NUR 425 LATEST EXAMS SCRIPT QUESTIONS AND
ANSWERS SURE A+
✔✔Describe fully compensated acid-be imbalance. - ✔✔-One system is causing the
disturbance, the other system is compensating and it WORKED.
-The pH is going to be normal, but it is going to be on the higher or lower end of a pH.
-7.35-7.4 --> acidic
-7.4-7.45 --> alkaline
✔✔Identify this acid base imbalance as either mixed, uncompensated, partially
compensated, or fully compensated. Also, identify the type of acid base balance.
pH: 7.36
CO2: 50 mmHg
HCO3: 35 mmHg - ✔✔Fully compensated respiratory acidosis
The pH is in the normal spectrum, but still less than 7.4 so we know the high CO2 level
is causing the altered pH. The kidneys are retaining bicarbonate to compensate for the
acidic pH, and it WORKED because the pH is now in the normal spectrum.
✔✔List causes of respiratory acidosis. - ✔✔-Hypoventilation
-Drug overdose
-Pulmonary edema, pneumonia, pulmonary embolism (later stage)
-Chest trauma
-Neuromuscular disease
-COPD
-Airway obstruction
✔✔List treatment for respiratory acidosis. - ✔✔We need to increase breathing, so...
-Administer narcan for drug overdose
-Reduce sedation
-Intubate or change ventilator settings
-Suction
,-Administer bronchodilators
-Treat pneumonia, pneumothorax
✔✔List causes of metabolic acidosis. - ✔✔-DKA
-Salicylate OD
-Shock (Lactic acid increases during shock)
-Sepsis
-Diarrhea
-Renal failure (Increased uric acid concentration)
✔✔List treatment for metabolic acidosis. - ✔✔We need to excrete acid or retain HCO3,
so...
-Administer sodium bicarbonate
-Encourage Kussmaul respirations or set ventilator settings to do this
-Antidiarrheal medications
-Dialysis
-Insulin
✔✔List causes of respiratory alkalosis. - ✔✔-Hyperventilation
-Initial stages of pulmonary embolism
-Hypoxia
-Fever
-Pregnancy
-High altitudes
-Anxiety
-Pain
-Mechanical ventilator causing hyperventilation
✔✔List treatment for respiratory alkalosis. - ✔✔We need to decrease RR, so...
-Administer analgesics, anxiolytics, antipyretics
-Stop or reverse drug that is causing increased CNS activation
-Breathe into a paper bag
-Change existing ventilator settings
✔✔List causes of metabolic alkalosis. - ✔✔-Vomiting
-K-wasting diuretics
-Overuse of antacids
-NG tubes suctioning
-Overadministration of NaHCO3
✔✔Potassium is _____. - ✔✔Acidic (For the sake of simplicity, know that high
potassium is gonna cause more of an acidic pH and low potassium is going to cause
more of an alkaline pH)
, ✔✔List treatment for metabolic alkalosis. - ✔✔We need to excrete bicarbonate and
retain acids, so...
-Discontinue dugs causing imbalance (Such as diuretic, antacid, sodium bicarbonate,
etc.)
-Discontinue NG tube suction
-Administer anti-emetics
-Admnister acetazolamide (Treats altitude sickness)
✔✔George Kent is a 54 year old widower with a history of chronic obstructive
pulmonary disease and was rushed to the emergency department with increasing
shortness of breath, pyrexia, and a productive cough with yellow-green sputum. He has
difficulty in communicating because of his inability to complete a sentence. One of his
sons, Jacob, says he has been unwell for three days. Upon examination, crackles and
wheezes can be heard in the lower lobes; he has a tachycardia and a bounding pulse.
Measurement of arterial blood gas shows pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L,
and PaO2 60 mm Hg. How would you interpret this?
A. Respiratory Acidosis, Uncompensated
B. Respiratory Acidosis, Partially Compensated
C. Metabolic Alkalosis, Uncompensated
D. Metabolic Acidosis, Partially, Compensated - ✔✔B (The patient has respiratory
acidosis (raised carbon dioxide) resulting from an acute exacerbation of chronic
obstructive pulmonary disease, with partial compensation.)
✔✔Carl, an elementary student, was rushed to the hospital due to vomiting and a
decreased level of consciousness. The patient displays slow and deep (Kussmaul
breathing), and he is lethargic and irritable in response to stimulation. He appears to be
dehydrated—his eyes are sunken and mucous membranes are dry—and he has a two
week history of polydipsia, polyuria, and weight loss. Measurement of arterial blood gas
shows pH 7.0, PaO2 90 mm Hg, PaCO2 23 mm Hg, and HCO3 12 mmol/L; other
results are Na+ 126 mmol/L, K+ 5 mmol/L, and Cl- 95 mmol/L. What is your
assessment?
A. Respiratory Acidosis, Uncompensated
B. Respiratory Acidosis, Partially Compensated
C. Metabolic Alkalosis, Uncompensated
D. Metabolic Acidosis, Partially Compensated - ✔✔D (The student was diagnosed
having diabetes mellitus. The results show that he has metabolic acidosis (low HCO3 -)
with respiratory compensation (low CO2).)
✔✔A cigarette vendor was brought to the emergency department of a hospital after she
fell into the ground and hurt her left leg. She is noted to be tachycardic and tachypneic.
Painkillers were carried out to lessen her pain. Suddenly, she started complaining that
she is still in pain and now experiencing muscle cramps, tingling, and paraesthesia.
Measurement of arterial blood gas reveals pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm
Hg, and HCO3 25 mmol/L. What does this mean?
