pq 9/10

Question 1

Is there a respiratory acidosis or respiratory alkalosis?
ABG: 7.32
PCO2: 50
99% O2 saturation on room air

Answer 1

Respiratory acidosis

Question 2

Is there a respiratory acidosis or respiratory alkalosis?
ABG: 7.52P
PCO2: 20
99% O2 saturation on room air

Answer 2

respiratory alkalosis

Question 3

You are asked to check on a teenager who just witnessed a traffic accident. He is hysterical and says he “might pass out.” You draw an ABG and get the following results: pH 7.42, PaCO2 38, PaO2 90 on room air. You interpret the results as:
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Normal

Answer 3

C. normal

Question 4

A very anxious patient who is hyperventilating would be expected to have a ABG results consistent with:
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis
E. Respiratory alkalosis and metabolic acidosis

Answer 4

C. respiratory alkalosis

Question 5

A patient with opiate overdose (took a bottle of oxycodone) and a respiration rate of 8 would be expected to have ABG results consistent with?
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis
E. Respiratory alkalosis and metabolic acidosis

Answer 5

D. respiratory acidosis

Question 6

A 12-year-old boy is admitted to complaining of difficulty in breathing. Arterial blood gas (ABG) studies performed while the patient is breathing room air (21% oxygen) reveal pH: 7.21; Po2, 65 mm Hg; Pco2, 62 mm Hg; and Hco3, 24mEq/liter. Which of the following reflect this child’s ABG results?
Metabolic Alkalosis
Metabolic Acidosis
Respiratory Alkalosis
Respiratory Acidosis

Answer 6

D. respiratory acidosis

Question 7

Arterial blood gas (ABG) studies reveal Na 140, Cl 104, HCO3 18. -

1) Does this patient have a increased anion gap? Na 140, Cl 104, HCO3 18.

2) What is the DDX?

Answer 7

1. yes
2. MUDPILES

Question 8

What is the primary disorder?
pH: 7.6 PCO2: 30 HCO3: 22
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Metabolic acidosis

Answer 8

A. respiratory alkalosis

Question 9

What is the primary disorder?
pH: 7.25 PCO2: 55 HCO3: 25
A. Metabolic alkalosis
B. Respiratory acidosis
C. Respiratory alkalosis
D. Metabolic acidosis

Answer 9

B. Respiratory acidosis

Question 10

What is the anion gap?
ABG: pH 7.21 Electrolytes: Na 145 mEq/L, K 4.5 mEq/L, Cl 105 mEq/L,
HCO3 25 mEq/L
A. 40
B. 35
C. 12
D. 15

Answer 10

D. 15

Question 11

What is the primary disorder?
pH: 7.25
PCO2: 40 HCO3: 18
A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Metabolic alkalosis

Answer 11

C. metabolic acidosis

Question 12

What is the primary disorder?
pH: 7.55 PCO2: 40 HCO3: 32
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis

Answer 12

D. Metabolic alkalosis

Question 13

A 24 year-old woman is found down by some bystanders. The medics are called and, upon arrival, find her with an oxygen saturation of 88% on room air and pinpoint pupils on exam. She is brought into the Harborview ER where a room air arterial blood gas is performed and reveals: pH 7.25, PCO2 60, PO2 65, HCO326, Base Excess 1.On his chemistry panel, her sodium is 137, chloride 100, bicarbonate 27.What is the primary disorder?
Group of answer choices
A. Metabolic acidosis
B. Respiratory acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis

Answer 13

B. Respiratory acidosis

Question 14

You are asked to review a 63-year-old female who was admitted with shortness of breath. On your arrival, the patient appears drowsy and is on 10L of oxygen via a mask. You perform an ABG, which reveals the following results:
PaO2: 52.5 mmHg(82.5 – 97.5 mmHg)
pH: 7.29 (7.35 – 7.45)
PaCO2: 68.2 mmHg (35.2 – 45 mmHg)
HCO3–: 26 (22 – 26 mEq/L)
Base excess: +1 (-2 to +2)
What does the ABG show?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis

