MEDICAL SURGICAL ASSESSMENT EXAM NEWEST /
MEDICAL SURGICAL ASSESSMENT PREPARATION /
MEDIC, Exams of Nursing
The nurse knows that an imbalance of which ion causes acid-base impairment?
a.Hydrogen
b.Calcium
c.Magnesium
d.Sodium hydrogen
Rationale: The concentration of hydrogen ions determines pH. Low pH designates an acidic
environment. High pH designates an alkaline environment. Calcium, magnesium, and sodium
are ions, but their imbalances are not direct acid-base impairments.
10. The nurse would expect a patient with respiratory acidosis to have an excessive amount of
a.Carbon dioxide.
b.Bicarbonate.
c.Oxygen.
d.Phosphate. carbon dioxide
Rationale: Respiratory acidosis occurs when the lungs are not able to excrete enough carbon
dioxide. Carbon dioxide and water create carbonic acid. A buildup of carbonic acid causes the
ECF to become more acidic, decreasing the pH. Bicarbonate is normal with uncompensated
respiratory acidosis or elevated with compensated respiratory acidosis. Excessive oxygen and
phosphate are not characteristic of respiratory acidosis.
11. A 2-year-old child was brought into the emergency department after ingesting several
morphine tablets from a bottle in his mothers purse. The nurse knows that the child is at
greatest risk for which acid-base imbalance?
a.Respiratory acidosis
b.Respiratory alkalosis
1|Page
,c.Metabolic acidosis
d.Metabolic alkalosis Respiratory acidosis
Rationale: Morphine overdose can cause respiratory depression and hypoventilation.
Hypoventilation results in retention of CO2 and respiratory acidosis. Respiratory alkalosis would
result from hyperventilation, causing a decrease in CO2 levels. Metabolic acid-base imbalance
would be a result of kidney dysfunction, vomiting, diarrhea, or other conditions that affect
metabolic acids.
12. A patient was admitted for a bowel obstruction and has had a nasogastric tube set to low
intermittent suction for the past 3 days. The patients respiratory rate has decreased to 12
breaths per minute. The nurse would expect the patient to have which of the following arterial
blood gas values?
a.pH 7.78, PaCO2 40 mm Hg, HCO3 30 mEq/L
b.pH 7.52, PaCO2 48 mm Hg, HCO3 28 mEq/L
c.pH 7.35, PaCO2 35 mm Hg, HCO3 26 mEq/L
d.pH 7.25, PaCO2 47 mm Hg, HCO3 29 mEq/L pH 7.52, PaCO2 48 mm Hg, HCO3 28 mEq/L
Rationale: Compensated metabolic alkalosis should show alkalosis pH and HCO3 (metabolic)
values, with a slightly acidic CO2 (compensatory respiratory acidosis). In this case, pH 7.52 is
alkaline (normal = 7.35 to 7.45), PaCO2is acidic (normal 35 to 45 mm Hg), and HCO3 is elevated
(normal = 22 to 26 mEq/L). A result of pH 7.78, PaCO2 40 mm Hg, HCO3 30 mEq/L is
uncompensated metabolic alkalosis. pH 7.35, PaCO2 35 mm Hg, HCO3 26 mEq/L is within
normal limits. pH 7.25, PaCO2 47 mm Hg, HCO3 29 mEq/L is compensated respiratory acidosis.
16. Which organ system is responsible for compensation of respiratory acidosis?
a.Respiratory
b.Renal
c.Gastrointestinal
d.Endocrine renal
2|Page
,rationale: The kidneys are responsible for respiratory acidosis compensation. A problem with
the respiratory system causes respiratory acidosis, so another organ system (renal) needs to
compensate. Problems with the gastrointestinal and endocrine systems can cause acid-base
imbalances, but these systems cannot compensate for an existing imbalance.
17. Which laboratory value should the nurse examine when evaluating uncompensated
respiratory alkalosis?
a.
PaO2
b.
Anion gap
c.
PaCO2
d.
HCO3 PaCO2
Rationale: Uncompensated respiratory imbalances are seen in the PaCO2 levels. PaO2 indicates
oxygen status. Anion gap is used for metabolic acidosis. HCO3 is used to evaluate compensation
for respiratory imbalances or uncompensated metabolic imbalances.
