Miami Dade College
2 MAXE · 2CDM
★ ★
MDC Medical Campus — School of Nursing
EST. 1960
THE COLLEGE OF THE AMERICAN DREAM.
MDC2 — Examination 2
AC I D - B A S E B A L A N C E · G I D I S O R D E RS · P R O C E D U R E S & PAT I E N T E D U C AT I O N
INSTITUTION Miami Dade College COURSE CODE MDC2
PROGRAM Associate of Science in Nursing — ACADEMIC YEAR
ADN
EXAM TITLE MDC2 Examination 2 — COURSE TITLE Med-Surg Nursing II
Comprehensive
TOTAL QUESTIONS 67 Questions FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each multiple-choice question.
▸ Content covers acid-base balance, metabolic and respiratory disorders, GI procedures (EGD, NG tube),
GERD management, PUD teaching, and stomatitis.
▸ Lab values and ABG interpretation are integrated throughout rationales.
▸ Correct answers and clinical rationales appear below each question for board review purposes.
▸ All clinical data reflects current evidence-based nursing practice.
, COMPREHENSIVE EXAMINATION Questions 1 – 67
1. How is acidosis defined in terms of acid-base balance?
A. Arterial blood pH above 7.45 with excess bicarbonate
B. The acid-base balance is upset by an excess of hydrogen; arterial blood pH below 7.35
C. Decreased free hydrogen ion level with pH above 7.45
D. Normal pH with abnormal CO₂ and HCO₃⁻
CORRECT ANSWER B — The acid-base balance is upset by an excess of hydrogen; arterial blood
pH below 7.35.
RATIONALE Acidosis = pH < 7.35. It occurs when there is an excess of hydrogen ions (H⁺) in the
blood and extracellular fluid. The body's buffer systems, lungs, and kidneys work
to maintain pH within the narrow range of 7.35–7.45. When these compensatory
mechanisms are overwhelmed, acid accumulates → pH drops → acidosis. The
first step in ABG interpretation is always checking the pH to determine if the
primary disorder is acidosis or alkalosis.
,2. Which of the following are causes of metabolic acidosis?
A. Anxiety, fever, hyperventilation, early sepsis
B. Diabetic Ketoacidosis, renal failure, starvation, diarrhea, ileostomy, hyperthyroidism,
pancreatitis, liver failure, dehydration, seizure activity, ethanol intoxication, aspirin
toxicity
C. COPD, severe asthma, opioid overdose, airway obstruction
D. Vomiting, NG suction, excess antacids, potassium-wasting diuretics
CORRECT ANSWER B — DKA, renal failure, starvation, diarrhea, ileostomy, hyperthyroidism,
pancreatitis, liver failure, dehydration, seizure activity, ethanol intoxication,
and aspirin toxicity.
RATIONALE Metabolic acidosis = too much acid. The hydrogen ions are either over-produced
(DKA — ketoacids; lactic acidosis — shock; ethanol intoxication) or under-
eliminated (renal failure — cannot excrete acid). Bicarbonate is either under-
produced (renal failure) or over-eliminated (diarrhea, ileostomy — loss of
bicarbonate-rich intestinal secretions). Aspirin toxicity causes a mixed acid-base
disorder — metabolic acidosis (salicylate effect) AND respiratory alkalosis
(hyperventilation from direct stimulation of respiratory center).
, 3. What are the signs and symptoms of metabolic acidosis?
A. Hyporeflexia, muscle cramping, positive Chvostek's sign, paresthesias
B. Kussmaul's breathing (>20 bpm), weakness, confusion, hypotension, cardiac changes due
to hyperkalemia, nausea, vomiting
C. Slow, shallow breathing, lethargy, coma, facial paralysis
D. Anxiety, hyperreflexia, tachycardia, bounding pulse
CORRECT ANSWER B — Kussmaul's breathing, weakness, confusion, hypotension, cardiac
changes due to hyperkalemia, nausea, vomiting.
RATIONALE Metabolic acidosis: Kussmaul respirations (deep, rapid breathing — lungs
compensating by blowing off CO₂), weakness, confusion (CNS depression from
acidosis), hypotension, and cardiac changes from HYPERKALEMIA (H⁺ shifts into
cells, K⁺ shifts out). Nausea and vomiting are common. Lab assessment: serum
potassium is HIGH. The priority assessment for an acidosis patient is CARDIAC —
hyperkalemia causes peaked T waves, widened QRS, and can progress to cardiac
arrest.
