Test Bank: Nursing

A Concept-Based

Approach to

Learning, Volumes

I, II & III, 3rd

Edition, Pearson

Education

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Copyright © 2019 Pearson Education, Inc.

Nursing: A Concept-Based Approach to Learning Vol. 1 2 & 3, 3e (Pearson)

Module 1 Acid-Base Balance

The Concept of Acid-Base Balance

1) A client is brought to the emergency department (ED) after passing out in a local department

store. The client has been fasting and has ketones in the urine. Which acid-base imbalance would

the nurse expect to assess in this client?

A) Metabolic acidosis

B) Respiratory alkalosis

C) Metabolic alkalosis

D) Respiratory acidosis

Answer: A

Explanation: A) A client who is fasting is at risk for development of metabolic acidosis. The

body recognizes fasting as starvation and begins to metabolize its own fatty acids into ketones,

which are metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in

metabolic alkalosis.

B) A client who is fasting is at risk for development of metabolic acidosis. The body recognizes

fasting as starvation and begins to metabolize its own fatty acids into ketones, which are

metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic

alkalosis.

C) A client who is fasting is at risk for development of metabolic acidosis. The body recognizes

fasting as starvation and begins to metabolize its own fatty acids into ketones, which are

metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic

alkalosis.

D) A client who is fasting is at risk for development of metabolic acidosis. The body recognizes

fasting as starvation and begins to metabolize its own fatty acids into ketones, which are

metabolic acids. Starvation would not result in respiratory acidosis or alkalosis or in metabolic

alkalosis.

Page Ref: 6

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods

and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care

that reflects an understanding of human growth and development, pathophysiology,

pharmacology, medical management and nursing management across the health-illness

continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and

Science: Relationships between knowledge/science and quality and safe patient care. | Nursing

Process: Assessment

Learning Outcome: 1.2. Differentiate alterations in acid-base balance.

MNL LO: Analyze the concept of acid-base balance and its application to nursing care.

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Copyright © 2019 Pearson Education, Inc.

2) Which risk factors exhibited by the client presenting in the emergency department (ED) would

place the client at risk for metabolic acidosis? Select all that apply.

A) Abdominal fistulas

B) Chronic obstructive pulmonary disease

C) Pneumonia

D) Acute renal failure

E) Hypovolemic shock

Answer: A, D, E

Explanation: A) Metabolic acidosis is rarely a primary disorder. It usually develops during the

course of another disease; presence of abdominal fistulas, which can cause excess bicarbonate

loss; acute renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and

pneumonia place the client at risk for respiratory acidosis with the increased retention of carbon

dioxide in the blood.

B) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of

another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute

renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia

place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in

the blood.

C) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of

another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute

renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia

place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in

the blood.

D) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of

another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute

renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia

place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in

the blood.

E) Metabolic acidosis is rarely a primary disorder. It usually develops during the course of

another disease; presence of abdominal fistulas, which can cause excess bicarbonate loss; acute

renal failure; and hypovolemic shock. Chronic obstructive pulmonary disease and pneumonia

place the client at risk for respiratory acidosis with the increased retention of carbon dioxide in

the blood.

Page Ref: 6, 14

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods

and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care

that reflects an understanding of human growth and development, pathophysiology,

pharmacology, medical management and nursing management across the health-illness

continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and

Science: Relationships between knowledge/science and quality and safe patient care. | Nursing

Process: Assessment

Learning Outcome: 1.2. Differentiate alterations in acid-base balance.

MNL LO: Analyze the concept of acid-base balance and its application to nursing care.

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Copyright © 2019 Pearson Education, Inc.

3) A child with acute asthma has a PaCO2 of 48 mmHg, a pH of 7.31, and a normal HCO3 blood

gas value. The nurse interprets these findings as indicative of which condition?

A) Metabolic acidosis

B) Respiratory alkalosis

C) Respiratory acidosis

D) Metabolic alkalosis

Answer: C

Explanation: A) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is

uncompensated respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH,

decreased PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH,

normal PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH,

normal PaCO2, and increased HCO3.

B) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated

respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased

PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal

PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH, normal

PaCO2, and increased HCO3.

C) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated

respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased

PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal

PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH, normal

PaCO2, and increased HCO3.

D) If the pH is decreased and the PaCO2 is increased with a normal HCO3, it is uncompensated

respiratory acidosis. Uncompensated respiratory alkalosis has an increased pH, decreased

PaCO2, and normal HCO3. Uncompensated metabolic acidosis has a decreased pH, normal

PaCO2, and decreased HCO3. Uncompensated metabolic alkalosis has an increased pH, normal

PaCO2, and increased HCO3.

Page Ref: 24

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods

and processes. | AACN Essential Competencies: IX.3. Implement holistic, patient-centered care

that reflects an understanding of human growth and development, pathophysiology,

pharmacology, medical management and nursing management across the health-illness

continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Knowledge and

Science: Relationships between knowledge/science and quality and safe patient care. | Nursing

Process: Diagnosis

Learning Outcome: 1.2. Differentiate alterations in acid-base balance.

MNL LO: Analyze the concept of acid-base balance and its application to nursing care.

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