MSN Exam for Fluid, Electrolyte, and Acid Base Problems

1. A client’s nursing diagnosis is Deficient Fluid Volume related to excessive fluid loss. Which action related to the fluid management should be delegated to a nursing assistant?

1. Administer IV fluids as prescribed by the physician.
2. Provide straws and offer fluids between meals.
3. Develop plan for added fluid intake over 24 hours
4. Teach family members to assist client with fluid intake

2. The client also has the nursing diagnosis Decreased Cardiac Output related to decrease plasma volume. Which finding on assessment supports this nursing diagnosis?

1. Flattened neck veins when client is in supine position
2. Full and bounding pedal and post-tibial pulses
3. Pitting edema located in feet, ankles, and calves
4. Shallow respirations with crackles on auscultation

3. The nursing care plan for the client with dehydration includes interventions for oral health. Which interventions are within the scope of practice for the LPN/LVN being supervised by the nurse? (Choose all that apply.)

1. Remind client to avoid commercial mouthwashes.
2. Encourage mouth rinsing with warm saline.
3. Assess lips, tongue, and mucous membranes
4. Provide mouth care every 2 hours while client is awake
5. Seek dietary consult to increase fluids on meal trays.

4. The physician has written the following orders for the client with Excess Fluid volume. The client’s morning assessment includes bounding peripheral pulses, weight gain of 2 pounds, pitting ankle edema, and moist crackles bilaterally. Which order takes priority at this time?

1. Weight client every morning.
2. Maintain accurate intake and output.
3. Restrict fluid to 1500 mL per day
4. Administer furosemide (Lasix) 40 mg IV push

5. You have been pulled to the telemetry unit for the day. The monitor informs you that the client has developed prominent U waves. Which laboratory value should you check immediately?

1. Sodium
2. Potassium
3. Magnesium
4. Calcium

6. The client’s potassium level is 6.7 mEq/L. Which intervention should you delegate to the student nurse under your supervision?

1. Administer Kayexalate 15 g orally
2. Administer spironolactone 25 mg orally
3. Assess WCG strip for tall T waves
4. Administer potassium 10 mEq orally

7. A client is admitted to the unit with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH). For which electrolyte abnormality will you be sure to monitor?

1. Hypokalemia
2. Hyperkalemia
3. Hyponatremia
4. Hypernatremia

8. The charge nurse assigned in the care for a client with acute renal failure and hypernatremia to you, a newly graduated RN. Which actions can you delegate to the nursing assistant?

1. Provide oral care every 3-4 hours
2. Monitor for indications of dehydration
3. Administer 0.45% saline by IV line
4. Assess daily weights for trends

9. The experienced LPN/LVN reports that a client’s blood pressure and heart rate have decreased and that when the face is assessed, one side twitches. What action should you take at this time?

1. Reassess the client’s blood pressure and heart rate
2. Review the client’s morning calcium level
3. Request a neurologic consult today
4. Check the client’s papillary reaction to light

10.You are preparing to discharge a client whose calcium level was low but is now just slightly within the normal range (9-10.5 mg/dL). Which statement by the client indicates the need for additional teaching?

1. “I will call my doctor if I experience muscle twitching or seizures.”
2. “I will make sure to take my vitamin D with my calcium each day.”
3. “I will take my calcium pill every morning before breakfast.”
4. “I will avoid dairy products, broccoli, and spinach when I eat.”

11.A nursing assistant asks why the client with a chronically low phosphorus level needs so much assistance with activities of daily living. What is your best response?

1. “The client’s low phosphorus is probably due to malnutrition.”
2. “The client is just worn out form not getting enough rest.”
3. “The client’s skeletal muscles are weak because of the low phosphorus.”
4. “The client will do more for herself when her phosphorus is normal”

12.You are reviewing a client’s morning laboratory results. Which of these results is of most concern?

1. Serum potassium 5.2 mEq/L
2. Serum sodium 134 mEq/L
3. Serum calcium 10.6 mg/dL
4. Serum magnesium 0.8 mEq/L

13. You are the charge nurse. Which client is most appropriate to assign to the step-down unit nurse pulled to the intensive care unit for the day?