2 MAXE · 2CDM
★ ★
MDC Medical Campus — School of Nursing
EST. 1960
THE COLLEGE OF THE AMERICAN DREAM.
MDC2 — Examination 2
AC I D - B A S E B A L A N C E · G I D I S O R D E RS · P R O C E D U R E S & PAT I E N T E D U C AT I O N
INSTITUTION Miami Dade College COURSE CODE MDC2
PROGRAM Associate of Science in Nursing — ACADEMIC YEAR
ADN
EXAM TITLE MDC2 Examination 2 — COURSE TITLE Med-Surg Nursing II
Comprehensive
TOTAL QUESTIONS 67 Questions FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each multiple-choice question.
▸ Content covers acid-base balance, metabolic and respiratory disorders, GI procedures (EGD, NG tube),
GERD management, PUD teaching, and stomatitis.
▸ Lab values and ABG interpretation are integrated throughout rationales.
▸ Correct answers and clinical rationales appear below each question for board review purposes.
▸ All clinical data reflects current evidence-based nursing practice.
, COMPREHENSIVE EXAMINATION Questions 1 – 67
1. How is acidosis defined in terms of acid-base balance?
A. Arterial blood pH above 7.45 with excess bicarbonate
B. The acid-base balance is upset by an excess of hydrogen; arterial blood pH below 7.35
C. Decreased free hydrogen ion level with pH above 7.45
D. Normal pH with abnormal CO₂ and HCO₃⁻
CORRECT ANSWER B — The acid-base balance is upset by an excess of hydrogen; arterial blood
pH below 7.35.
RATIONALE Acidosis = pH < 7.35. It occurs when there is an excess of hydrogen ions (H⁺) in the
blood and extracellular fluid. The body's buffer systems, lungs, and kidneys work
to maintain pH within the narrow range of 7.35–7.45. When these compensatory
mechanisms are overwhelmed, acid accumulates → pH drops → acidosis. The
first step in ABG interpretation is always checking the pH to determine if the
primary disorder is acidosis or alkalosis.
,2. Which of the following are causes of metabolic acidosis?
A. Anxiety, fever, hyperventilation, early sepsis
B. Diabetic Ketoacidosis, renal failure, starvation, diarrhea, ileostomy, hyperthyroidism,
pancreatitis, liver failure, dehydration, seizure activity, ethanol intoxication, aspirin
toxicity
C. COPD, severe asthma, opioid overdose, airway obstruction
D. Vomiting, NG suction, excess antacids, potassium-wasting diuretics
CORRECT ANSWER B — DKA, renal failure, starvation, diarrhea, ileostomy, hyperthyroidism,
pancreatitis, liver failure, dehydration, seizure activity, ethanol intoxication,
and aspirin toxicity.
RATIONALE Metabolic acidosis = too much acid. The hydrogen ions are either over-produced
(DKA — ketoacids; lactic acidosis — shock; ethanol intoxication) or under-
eliminated (renal failure — cannot excrete acid). Bicarbonate is either under-
produced (renal failure) or over-eliminated (diarrhea, ileostomy — loss of
bicarbonate-rich intestinal secretions). Aspirin toxicity causes a mixed acid-base
disorder — metabolic acidosis (salicylate effect) AND respiratory alkalosis
(hyperventilation from direct stimulation of respiratory center).
, 3. What are the signs and symptoms of metabolic acidosis?
A. Hyporeflexia, muscle cramping, positive Chvostek's sign, paresthesias
B. Kussmaul's breathing (>20 bpm), weakness, confusion, hypotension, cardiac changes due
to hyperkalemia, nausea, vomiting
C. Slow, shallow breathing, lethargy, coma, facial paralysis
D. Anxiety, hyperreflexia, tachycardia, bounding pulse
CORRECT ANSWER B — Kussmaul's breathing, weakness, confusion, hypotension, cardiac
changes due to hyperkalemia, nausea, vomiting.
RATIONALE Metabolic acidosis: Kussmaul respirations (deep, rapid breathing — lungs
compensating by blowing off CO₂), weakness, confusion (CNS depression from
acidosis), hypotension, and cardiac changes from HYPERKALEMIA (H⁺ shifts into
cells, K⁺ shifts out). Nausea and vomiting are common. Lab assessment: serum
potassium is HIGH. The priority assessment for an acidosis patient is CARDIAC —
hyperkalemia causes peaked T waves, widened QRS, and can progress to cardiac
arrest.
