Acid-Base Imbalances

A nurse is reviewing ABG results. Which pH value indicates acid-base balance is within the normal homeostatic range? A. 7.30 B. 7.38 C. 7.47 D. 7.50

B. 7.38

Which statement best describes the relationship between hydrogen ions (H+) and pH? A. High pH means high H+ B. pH is linear scale of protein concentration C. Low pH means more acidic with more H+ D. Bases have more H+ than acids

C. Low pH means more acidic with more H+

The body’s fastest mechanism for resisting pH change is the: A. Renal control B. Respiratory control C. Physiological (chemical) buffer system D. Endocrine regulation

C. Physiological (chemical) buffer system

A client has a pH of 7.25. This state is: A. Alkalemia B. Homeostasis C. Acidemia D. Alkalosis

C. Acidemia

Carbonic acid (H2CO3) is what type of acid? A. Nonvolatile acid B. Volatile acid C. Basic salt D. Fixed acid

B. Volatile acid

Which organs excrete acids from the body? (Select all that apply) A. Lungs B. Liver C. Kidneys D. Pancreas E. Skin

A, C

In a basic environment (increased pH), the hemoglobin buffer system: A. Binds H+ B. Loses H+ C. Converts to bicarbonate D. Increases CO2 production

B. Loses H+

The renal system maintains acid-base balance primarily by regulating: A. CO2 B. Hydrogen peroxide C. Bicarbonate (HCO3-) D. Hemoglobin

C. Bicarbonate (HCO3-)

Normal arterial PaCO2 range is: A. 22–26 mmHg B. 35–45 mmHg C. 7.35–7.45 mmHg D. 80–100 mmHg

B. 35–45 mmHg

A bicarbonate (HCO3-) level of 24 mEq/L is: A. Critically low B. Abnormally high C. Within normal range D. Metabolic acidosis

C. Within normal range

Most common cause of metabolic acidosis is: A. Excess vomiting B. Hyperventilation C. Accumulation of nonvolatile acids D. Overuse of antacids

C. Accumulation of nonvolatile acids

Severe diarrhea places a client at risk for: A. Metabolic alkalosis B. Respiratory acidosis C. Metabolic acidosis D. Respiratory alkalosis

C. Metabolic acidosis

Rapid, deep breathing in metabolic acidosis is: A. Cheyne-Stokes B. Hypoventilation C. Kussmaul respirations D. Apneic episodes

C. Kussmaul respirations

Expected ABG for uncompensated metabolic acidosis is: A. pH 7.50 PaCO2 30 HCO3 24 B. pH 7.30 PaCO2 40 HCO3 18 C. pH 7.32 PaCO2 50 HCO3 26 D. pH 7.48 PaCO2 45 HCO3 30

B. pH 7.30 PaCO2 40 HCO3 18

With compensation for metabolic acidosis, PaCO2 will: A. Increase B. Stay same C. Decrease D. Reach 60 mmHg

C. Decrease

An early symptom of metabolic acidosis is: A. Convulsions B. Blurred vision C. Lethargy and headache D. Flushed skin

C. Lethargy and headache

Which IV fluid is commonly used to treat metabolic acidosis? A. 3% NaCl B. D5W C. Lactated Ringers D. 0.45% NS

C. Lactated Ringers

ABG: pH 7.29 PaCO2 32 HCO3 16 indicates: A. Uncompensated metabolic acidosis B. Metabolic acidosis with respiratory compensation C. Respiratory acidosis D. Metabolic alkalosis

B. Metabolic acidosis with respiratory compensation

Lactic acid is eliminated primarily via the: A. Lungs B. Kidneys C. Sweat glands D. Intestines

B. Kidneys

Which can lead to metabolic acidosis? (Select all that apply) A. Sepsis B. Kidney dysfunction C. Diabetic ketoacidosis D. Prolonged vomiting E. Anxiety attack

A, B, C

Vomiting for 24 hours places a client at risk for: A. Respiratory acidosis B. Metabolic acidosis C. Metabolic alkalosis D. Respiratory alkalosis

C. Metabolic alkalosis

ABG: pH 7.52 PaCO2 40 HCO3 32 indicates: A. Metabolic acidosis B. Respiratory alkalosis C. Uncompensated metabolic alkalosis D. Compensated respiratory acidosis

C. Uncompensated metabolic alkalosis

Lungs compensate for metabolic alkalosis by: A. Hyperventilation to blow off CO2 B. Hypoventilation to retain CO2 C. Increasing depth of breaths D. Switching to anaerobic metabolism

B. Hypoventilation to retain CO2

Which finding suggests respiratory compensation for metabolic alkalosis? A. PaCO2 30 B. PaCO2 50 C. HCO3 18 D. pH 7.30

B. PaCO2 50

Typical IV fluid for metabolic alkalosis is: A. Lactated Ringers B. Normal Saline (0.9% NaCl) C. D5W D. 3% saline

B. Normal Saline (0.9% NaCl)

Which can cause metabolic alkalosis? A. Diarrhea B. Drug overdose C. Excess ingestion of bicarbonate D. Rib fractures

C. Excess ingestion of bicarbonate

With hyperemesis, expected pH change is: A. Decrease below 7.35 B. Stay exactly 7.40 C. Tip toward alkaline above 7.45 D. Drop to 6.8