1. A 68-year-old client on ventilator with acute respiratory failure and respiratory acidosis
2. A 72-year-old client with COPD and normal arterial blood gases (ABGs) who is ventilator-dependent
3. A 56-year-old new admission client with diabetic ketoacidosis (DKA) on a n insulin drip
4. A 38-year-old client on a ventilator with narcotic overdose and respiratory alkalosis

14.A client with respiratory failure is receiving mechanical ventilation and continues to produce ABG results indicating respiratory acidosis. Which action should you expect to correct this problem?

1. Increase the ventilator rate from 6 to 10 per minute
2. Decrease the ventilator rate from 10 to 6 per minute
3. Increase the oxygen concentration fro 30% to 40%
4. Decrease the oxygen concentration fro 40% to 30%

15.Which action should you delegate to the nursing assistant for the client with diabetic ketoacidosis? (Choose all that apply.)

16.You are admitting an elderly client to the medical unit. Which factor indicates that this client has a risk for acid-base imbalances?

1. Myocardial infarction 1 year ago
2. Occasional use of antacids
3. Shortness of breath with extreme exertion
4. Chronic renal insufficiency

17.A client with lung cancer has received oxycodone 10 mg orally for pain. When the student nurse assesses the client, which finding should you instruct the student to report immediately?

1. Respiratory rate of 8 to 10 per minute
2. Pain level decreased from 6/10 to 2/10
3. Client requests room door be closed.
4. Heart rate 90-100 per minute

18.The nursing assistant reports to you that a client seems very anxious and that vital signs included a respiratory rate of 38 per minute. Which acid-base imbalance should you suspect?

1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis

19.A client is admitted to the unit for chemotherapy. To prevent an acid-base problem, which of the following would you instruct the nursing assistant to report?

1. Repeated episodes of nausea and vomiting
2. Complaints of pain associated with exertion
3. Failure to eat all food on breakfast tray
4. Client hair loss during morning bath

20.A client has a nasogastric tube connected to intermittent wall suction. The student nurse asks why the client’s respiratory rate has increased. What your best response?

1. “It’s common for clients with uncomfortable procedures such as nasogastric tubes to have a higher rate to breathing.”
2. “The client may have a metabolic alkalosis due to the NG suctioning and the increased respiratory rate is a compensatory mechanism.”
3. “Whenever a client develops a respiratory acid-base problem, increasing the respiratory rate helps correct the problem.”
4. “The client is hyperventilating because of anxiety and we will have to stay alert for development of a respiratory acidosis.”

21. 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?

1. Respiratory Acidosis, Uncompensated
2. Respiratory Acidosis, Partially Compensated
3. Metabolic Alkalosis, Uncompensated
4. Metabolic Acidosis, Partially Compensated

22. 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?

1. Respiratory Acidosis, Uncompensated
2. Respiratory Acidosis, Partially Compensated
3. Metabolic Alkalosis, Uncompensated
4. Metabolic Acidosis, Partially, Compensated

23. 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?

1. Respiratory Alkalosis, Uncompensated
2. Respiratory Acidosis, Partially Compensated
3. Metabolic Alkalosis, Uncompensated
4. Metabolic Alkalosis, Partially Compensated

24. Ricky’s grandmother is suffering from persistent vomiting for two days now. She appears to be lethargic and weak and has myalgia. She is noted to have dry mucus membranes and her capillary refill takes >4 seconds. She is diagnosed as having gastroenteritis and dehydration. Measurement of arterial blood gas shows pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L. What acid-base disorder is shown?

1. Respiratory Alkalosis, Uncompensated
2. Respiratory Acidosis, Partially Compensated
3. Metabolic Alkalosis, Uncompensated
4. Metabolic Alkalosis, Partially Compensated

25. Mrs. Johansson, who had undergone surgery in the post-anesthesia care unit (PACU), is difficult to arouse two hours following surgery. Nurse Florence in the PACU has been administering Morphine Sulfate intravenously to the client for complaints of post-surgical pain. The client’s respiratory rate is 7 per minute and demonstrates shallow breathing. The patient does not respond to any stimuli! The nurse assesses the ABCs (remember Airway, Breathing, Circulation!) and obtains ABGs STAT! Measurement of arterial blood gas shows pH 7.10, PaCO2 70 mm Hg and HCO3 24 mEq/L. What does this mean?

