Review Practice Exercise 3

Fluids and Electrolytes & Acid-Base Balance > Fundamentals

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Practice Exercise 3

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Total Questions : 5

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Question 1:

An older client comes to the emergency department experiencing chest pain and shortness of breath. An arterial blood gas is ordered. Which of the following ABG results indicates respiratory acidosis?

A. pH 7.54; PaCO₂ 28 mmHg; HCO₃⁻ 22 mEq/L B. pH 7.32; PaCO₂ 46 mmHg; HCO₃⁻ 24 mEq/L C. pH 7.31; PaCO₂ 35 mmHg; HCO₃⁻ 20 mEq/L D. pH 7.50; PaCO₂ 37 mmHg; HCO₃⁻ 28 mEq/L

Answer and Explanation

Choice A:

pH 7.54; PaCO₂ 28; HCO₃⁻ 22: Respiratory alkalosis (high pH, low PaCO₂).

Choice B:

pH 7.32; PaCO₂ 46; HCO₃⁻ 24: Respiratory acidosis (acute): low pH with elevated PaCO₂; HCO₃⁻ normal (no or minimal compensation).

Choice C:

pH 7.31; PaCO₂ 35; HCO₃⁻ 20: Metabolic acidosis: low pH with low HCO₃⁻; PaCO₂ not elevated.

Choice D:

pH 7.50; PaCO₂ 37; HCO₃⁻ 28: Metabolic alkalosis: high pH with elevated HCO₃⁻ and near-normal PaCO₂.

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Question 2:

The client’s arterial blood gas results are pH 7.32; PaCO₂ 58; HCO₃⁻ 32. The nurse knows that the client is experiencing which acid–base imbalance?

A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis D. Respiratory alkalosis

Answer and Explanation

Choice A:

Metabolic acidosis: In metabolic acidosis you would expect low HCO₃⁻ (not high). Here HCO₃⁻ is elevated, so metabolic acidosis is not the primary problem.

Choice B:

Respiratory acidosis: The pH is acidic and PaCO₂ is markedly elevated (58 mmHg - hypoventilation), indicating a primary respiratory acidosis. The HCO₃⁻ is elevated, reflecting renal (metabolic) compensation.

Choice C:

Metabolic alkalosis: Would present with an elevated pH and elevated HCO₃⁻. Here pH is low, so not metabolic alkalosis.

Choice D:

Respiratory alkalosis: Would present with low PaCO₂ and alkalemia (high pH). This ABG shows the opposite (high PaCO₂ and acidemia), so it’s not respiratory alkalosis.

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Question 3:

Which acid–base imbalance would the nurse suspect after assessing the following arterial blood gas values (pH, 7.30; PaCO₂, 36 mm Hg; HCO3-, 14 mEq/L)?

A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

Answer and Explanation

Choice A:

Respiratory acidosis: Would show low pH with high PaCO₂. Here PaCO₂ is normal, so not respiratory acidosis.

Choice B:

Respiratory alkalosis: Would show high pH with low PaCO₂. Here the pH is low and HCO₃⁻ is abnormal, so not respiratory alkalosis.

Choice C:

Metabolic acidosis: Low pH (acidemia) with low HCO₃⁻ = metabolic acidosis. PaCO₂ is normal, so there’s no respiratory compensation yet.

Choice D:

Metabolic alkalosis: Would show high pH and high HCO₃⁻, which is the opposite of this ABG.

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Question 4:

The nurse alertly assesses the acid–base balance of a patient because she is aware that the patient will be unable to effectively control his carbonic acid supply. This is most likely a patient with bad damage to which of the following?

A. Kidneys B. Lungs C. Adrenal glands D. Blood vessels

Answer and Explanation

Choice A:

Kidneys regulate the metabolic component (bicarbonate HCO₃⁻) and excrete or retain H⁺ and HCO₃⁻; they do not directly control CO₂ (carbonic acid) removal.

Choice B:

Lungs: The lungs control CO₂ elimination (CO₂ + H₂O ↔ H₂CO₃). Impaired ventilation or lung damage prevents effective removal of CO₂, altering the carbonic acid component and causing respiratory acid–base disturbances.

Choice C:

Adrenal glands influence electrolyte and volume status (aldosterone) and can indirectly affect acid–base balance, but they are not the primary controllers of carbonic acid/CO₂.

Choice D:

Blood vessels transport gases and acids but do not control CO₂ elimination; impaired vasculature alone would not be described as inability to control carbonic acid supply.

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Question 5:

Which assessment finding would lead the nurse to suspect that a patient’s IV has infiltrated?

A. In the past hour, only 50 mL of fluid has infused. B. The insertion site is red, hot, and swollen. C. The patient’s temperature has risen to 101°F (38.3°C). D. The site is pale, cool, swollen, and painful.

Answer and Explanation

Choice A:

In the past hour, only 50 mL of fluid has infused: Slow or reduced infusion rate is nonspecific - could indicate an occlusion, a kinking of the tubing, an air or pressure issue, or infiltration, but by itself it is not the most characteristic sign of infiltration.

Choice B:

The insertion site is red, hot, and swollen: Redness and warmth are classic for phlebitis (inflammation of the vein) or local infection, not infiltration. Phlebitis tends to be tender along the course of the vein.

Choice C:

The patient’s temperature has risen to 101°F (38.3°C). A fever suggests systemic infection or catheter-related bacteremia - a serious sign but not the characteristic local finding of infiltration.

Choice D:

The site is pale, cool, swollen, and painful: Infiltration typically causes pallor, coolness at the site (because fluid is in tissue, not in blood flow), swelling, and sometimes pain or discomfort.

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Practice Exercise 3

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