A. Respiratory Alkalosis, Uncompensated
B. Respiratory Acidosis, Partially Compensated
ANSWERS SURE A+
✔✔Describe fully compensated acid-be imbalance. - ✔✔-One system is causing the
disturbance, the other system is compensating and it WORKED.
-The pH is going to be normal, but it is going to be on the higher or lower end of a pH.
-7.35-7.4 --> acidic
-7.4-7.45 --> alkaline
✔✔Identify this acid base imbalance as either mixed, uncompensated, partially
compensated, or fully compensated. Also, identify the type of acid base balance.
pH: 7.36
CO2: 50 mmHg
HCO3: 35 mmHg - ✔✔Fully compensated respiratory acidosis
The pH is in the normal spectrum, but still less than 7.4 so we know the high CO2 level
is causing the altered pH. The kidneys are retaining bicarbonate to compensate for the
acidic pH, and it WORKED because the pH is now in the normal spectrum.
✔✔List causes of respiratory acidosis. - ✔✔-Hypoventilation
-Drug overdose
-Pulmonary edema, pneumonia, pulmonary embolism (later stage)
-Chest trauma
-Neuromuscular disease
-COPD
-Airway obstruction
✔✔List treatment for respiratory acidosis. - ✔✔We need to increase breathing, so...
-Administer narcan for drug overdose
-Reduce sedation
-Intubate or change ventilator settings
-Suction
,-Administer bronchodilators
-Treat pneumonia, pneumothorax
✔✔List causes of metabolic acidosis. - ✔✔-DKA
-Salicylate OD
-Shock (Lactic acid increases during shock)
-Sepsis
-Diarrhea
-Renal failure (Increased uric acid concentration)
✔✔List treatment for metabolic acidosis. - ✔✔We need to excrete acid or retain HCO3,
so...
-Administer sodium bicarbonate
-Encourage Kussmaul respirations or set ventilator settings to do this
-Antidiarrheal medications
-Dialysis
-Insulin
✔✔List causes of respiratory alkalosis. - ✔✔-Hyperventilation
-Initial stages of pulmonary embolism
-Hypoxia
-Fever
-Pregnancy
-High altitudes
-Anxiety
-Pain
-Mechanical ventilator causing hyperventilation
✔✔List treatment for respiratory alkalosis. - ✔✔We need to decrease RR, so...
-Administer analgesics, anxiolytics, antipyretics
-Stop or reverse drug that is causing increased CNS activation
-Breathe into a paper bag
-Change existing ventilator settings
✔✔List causes of metabolic alkalosis. - ✔✔-Vomiting
-K-wasting diuretics
-Overuse of antacids
-NG tubes suctioning
-Overadministration of NaHCO3
✔✔Potassium is _____. - ✔✔Acidic (For the sake of simplicity, know that high
potassium is gonna cause more of an acidic pH and low potassium is going to cause
more of an alkaline pH)
, ✔✔List treatment for metabolic alkalosis. - ✔✔We need to excrete bicarbonate and
retain acids, so...
-Discontinue dugs causing imbalance (Such as diuretic, antacid, sodium bicarbonate,
etc.)
-Discontinue NG tube suction
-Administer anti-emetics
-Admnister acetazolamide (Treats altitude sickness)
✔✔George Kent is a 54 year old widower with a history of chronic obstructive
pulmonary disease and was rushed to the emergency department with increasing
shortness of breath, pyrexia, and a productive cough with yellow-green sputum. He has
difficulty in communicating because of his inability to complete a sentence. One of his
sons, Jacob, says he has been unwell for three days. Upon examination, crackles and
wheezes can be heard in the lower lobes; he has a tachycardia and a bounding pulse.
Measurement of arterial blood gas shows pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L,
and PaO2 60 mm Hg. How would you interpret this?
A. Respiratory Acidosis, Uncompensated
B. Respiratory Acidosis, Partially Compensated
C. Metabolic Alkalosis, Uncompensated
D. Metabolic Acidosis, Partially, Compensated - ✔✔B (The patient has respiratory
acidosis (raised carbon dioxide) resulting from an acute exacerbation of chronic
obstructive pulmonary disease, with partial compensation.)
✔✔Carl, an elementary student, was rushed to the hospital due to vomiting and a
decreased level of consciousness. The patient displays slow and deep (Kussmaul
breathing), and he is lethargic and irritable in response to stimulation. He appears to be
dehydrated—his eyes are sunken and mucous membranes are dry—and he has a two
week history of polydipsia, polyuria, and weight loss. Measurement of arterial blood gas
shows pH 7.0, PaO2 90 mm Hg, PaCO2 23 mm Hg, and HCO3 12 mmol/L; other
results are Na+ 126 mmol/L, K+ 5 mmol/L, and Cl- 95 mmol/L. What is your
assessment?
A. Respiratory Acidosis, Uncompensated
B. Respiratory Acidosis, Partially Compensated
C. Metabolic Alkalosis, Uncompensated
D. Metabolic Acidosis, Partially Compensated - ✔✔D (The student was diagnosed
having diabetes mellitus. The results show that he has metabolic acidosis (low HCO3 -)
with respiratory compensation (low CO2).)
✔✔A cigarette vendor was brought to the emergency department of a hospital after she
fell into the ground and hurt her left leg. She is noted to be tachycardic and tachypneic.
Painkillers were carried out to lessen her pain. Suddenly, she started complaining that
she is still in pain and now experiencing muscle cramps, tingling, and paraesthesia.
Measurement of arterial blood gas reveals pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm
Hg, and HCO3 25 mmol/L. What does this mean?
A. Respiratory Alkalosis, Uncompensated
B. Respiratory Acidosis, Partially Compensated