1. Respiratory Alkalosis, Partially Compensated
2. Respiratory Acidosis, Uncompensated
3. Metabolic Alkalosis, Partially Compensated
4. Metabolic Acidosis, Uncompensated

26. Baby Angela was rushed to the Emergency Room following her mother’s complaint that the infant has been irritable, difficult to breastfeed and has had diarrhea for the past 3 days. The infant’s respiratory rate is elevated and the fontanels are sunken. The Emergency Room physician orders ABGs after assessing the ABCs. The results from the ABG results show pH 7.39, PaCO2 27 mmHg and HCO3 19 mEq/L. What does this mean?

1. Respiratory Alkalosis, Fully Compensated
2. Metabolic Acidosis, Uncompensated
3. Metabolic Acidosis, Fully Compensated
4. Respiratory Acidosis, Uncompensated

27. Mr. Wales, who underwent post-abdominal surgery, has a nasogastric tube. The nurse on duty notes that the nasogastric tube (NGT) is draining a large amount (900 cc in 2 hours) of coffee ground secretions. The client is not oriented to person, place, or time. The nurse contacts the attending physician and STAT ABGs are ordered. The results from the ABGs show pH 7.57, PaCO2 37 mmHg and HCO3 30 mEq/L. What is your assessment?

1. Metabolic Acidosis, Uncompensated
2. Metabolic Alkalosis, Uncompensated
3. Respiratory Alkalosis, Uncompensated
4. Metabolic Alkalosis, Partially Compensated

28. Client Z is admitted to the hospital and is to undergo brain surgery. The client is very anxious and scared of the upcoming surgery. He begins to hyperventilate and becomes very dizzy. The client loses consciousness and the STAT ABGs reveal pH 7.61, PaCO2 22 mmHg and HCO3 25 mEq/L. What is the ABG interpretation based on the findings?

1. Metabolic Acidosis, Uncompensated
2. Respiratory Alkalosis, Partially Compensated
3. Respiratory Alkalosis, Uncompensated
4. Metabolic Alkalosis, Partially Compensated

29. Three-year-old Adrian is admitted to the hospital with a diagnosis of asthma and respiratory distress syndrome. The mother of the child reports to the nurse on duty that she has witnessed slight tremors and behavioral changes in her child over the past four days. The attending physician orders routine ABGs following an assessment of the ABCs. The ABG results are pH 7.35, PaCO2 72 mmHg and HCO3 38 mEq/L. What acid-base disorder is shown?

1. Respiratory Acidosis, Uncompensated
2. Respiratory Acidosis, Fully Compensated
3. Respiratory Alkalosis, Fully Compensated
4. Metabolic Alkalosis, Partially Compensated

30. Anne, who is drinking beer at a party, falls and hits her head on the ground. Her friend Liza dials “911” because Anne is unconscious, depressed ventilation (shallow and slow respirations), rapid heart rate, and is profusely bleeding from both ears. Which primary acid-base imbalance is Anne at risk for if medical attention is not provided?

1. Metabolic Acidosis
2. Metabolic Alkalosis
3. Respiratory Acidosis
4. Respiratory Alkalosis

31. Dave, a 6-year-old boy, was rushed to the hospital following her mother’s complaint that her son has been vomiting, nauseated and has overall weakness. After series of tests, the nurse notes the laboratory results: potassium: 2.9 mEq. Which primary acid-base imbalance is this boy at risk for if medical intervention is not carried out?

1. Respiratory Acidosis
2. Respiratory Alkalosis
3. Metabolic Acidosis
4. Metabolic Alkalosis

32. An old beggar was admitted to the emergency department due to shortness of breath, fever, and a productive cough. Upon examination, crackles and wheezes are noted in the lower lobes; he appears to be tachycardic and has a bounding pulse. Measurement of arterial blood gas shows pH 7.2, PaCO2 66 mm Hg, HCO3 27 mmol/L, and PaO2 65 mm Hg. As a knowledgeable nurse, you know that the normal value for pH is:

1. 7.20
2. 7.30
3. 7.40
4. 7.50

33. Liza’s mother is seen in the emergency department at a community hospital. She admits that her mother is taking many tablets of aspirin (salicylates) over the last 24-hour period because of a severe headache. Also, the mother complains of an inability to urinate. The nurse on duty took her vital signs and noted the following: Temp = 97.8 °F; apical pulse = 95; respiration = 32 and deep. Which primary acid-base imbalance is the gentleman at risk for if medical attention is not provided?

