Renal System
Final Test Review
(Questions & Solutions)
2025
1
,I. Acid–Base Disorders (Questions 1–6)
1. A 68-year-old with COPD exacerbation develops acute hypercapnia.
ABG: pH 7.25, PaCO₂ 65 mm Hg, HCO₃⁻ 26 mEq/L. What is the primary
disorder?
A) Acute respiratory acidosis
B) Chronic respiratory acidosis
C) Metabolic acidosis
D) Metabolic alkalosis
ANS: A
Rationale: pH low with elevated PaCO₂ and near‐normal HCO₃⁻ indicates
acute respiratory acidosis.
2. A 45-year-old diabetic in DKA has pH 7.10, PaCO₂ 28 mm Hg, HCO₃⁻ 8
mEq/L. Which best describes this ABG?
A) Primary metabolic acidosis with respiratory compensation
B) Primary respiratory alkalosis
C) Primary metabolic alkalosis
D) Mixed respiratory and metabolic acidosis
ANS: A
Rationale: Low pH with low HCO₃⁻ and compensatory low PaCO₂
indicates primary metabolic acidosis.
3. A patient on high‐dose loop diuretics has pH 7.50, PaCO₂ 48 mm Hg,
HCO₃⁻ 38 mEq/L. Primary disorder?
A) Metabolic alkalosis
B) Respiratory alkalosis
C) Metabolic acidosis
D) Respiratory acidosis
ANS: A
Rationale: Alkalemic pH with high HCO₃⁻ and elevated PaCO₂
(compensation) indicates metabolic alkalosis.
4. A woman with panic attacks has pH 7.55, PaCO₂ 28 mm Hg, HCO₃⁻ 24
2
, mEq/L. What is primary disorder?
A) Acute respiratory alkalosis
B) Chronic respiratory alkalosis
C) Metabolic alkalosis
D) Mixed disorder
ANS: A
Rationale: High pH, low PaCO₂, and normal HCO₃⁻ reflect acute
respiratory alkalosis from hyperventilation.
5. A chronically ventilated COPD patient has pH 7.36, PaCO₂ 60 mm Hg,
HCO₃⁻ 36 mEq/L. Which best describes this ABG?
A) Chronic respiratory acidosis
B) Acute respiratory acidosis
C) Metabolic acidosis
D) Mixed disorder
ANS: A
Rationale: Normal pH with high PaCO₂ and elevated HCO₃⁻ indicates
chronic respiratory compensation.
6. A patient with diarrhea has pH 7.28, PaCO₂ 32 mm Hg, HCO₃⁻ 14
mEq/L. What is the primary process?
A) Metabolic acidosis with respiratory compensation
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
ANS: A
Rationale: Diarrhea causes loss of bicarbonate, producing metabolic
acidosis with compensatory hyperventilation.
II. Acute Kidney Injury/Acute Renal Failure (Questions 7–12)
7. A hypovolemic patient’s creatinine rises from 1.0 to 1.8 mg/dL after
diuretics; FeNa is 0.5%. Diagnosis?
A) Prerenal AKI
B) Intrinsic AKI
C) Postrenal AKI
3
Final Test Review
(Questions & Solutions)
2025
1
,I. Acid–Base Disorders (Questions 1–6)
1. A 68-year-old with COPD exacerbation develops acute hypercapnia.
ABG: pH 7.25, PaCO₂ 65 mm Hg, HCO₃⁻ 26 mEq/L. What is the primary
disorder?
A) Acute respiratory acidosis
B) Chronic respiratory acidosis
C) Metabolic acidosis
D) Metabolic alkalosis
ANS: A
Rationale: pH low with elevated PaCO₂ and near‐normal HCO₃⁻ indicates
acute respiratory acidosis.
2. A 45-year-old diabetic in DKA has pH 7.10, PaCO₂ 28 mm Hg, HCO₃⁻ 8
mEq/L. Which best describes this ABG?
A) Primary metabolic acidosis with respiratory compensation
B) Primary respiratory alkalosis
C) Primary metabolic alkalosis
D) Mixed respiratory and metabolic acidosis
ANS: A
Rationale: Low pH with low HCO₃⁻ and compensatory low PaCO₂
indicates primary metabolic acidosis.
3. A patient on high‐dose loop diuretics has pH 7.50, PaCO₂ 48 mm Hg,
HCO₃⁻ 38 mEq/L. Primary disorder?
A) Metabolic alkalosis
B) Respiratory alkalosis
C) Metabolic acidosis
D) Respiratory acidosis
ANS: A
Rationale: Alkalemic pH with high HCO₃⁻ and elevated PaCO₂
(compensation) indicates metabolic alkalosis.
4. A woman with panic attacks has pH 7.55, PaCO₂ 28 mm Hg, HCO₃⁻ 24
2
, mEq/L. What is primary disorder?
A) Acute respiratory alkalosis
B) Chronic respiratory alkalosis
C) Metabolic alkalosis
D) Mixed disorder
ANS: A
Rationale: High pH, low PaCO₂, and normal HCO₃⁻ reflect acute
respiratory alkalosis from hyperventilation.
5. A chronically ventilated COPD patient has pH 7.36, PaCO₂ 60 mm Hg,
HCO₃⁻ 36 mEq/L. Which best describes this ABG?
A) Chronic respiratory acidosis
B) Acute respiratory acidosis
C) Metabolic acidosis
D) Mixed disorder
ANS: A
Rationale: Normal pH with high PaCO₂ and elevated HCO₃⁻ indicates
chronic respiratory compensation.
6. A patient with diarrhea has pH 7.28, PaCO₂ 32 mm Hg, HCO₃⁻ 14
mEq/L. What is the primary process?
A) Metabolic acidosis with respiratory compensation
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
ANS: A
Rationale: Diarrhea causes loss of bicarbonate, producing metabolic
acidosis with compensatory hyperventilation.
II. Acute Kidney Injury/Acute Renal Failure (Questions 7–12)
7. A hypovolemic patient’s creatinine rises from 1.0 to 1.8 mg/dL after
diuretics; FeNa is 0.5%. Diagnosis?
A) Prerenal AKI
B) Intrinsic AKI
C) Postrenal AKI
3