Answer 14

A. Respiratory acidosis

Question 15

A 17-year-old patient presents to A&E complaining of a tight feeling in their chest, shortness of breath as well as some tingling in their fingers and around their mouth. They have no significant past medical history and are not on any regular medication. An ABG is performed on the patient whilst they’re breathing room air and the results are shown below:
PaO2: 105 mmHg(82.5 – 97.5 mmHg)
pH: 7.49(7.35 – 7.45)
PaCO2: 24mmHg (35.2 – 45 mmHg)
HCO3–: 22(22 – 26 mEq/L)
HCO3–: 22(22 – 26 mEq/L)
Base excess: +2(-2 to +2)
What does the ABG show?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis

Answer 15

C. Respiratory alkalosis

Question 16

An 89-year-old patient presents with fever, rigors, hypotension and reduced urine output. They appear confused and are unable to provide any meaningful history. The care home that the patient came from has provided some basic documentation. You look through the information available and note that the district nurse changed this patient’s catheter 24 hours ago. The medical registrar commences antibiotics, aggressive fluid resuscitation and asks you to perform an arterial blood gas, with the results shown below. The patient was not on oxygen at the time of the ABG.
PaO2: 93 mmHg (82.5 – 97.5 mmHg)
pH: 7.29 (7.35 – 7.45)
PaCO2: 41.2 mmHg(35.2 – 45 mmHg)
HCO3-: 15 (22 – 26 mEq/L)
Base excess: – 4(-2 to +2)
What does the ABG show?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis

Answer 16

B. Metabolic acidosis

Question 17

A 22-year-old female is brought into A&E by ambulance with a 5-day history of vomiting and lethargy. When you begin to talk with the patient you note that she appears disorientated and looks clinically dehydrated. At present, you are unable to gain any further details, but the patient looks very unwell from the end of the bed. You gain IV access, send off a routine panel of bloods and commence some fluids. You ask the nurse to check the patient’s observations and she notes an increased respiratory rate, low blood pressure and tachycardia. You perform an ABG on the advice of your registrar. The results of the ABG are shown below (the patient was not on oxygen when this was taken).
PaO2: 97.5 mmHg (82.5 – 97.5 mmHg)
pH: 7.3(7.35 – 7.45)
PaCO2: 30.7 mmHg (35.2 – 45 mmHg)
HCO3-: 13 (22 – 26 mEq/L)
Base excess: -4 (-2 to +2)
What does the ABG show?
A. Respiratory acidosis with renal compensation
B. Metabolic acidosis with respiratory compensation
C. Respiratory alkalosis renal compensation
D. Metabolic alkalosis respiratory compensation

Answer 17

B. Metabolic acidosis with respiratory compensation

Question 18

A 56-year-old man was found unconscious at home with a respiratory rate of 6 breaths per minute and pinprick pupils. An ambulance was called and the paramedics administered some naloxone. On arrival to A&E his ABG showed the following (not on oxygen at the time of the ABG):
PaO2: 59 mmHg (82.5 – 97.5 mmHg)
pH: 7.31(7.35 – 7.45)
PaCO2:53 mmHg (35.2 – 45 mmHg)
HCO3-: 22(22 – 26 mEq/L)
Base Excess: +1(-2 to +2)
What does the ABG show?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis

Answer 18

A. respiratory acidosis

Question 19

A 77-year-old lady was admitted to hospital 10 days ago with a fractured neck of femur. The orthopaedic team repaired the fracture and she has been an inpatient on the orthopaedic ward recovering ever since. The patient’s nurse is becoming increasingly concerned as the patient’s oxygen requirements are increasing (she is now on 3L) and the patient is now tachyapnoeic (respiratory rate 35). In addition, the patient has recently started complaining of calf pain. You review the patient and perform an ABG which reveals the following:
PaO2: 45 mmHg (82.5 – 97.5 mmHg)
pH: 7.51(7.35 – 7.45)
PaCO2: 23.2 mmHg (35.2 – 45 mmHg)
HCO3-: 21(22 – 26 mEq/L)
Base Excess: 0(-2 to +2)
What does the ABG show?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis

Answer 19

C. respiratory alkalosis

Question 20

For which of the following electrolyte abnormalities should you be particularly vigilant?
Hyperkalemia.
Hypermagnesemia
Hypocalcemia
Hypophosphatemia