1. Respiratory Acidosis
2. Respiratory Alkalosis
3. Metabolic Acidosis
4. Metabolic Alkalosis

34. A patient who is hospitalized due to vomiting and a decreased level of consciousness displays slow and deep (Kussmaul breathing), and he is lethargic and irritable in response to stimulation. The doctor diagnosed him of having dehydration. Measurement of arterial blood gas shows pH 7.0, PaO2 90 mm Hg, PaCO2 22 mm Hg, and HCO3 14 mmol/L; other results are Na+ 120 mmol/L, K+ 2.5 mmol/L, and Cl- 95 mmol/L. As a knowledgeable nurse, you know that the normal value for PaCO2 is:

1. 22 mm Hg
2. 36 mm Hg
3. 48 mm Hg
4. 50 mm Hg

35. A company driver is found at the scene of an automobile accident in a state of emotional distress. He tells the paramedics that he feels dizzy, tingling in his fingertips, and does not remember what happened to his car. Respiratory rate is rapid at 34/minute. Which primary acid-base disturbance is the young man at risk for if medical attention is not provided?

1. Respiratory Acidosis
2. Respiratory Alkalosis
3. Metabolic Acidosis
4. Metabolic Alkalosis

36. An elderly client was admitted to hospital in a coma. Analysis of the arterial blood gave the following values: PCO2 16 mm Hg, HCO3- 5 mmol/L and pH 7.1. As a well-rounded nurse, you know that the normal value for HCO3 is:

1. 20 mmol/L
2. 24 mmol/L
3. 29 mmol/L
4. 31 mmol/L

37. In a patient undergoing surgery, it was vital to aspirate the contents of the upper gastrointestinal tract. After the operation, the following values were acquired from an arterial blood sample: pH 7.55, PCO2 52 mm Hg and HCO3- 40 mmol/l. What is the underlying disorder?

1. Respiratory Acidosis
2. Respiratory Alkalosis
3. Metabolic Acidosis
4. Metabolic Alkalosis

38. A mountaineer attempts an assault on a high mountain in the Andes and reaches an altitude of 5000 meters (16,400 ft) above sea level. What will happen to his arterial PCO2 and pH?

1. Both will be lower than normal.
2. The pH will rise and PCO2 will fall.
3. Both will be higher than normal due to the physical exertion.
4. The pH will fall and PCO2 will rise

39. A young woman is found comatose, having taken an unknown number of sleeping pills an unknown time before. An arterial blood sample yields the following values: pH 6.90, HCO3- 13 meq/liter and PaCO2 68 mmHg. This patient’s acid-base status is most accurately described as:

1. Metabolic Acidosis
2. Respiratory Acidosis
3. Simultaneous Respiratory and Metabolic Acidosis
4. Respiratory Acidosis with Complete Renal Compensation

40. A mother is admitted in the emergency department following complaints of fever and chills. The nurse on duty took her vital signs and noted the following: Temp = 100 °F; apical pulse = 95; respiration = 20 and deep. Measurement of arterial blood gas shows pH 7.37, PaO2 90 mm Hg, PaCO2 40 mm Hg, and HCO3 24 mmol/L. What is your assessment?

