acidosis, pH > 7.45 = alkalosis. (2) Then evaluate PaCO₂ (respiratory
component) — if abnormal in the same direction as pH, the problem is metabolic;
if abnormal in the opposite direction, the problem is respiratory. (3) Check HCO₃⁻
(metabolic component). (4) Determine if compensation is present.
2. What acid-base imbalance would the nurse expect to see in an asthmatic patient
experiencing an acute exacerbation?
A. Metabolic alkalosis
B. Respiratory acidosis
C. Respiratory alkalosis
D. Metabolic acidosis
CORRECT ANSWER B — Respiratory acidosis.
RATIONALE Asthma causes bronchoconstriction and airway obstruction, leading to CO₂
retention (hypercapnia). Elevated CO₂ combines with water to form carbonic acid,
decreasing pH — producing respiratory acidosis. The PaCO₂ will be elevated (>45
mm Hg) and pH will be low (<7.35). Treatment focuses on bronchodilators,
oxygen, and pulmonary hygiene to improve ventilation and eliminate excess CO₂.
,3. Which of the following are common causes of respiratory acidosis? Select all that apply.
A. COPD, asthma, pneumonia, and pulmonary edema
B. Prolonged vomiting and NG suctioning
C. Diabetic ketoacidosis and starvation
D. Excessive antacid use and blood transfusion
CORRECT ANSWER A — COPD, asthma, pneumonia, pulmonary edema, muscle weakness,
inadequate chest expansion, sleep apnea, respiratory depression
(drugs/alcohol/anesthesia/electrolyte imbalance), and high ICP.
RATIONALE Respiratory acidosis results from hypoventilation — anything that impairs gas
exchange or reduces respiratory drive. Pulmonary causes: COPD, asthma,
pneumonia, pulmonary edema, sleep apnea. Neuromuscular causes: muscle
weakness, inadequate chest expansion. CNS causes: respiratory depression from
drugs/alcohol/anesthesia, high ICP, electrolyte imbalances causing respiratory
muscle dysfunction.
4. A patient with respiratory acidosis would exhibit which signs and symptoms? Select all
that apply.
A. Bradycardia, thready weak pulses, hypotension, and hypoxia
B. Tachycardia, hypertension, and hyperreflexia
C. Anxiety, irritability, tetany, and seizures
D. Increased deep tendon reflexes and muscle twitching
CORRECT ANSWER A — Bradycardia, thready weak pulses, hypotension, hypoxia, pale/cyanotic
skin, lethargy, confusion, stupor, coma, headache, hyporeflexia, muscle
weakness, flaccid paralysis, and hyperkalemia with ECG changes (tall T
waves, wide QRS, prolonged PR).
RATIONALE Acidosis (both respiratory and metabolic) produces CNS depression — think "LOW
and SLOW." Vital signs: bradycardia, weak pulses, hypotension. CNS: lethargy →
confusion → stupor → coma. Musculoskeletal: hyporeflexia, weakness, flaccid
paralysis. Cardiac: dysrhythmias from hyperkalemia — tall T waves, wide QRS,
prolonged PR interval. Skin is pale and cyanotic.
, 5. Which interventions are appropriate for the treatment of respiratory acidosis?
A. Administer sodium bicarbonate IV push
B. Stabilize the airway, administer bronchodilators and oxygen, perform pulmonary hygiene,
suction PRN, and increase ventilation rate if on a ventilator
C. Administer ammonium chloride and discontinue suctioning
D. Encourage the patient to breathe into a paper bag
CORRECT ANSWER B — Stabilize airway, bronchodilators, O₂, pulmonary hygiene, suction PRN,
increase ventilation rate if on ventilator; for underlying causes: correct
electrolyte imbalance, antibiotics if infection.
RATIONALE Respiratory acidosis treatment focuses on improving ventilation to eliminate
excess CO₂. Priority: patent airway, bronchodilators, oxygen, positioning and
breathing/coughing techniques, suctioning, and mechanical ventilation with
increased rate if intubated. Treat underlying causes: correct hyperkalemia,
administer antibiotics for infection. Endotracheal intubation may be necessary for
severe cases. Sodium bicarbonate is for metabolic acidosis.
6. How does the body compensate for respiratory acidosis?
A. Decrease respirations to retain CO₂
B. Increase respirations to increase pH
C. Increase renal excretion of bicarbonate
D. Decrease renal reabsorption of H⁺ ions
CORRECT ANSWER B — Increase respirations to increase pH.
RATIONALE The body's immediate compensation for respiratory acidosis is to increase the
respiratory rate and depth — "blowing off" excess CO₂ raises pH toward normal.
This is why tachypnea and Kussmaul respirations are seen in metabolic acidosis
(the lungs compensate for a metabolic problem). Renal compensation (retaining
HCO₃⁻ and excreting H⁺) occurs more slowly over hours to days.