18. The nurse is caring for a diabetic patient in renal failure. Which laboratory findings would
the nurse expect?
a.
pH 7.3, PaCO2 36 mm Hg, HCO3 19 mEq/L
b.
pH 7.5, PaCO2 35 mm Hg, HCO3 35 mEq/L
c.
3|Page
, pH 7.3, PaCO2 47 mm Hg, HCO3 23 mEq/L
d.
pH 7.35, PaCO2 40 mm Hg, HCO3 25 mEq/L pH 7.3, PaCO2 36 mm Hg, HCO3 19 mEq/L
Rationale: Patients in renal failure develop metabolic acidosis. The laboratory values that reflect
this are pH 7.3, PaCO2 36 mm Hg, HCO3 19 mEq/L. A laboratory finding of pH 7.5, PaCO2 35 mm
Hg, HCO3 35 mEq/L is metabolic alkalosis. pH 7.3, PaCO2 47 mm Hg, HCO3 23 mEq/L is
respiratory acidosis. pH 7.35, PaCO2 40 mm Hg, HCO3 25 mEq/L values are within normal range.
29. A patient is to receive 1500 mL of 0.9% sodium chloride intravenously at a rate of 125 mL/hr.
The nurse is using microdrip gravity drip tubing. What is the minute flow rate (drops per
minute)?
a.
12 gtt/min
b.
24 gtt/min
c.
125 gtt/min
d.
150 gtt/min 125 gtts/min
Rationale: Microdrip tubing delivers 60 gtt/mL. Calculation for a rate of 125 mL/hr using
microdrip tubing: (125 mL/1 hr)(60 gtt/1 mL)(1 hr/60 min) = 125 gtt/min.
Exam 2 Urinary elimination, bowel elimination, inflammation, infection, and immunity
How do you obtain a clean catch urine specimen for culture and sensitivity?
SG Wash and dry yours hands thoroughly, remove the lid on the container and set it aside,
for women, keep the legs apart and hold the skin folds apart while voiding, clean genital area
4|Page
MEDICAL SURGICAL ASSESSMENT PREPARATION /
MEDIC, Exams of Nursing
The nurse knows that an imbalance of which ion causes acid-base impairment?
a.Hydrogen
b.Calcium
c.Magnesium
d.Sodium hydrogen
Rationale: The concentration of hydrogen ions determines pH. Low pH designates an acidic
environment. High pH designates an alkaline environment. Calcium, magnesium, and sodium
are ions, but their imbalances are not direct acid-base impairments.
10. The nurse would expect a patient with respiratory acidosis to have an excessive amount of
a.Carbon dioxide.
b.Bicarbonate.
c.Oxygen.
d.Phosphate. carbon dioxide
Rationale: Respiratory acidosis occurs when the lungs are not able to excrete enough carbon
dioxide. Carbon dioxide and water create carbonic acid. A buildup of carbonic acid causes the
ECF to become more acidic, decreasing the pH. Bicarbonate is normal with uncompensated
respiratory acidosis or elevated with compensated respiratory acidosis. Excessive oxygen and
phosphate are not characteristic of respiratory acidosis.
11. A 2-year-old child was brought into the emergency department after ingesting several
morphine tablets from a bottle in his mothers purse. The nurse knows that the child is at
greatest risk for which acid-base imbalance?
a.Respiratory acidosis
b.Respiratory alkalosis
1|Page
,c.Metabolic acidosis
d.Metabolic alkalosis Respiratory acidosis
Rationale: Morphine overdose can cause respiratory depression and hypoventilation.
Hypoventilation results in retention of CO2 and respiratory acidosis. Respiratory alkalosis would
result from hyperventilation, causing a decrease in CO2 levels. Metabolic acid-base imbalance
would be a result of kidney dysfunction, vomiting, diarrhea, or other conditions that affect
metabolic acids.