1. Hyperthermia
2. Hyperthermia and Respiratory Alkalosis
3. Hypothermia
4. Hypothermia and Respiratory Alkalosis

Answers and Rationales

1. ANSWER B – The nursing assistant can reinforce additional fluild intake once it is part of the care plan. Administering IV fluids, developing plans, and teaching families require additional education and skills that are within the scope of practice for the RN.
2. ANSWER A – Normally, neck veins are distended when the client is in the supine position. The veins flatten as the client moves to a sitting position. The other three responses are characteristic of Excess Fluid Volume.
3. ANSWER A, B, C, D – The LPN/LVN’s scope of practice and educational preparation includes oral care and routine observation. State practice acts vary as to whether LPN/LVNs are permitted to perform assessment. The client should be reminded to avoid most commercial mouthwashes that contain alcohol, a drying agent. Initiating a dietary consult is within the purview of the RN or physician.
4. ANSWER D – Bilateral moist crackles indicate fluid-filled alveoli, which interferes with gas exchange. Furosemide is a potent loop diuretic that will help mobilize the fluid in the lungs. The other orders are important but not urgent.
5. ANSWER B – Suspect hypokalemia and check the client’s potassium level. Common ECG changes with hypokalemia include ST depression, inverted T waves, and prominent U waves. Client with hypokalemia may also develop heart block.
6. ANSWER A – The client’s potassium level is high (normal range 3.5-5.0). Kayexalate removes potassium from the body through the gastrointestinal system. Spironolactone is a potassium-sparing diuretic that may cause the client’s potassium level to go even higher. The nursing student may not have the skill to assess ECG strips and this should be done by the RN.
7. ANSWER C – SIADH causes a relative sodium deficit due to excessive retention of water.
8. ANSWER A – Providing oral care is within the scope of practice for the nursing assistant. Monitoring and assessing clients, as well as administering IV fluids, require the additional education and skill of the RN.
9. ANSWER B – A positive Chvostek’s sign (facial twitching of one side of the mouth, nose, and cheek in response to tapping the face just below and in front of the ear) is a neurologic manifestation of hypocalcemia. The LPN/LVN is experienced and possesses the skills to take accurate vital signs.
10. ANSWER D – Clients with low calcium levels should be encouraged to consume dairy products, seafood, nuts, broccoli, and spinach. Which are all good sources of dietary calcium.
11. ANSWER C – A musculoskeletal manifestation of low phosphorous is generalized muscle weakness that may lead to acute muscle breakdown (rhabdomyolysis). Even though the other statements are true, they do not answer the nursing assistant’s question.
12. ANSWER D – While all of these laboratory values are outside of the normal range, the magnesium is most outside of normal. With a magnesium level this low, the client is at risk for ECG changes and life-threatening ventricular dysrhythmias.
13. ANSWER B – The client with COPD, although ventilator dependent, is the most stable of this group. Clients with acid-base imbalances often require frequent laboratory assessment and changes in therapy to correct their disorders. In addition, the client with DKA is a new admission and will require an in-depth admission assessment. All three of these clients need care from an experienced critical care nurse.
14. ANSWER A – the blood gas component responsible for respiratory acidosis is CO2 (Carbon dioxide). Increasing the ventilator rate will blow off more CO2 and decrease the acidosis. Changes in the oxygen setting may improve oxygenation but will not affect respiratory acidosis.
15. ANSWER B, C – The nursing assistant’s training and education include how to take vital signs and record intake and output. The need to take vital signs this frequently indicates that the client maybe unstable. The nurse should give the nursing assistant reporting parameters when delegating this action, should also check the vital signs for indications in instability. Performing fingerstick glucose checks and assessing clients require additional education and skill that are appropriate to licensed nurses. Some facilities may train experienced nursing assistants to perform fingerstick glucose checks and change their role descriptions to designate their new skills, but this is beyond the normal scope of practice for a nursing assistant.
16. ANSWER D – Risk factors for acid-base imbalances in the older adult include chronic renal disease and pulmonary disease. Occasional antacid use will not cause imbalances, although antacid abuse is a risk factor for metabolic alkalosis.
17. ANSWER A – A decreased respiratory rate indicates respiratory depression which also puts the client at risk for respiratory acidosis, All of the other findings are important and should be reported to the RN, but the respiratory rate is urgent.
18. ANSWER B – The client is most likely hyperventilating and blowing off CO2. This decrease in CO2 will lead to an increase in pH, causing respiratory alkalosis. Respiratory acidosis results from respiratory depression and retained CO2. Metabolic acidosis and alkalosis result from problems related to renal acid-base control.
19. ANSWER A – Prolonged nausea and vomiting can result in acid deficit that can lead to metabolic alkalosis. The other findings are important and need to be assessed but are not related to acid-base imbalances.