C. Tip toward alkaline above 7.45

Symptoms of metabolic alkalosis may progress to: A. Flushed skin and restlessness B. Disorientation and Kussmaul respirations C. Confusion and coma D. Rapid shallow breathing

C. Confusion and coma

Kidney compensation for metabolic alkalosis (non-renal cause) is to: A. Retain bicarbonate B. Excrete more bicarbonate C. Hold onto hydrogen ions D. Produce more carbonic acid

B. Excrete more bicarbonate

Which electrolyte alteration is frequently seen in metabolic alkalosis from vomiting? A. High CO2 B. High bicarbonate C. Low pH D. Low bicarbonate

B. High bicarbonate

Opioid overdose with RR 6 breaths/min most likely causes: A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis D. Respiratory alkalosis

B. Respiratory acidosis

Which ABG is consistent with uncompensated respiratory acidosis? A. pH 7.32 PaCO2 52 HCO3 24 B. pH 7.48 PaCO2 30 HCO3 22 C. pH 7.30 PaCO2 38 HCO3 18 D. pH 7.50 PaCO2 48 HCO3 30

A. pH 7.32 PaCO2 52 HCO3 24

Primary compensation for respiratory acidosis is: A. Lungs hyperventilate B. Kidneys excrete bicarbonate and retain H+ C. Kidneys retain bicarbonate and excrete H+ D. Lungs hypoventilate to retain O2

C. Kidneys retain bicarbonate and excrete H+

In chronic respiratory acidosis, nurse expects: A. HCO3 < 22 B. HCO3 > 26 C. PaCO2 < 35 D. pH > 7.45

B. HCO3 > 26

Early symptoms of respiratory acidosis may include: A. Paresthesia and lightheadedness B. Headache, restlessness, flushed skin C. Kussmaul respirations and nausea D. Hypotension and bradycardia

B. Headache, restlessness, flushed skin

Which can lead to respiratory acidosis? (Select all that apply) A. Drug overdose (benzodiazepines) B. Rib fractures C. Airway obstruction D. Panic attack E. Diarrhea

A, B, C

With severe respiratory acidosis, nurse should watch for: A. Increased LOC B. Hyperreflexia C. Disorientation and coma D. Deep rapid breathing

C. Disorientation and coma

Treatment priority for respiratory acidosis is: A. IV bicarbonate B. Treat underlying cause and remove excess CO2 C. Paper bag breathing D. IV Lactated Ringers

B. Treat underlying cause and remove excess CO2

Chemoreceptors respond to acidosis by: A. Decreasing breathing rate B. Telling kidneys stop producing bicarb C. Increasing rate and depth of ventilation D. Telling hemoglobin bind more oxygen

C. Increasing rate and depth of ventilation

“Lungs = Fast” and “Kidneys = Slow” refers to: A. Speed of circulation B. Response time for acid-base compensation C. Rate of drug metabolism D. Speed of water absorption

B. Response time for acid-base compensation

Severe panic attack is most likely to cause: A. Respiratory acidosis B. Metabolic alkalosis C. Respiratory alkalosis D. Metabolic acidosis

C. Respiratory alkalosis

ABG: pH 7.50 PaCO2 28 HCO3 24 indicates: A. Uncompensated respiratory alkalosis B. Compensated metabolic alkalosis C. Respiratory acidosis D. Normal balance

A. Uncompensated respiratory alkalosis

Compensation for respiratory alkalosis involves: A. Lungs retain more CO2 B. Kidneys excrete more H+ C. Kidneys decrease bicarbonate reabsorption D. Kidneys produce more bicarbonate

C. Kidneys decrease bicarbonate reabsorption

A client in respiratory alkalosis may report: A. Flushed skin and blurred vision B. Headache and Kussmaul respirations C. Lightheadedness and paresthesia D. Coma and convulsions

C. Lightheadedness and paresthesia

During compensation for respiratory alkalosis, HCO3- will: A. Increase above 26 B. Decrease below 22 C. Stay 22–26 D. Drop to 0

B. Decrease below 22

An intervention for hyperventilation to counteract CO2 loss is: A. Supplemental oxygen B. Paper bag method C. Prone positioning D. IV bicarbonate

B. Paper bag method

Early pulmonary disease can cause respiratory alkalosis due to: A. CO2 trapping B. Lactic acid accumulation C. Hyperventilation D. Renal failure

C. Hyperventilation

In ROME, “Respiratory Opposite” means: A. Respiratory problems cause opposite symptoms of metabolic problems B. In respiratory imbalances, pH and PaCO2 move in opposite directions C. Lungs and kidneys always do opposite D. Acidosis and alkalosis are opposites

B. In respiratory imbalances, pH and PaCO2 move in opposite directions

ABG: pH 7.48 PaCO2 48 HCO3 30 is: A. Respiratory alkalosis B. Metabolic alkalosis C. Respiratory acidosis D. Metabolic acidosis

B. Metabolic alkalosis

Which ABG requires most immediate intervention? A. pH 7.36 PaCO2 44 HCO3 25 B. pH 7.44 PaCO2 36 HCO3 23 C. pH 7.30 PaCO2 50 HCO3 24 D. pH 7.42 PaCO2 38 HCO3 24

C. pH 7.30 PaCO2 50 HCO3 24