Answer 20

A. hyperkalemia

Question 21

You are seeing a 48-year-old woman in your office for fatigue. A nurse who just took the patient’s vital signs noted a spasm in the patient’s right hand when the blood pressure cuff was fully inflated on that arm. During your interview, you notice the patient’s cheek muscles twitch when she scratches her cheek. She mentions that her fingertips, toes, and perioral region are numb and tingling. Which of the following electrolyte abnormalities is associated with these findings?
Hypercalcemia
Hypocalcemia.
C. Hypermagnesemia.
D. Hyperkalemia.

Answer 21

B. hypocalcemia

Question 22

You have admitted a 70-year-old woman who has a serum potassium level of 2.8 mmol/L (normal reference, 3.5-5 mmol/L). She has a long history of essential hypertension, for which takes daily hydrochlorothiazide (recently increased to 50 mg/d with good result). Her physical examination is normal and she has no electrocardiographic (EKG) changes. You start intravenous (IV) and oral potassium supplementation. After 3 days, her serum potassium level remains at 2.9 mmol/L. Which of the following electrolyte abnormalities may be responsible for her refractory hypokalemia?
A. Hyponatremia.
B. Hypocalcemia.
C. Hypomagnesemia.
D. Hypophosphatemia.

Answer 22

C. Hypomagnesemia

Question 23

You are managing a 37-year-old woman who has just delivered her third child. During this last pregnancy, she had late-onset accelerated hypertension consistent with preeclampsia. Immediately after her delivery, IV magnesium therapy is initiated to prevent worsening of the hypertension. You are monitoring for magnesium toxicity. Which of the following conditions would be an indication of magnesium toxicity?
A. Hyperventilation.
B. Hyporeflexia.
C. Polyuria.
D. Seizures.

Answer 23

B. Hyporeflexia

Question 24

You are seeing an 84-year-old man in your office, accompanied by his daughter. His only significant medical diagnosis is hypertension, which is well controlled with low-dose hydrochlorothiazide. He says he has had increasing confusion over the past several weeks, and an upset stomach. His daughter reports that he has had increasing difficulty with constipation for a week or so. Although confused, the patient reports that he has been taking a large amount of an antacid for the past month in an effort to control his dyspepsia. Which of the following conditions might explain his constellation of symptoms?
A. Metabolic alkalosis secondary to antacid use.
B. Hypomagnesemia secondary to diuretic use.
C. Hyponatremia secondary to diuretic use.
D. Hypercalcemia secondary to antacid use.

Answer 24

D. Hypercalcemia secondary to antacid use

Question 25

All of the following changes would tend to cause interstitial fluid edema in a tissue EXCEPT one. Which one is the EXCEPTION?
A. Increased venous resistance
B. Increased venous pressure
C. Increased capillary filtration coefficient
D. Increased plasma protein concentration

Answer 25

D. increased plasma protein concentration

Question 26

A common collaborative problem related to both hyperkalemia and hypokalemia is which potential complication?
A. Seizures
B. Paralysis
C. Dysrhythmias
D. Acute kidney injury

Answer 26

C. dysrhythmias

Question 27

In a patient with sodium imbalances, the primary clinical manifestations are related to alterations in what body system?
A. Kidneys
B. Cardiovascular system
C. Musculoskeletal system
D. Central nervous system

Answer 27

D. central nervous system

Question 28

In a patient with a positive Chvostek’s sign, the nurse would expect the IV administration of which medication?
A. Calcitonin
B. Vitamin D
C. Loop diuretics
D. Calcium gluconate

Answer 28

D. calcium gluconate

Question 29

Which of the following statements is incorrect?
A. Beta-adrenergic stimulation would tend to cause hypokalemia by shifting potassium from the extracellular fluid into the cells
B. Injection of excess insulin into a patient would tend to cause hypokalemia
C. Strenuous, sustained exercise may tend to cause significant hyperkalemia
D. Increased extracellular fluid osmolarity would tend to cause hypokalemia

Answer 29

D. increased extracellular fluid osmolarity would tend to cause hypokalemia