20. ANSWER B – Nasogastric suctioning can result in a decrease in acid components and metabolic alkalosis. The client’s increase in rate and depth of ventilation is an attempt to compensate by blowing off CO2. the first response maybe true but does not address all the components of the question. The third and fourth answers are inaccurate.
21. Answer: B. Respiratory Acidosis, Partially Compensated. The patient has respiratory acidosis (raised carbon dioxide) resulting from an acute exacerbation of chronic obstructive pulmonary disease, with partial compensation.
22. Answer: D. Metabolic Acidosis, Partially, Compensated. The student was diagnosed having diabetes mellitus. The results show that he has metabolic acidosis (low HCO3 -) with respiratory compensation (low CO2).
23. Answer: A. Respiratory Alkalosis, Uncompensated. The primary disorder is acute respiratory alkalosis (low CO2) due to the pain and anxiety causing her to hyperventilate. There has not been time for metabolic compensation.
24. Answer: C. Metabolic Alkalosis, Uncompensated. The primary disorder is uncompensated metabolic alkalosis (high HCO3 -). As CO2 is the strongest driver of respiration, it generally will not allow hypoventilation as compensation for metabolic alkalosis.
25. Answer: B. Respiratory Acidosis, Uncompensated. The results show that Mrs. Johansson has respiratory acidosis because of decreased pH and increased PaCO2 which mean acidic in nature. Meanwhile, it is uncompensated because HCO3 is within the normal range.
26. Answer: C. Metabolic Acidosis, Fully Compensated. Baby Angela has metabolic acidosis due to decreased HCO3 and slightly acidic pH. Her pH value is within the normal range which made the result fully compensated.
27. Answer: B. Metabolic Alkalosis, Uncompensated. The postoperative client’s ABG results show that he has metabolic alkalosis because of an increased pH and HCO3. It is uncompensated due to the normal PaCO2 which is within 35 to 45 mmHg.
28. Answer: C. Respiratory Alkalosis, Uncompensated. The results show that client Z has respiratory alkalosis since there is an increase in the pH value and a decrease in PaCO2 which are both basic. It is uncompensated due to the normal HCO3 which is within 22-26 mEq/L.
29. Answer: B. Respiratory Acidosis, Fully Compensated. The patient has respiratory acidosis (raised carbon dioxide) resulting from asthma and respiratory distress syndrome, with compensation having normal pH value within 7.35to 7.45, increased PaCO2 which is acidic and increased HCO3 which is basic.
30. Answer: C. Respiratory Acidosis. One of the risk factors of having respiratory acidosis is hypoventilation which may be due to brain trauma, coma, and hypothyroidism or myxedema. Other risk factors include COPD, Respiratory conditions such as pneumothorax, pneumonia and status asthmaticus. Drugs such as Morphine and MgSO4 toxicity are also risk factors of respiratory acidosis.
31. Answer: D. Metabolic Alkalosis. Vomiting, hypokalemia, overdosage of NaHCO3 and NGT suctioning are considered risk factors of metabolic alkalosis.
32. Answer: C. 7.40. Normal blood pH must be maintained within a narrow range of 7.35-7.45 to ensure the proper functioning of metabolic processes and the delivery of the right amount of oxygen to tissues. Acidosis refers to an excess of acid in the blood that causes the pH to fall below 7.35, and alkalosis refers to an excess of base in the blood that causes the pH to rise above 7.45.
33. Answer. C. Metabolic Acidosis. Salicylate overdose causes a high anion gap metabolic acidosis in both children and adults. Adults commonly develop a mixed acid-base disorder as a respiratory alkalosis due to direct respiratory centre stimulation occurs as well. This second disorder is uncommon in children.
34. Answer: B. 36 mm Hg. The normal range for PaCO2 is from 35 to 35 mm Hg.
35. Answer: B. Respiratory Alkalosis. Hyperventilation is typically the underlying cause of respiratory alkalosis. Hyperventilation is also known as overbreathing. When someone is hyperventilating, they tend to breathe very deeply or very rapidly.
36. Answer: B. 24 mmol/L. The normal value for bicarbonate (HCO3) is 22-26 mmol/L or mEq/L. It may vary slightly among different laboratories. The given values show the common measurement range of results for these tests. Some laboratories use different measurements or may test different specimens.
37. Answer: D. Metabolic Alkalosis. NGT suctioning, vomiting, hypokalemia and overdosage of NaHCO3 are considered risk factors of metabolic alkalosis.
38. Answer: B. The pH will rise and PCO2 will fall. The mountaineer will suffer from a respiratory alkalosis. The decline in the PO2 with altitude will stimulate breathing to offset the hypoxia. Carbon dioxide is driven from the blood faster than it is produced in the tissues so PCO2 falls and pH rises.
39. Answer: C. Simultaneous Respiratory and Metabolic Acidosis. Whenever the PCO2 and HCO3 are abnormal in opposite directions, ie, one above normal while the other is reduced, a mixed respiratory and metabolic acid-base disorder exists. When the PCO2 is elevated and the [HCO3-] reduced, respiratory acidosis and metabolic acidosis coexist.
40. Answer: A. Hyperthermia. An individual is considered to have hyperthermia if he or she has a temperature of >37.5 or 38.3 °C (99.5 or 100.9 °F). Measurement of arterial blood gases are normal.