12. A patient was admitted for a bowel obstruction and has had a nasogastric tube set to low
intermittent suction for the past 3 days. The patients respiratory rate has decreased to 12
breaths per minute. The nurse would expect the patient to have which of the following arterial
blood gas values?
a.pH 7.78, PaCO2 40 mm Hg, HCO3 30 mEq/L
b.pH 7.52, PaCO2 48 mm Hg, HCO3 28 mEq/L
c.pH 7.35, PaCO2 35 mm Hg, HCO3 26 mEq/L
d.pH 7.25, PaCO2 47 mm Hg, HCO3 29 mEq/L pH 7.52, PaCO2 48 mm Hg, HCO3 28 mEq/L
Rationale: Compensated metabolic alkalosis should show alkalosis pH and HCO3 (metabolic)
values, with a slightly acidic CO2 (compensatory respiratory acidosis). In this case, pH 7.52 is
alkaline (normal = 7.35 to 7.45), PaCO2is acidic (normal 35 to 45 mm Hg), and HCO3 is elevated
(normal = 22 to 26 mEq/L). A result of pH 7.78, PaCO2 40 mm Hg, HCO3 30 mEq/L is
uncompensated metabolic alkalosis. pH 7.35, PaCO2 35 mm Hg, HCO3 26 mEq/L is within
normal limits. pH 7.25, PaCO2 47 mm Hg, HCO3 29 mEq/L is compensated respiratory acidosis.
16. Which organ system is responsible for compensation of respiratory acidosis?
a.Respiratory
b.Renal
c.Gastrointestinal
d.Endocrine renal
2|Page
,rationale: The kidneys are responsible for respiratory acidosis compensation. A problem with
the respiratory system causes respiratory acidosis, so another organ system (renal) needs to
compensate. Problems with the gastrointestinal and endocrine systems can cause acid-base
imbalances, but these systems cannot compensate for an existing imbalance.
17. Which laboratory value should the nurse examine when evaluating uncompensated
respiratory alkalosis?
a.
PaO2
b.
Anion gap
c.
PaCO2
d.
HCO3 PaCO2
Rationale: Uncompensated respiratory imbalances are seen in the PaCO2 levels. PaO2 indicates
oxygen status. Anion gap is used for metabolic acidosis. HCO3 is used to evaluate compensation
for respiratory imbalances or uncompensated metabolic imbalances.
18. The nurse is caring for a diabetic patient in renal failure. Which laboratory findings would
the nurse expect?
a.
pH 7.3, PaCO2 36 mm Hg, HCO3 19 mEq/L
b.
pH 7.5, PaCO2 35 mm Hg, HCO3 35 mEq/L
c.
3|Page
, pH 7.3, PaCO2 47 mm Hg, HCO3 23 mEq/L
d.
pH 7.35, PaCO2 40 mm Hg, HCO3 25 mEq/L pH 7.3, PaCO2 36 mm Hg, HCO3 19 mEq/L
Rationale: Patients in renal failure develop metabolic acidosis. The laboratory values that reflect
this are pH 7.3, PaCO2 36 mm Hg, HCO3 19 mEq/L. A laboratory finding of pH 7.5, PaCO2 35 mm
Hg, HCO3 35 mEq/L is metabolic alkalosis. pH 7.3, PaCO2 47 mm Hg, HCO3 23 mEq/L is
respiratory acidosis. pH 7.35, PaCO2 40 mm Hg, HCO3 25 mEq/L values are within normal range.
29. A patient is to receive 1500 mL of 0.9% sodium chloride intravenously at a rate of 125 mL/hr.
The nurse is using microdrip gravity drip tubing. What is the minute flow rate (drops per
minute)?
a.
12 gtt/min
b.
24 gtt/min
c.
125 gtt/min
d.
150 gtt/min 125 gtts/min
Rationale: Microdrip tubing delivers 60 gtt/mL. Calculation for a rate of 125 mL/hr using
microdrip tubing: (125 mL/1 hr)(60 gtt/1 mL)(1 hr/60 min) = 125 gtt/min.
Exam 2 Urinary elimination, bowel elimination, inflammation, infection, and immunity
How do you obtain a clean catch urine specimen for culture and sensitivity?
SG Wash and dry yours hands thoroughly, remove the lid on the container and set it aside,
for women, keep the legs apart and hold the skin folds apart while voiding, clean genital area
4|Page
