Unit3: Ch 8 (Porth's 5th Ed) Disorders of Fluid and Electrolyte, and Acid Base Balance

Question 1

During a period of extreme excess fluid volume, a renal dialysis patient may be
administered which type of IV solution to shrink the swollen cells by pulling water out
of the cell?
A) 0.9% sodium chloride
B) 5% dextrose and water
C) 3% sodium chloride
D) Lactated Ringer solution

Answer 1

Ans: C
Feedback:
When cells are placed in a hypotonic solution, which has a lower effective osmolality
than the ICF, they swell as water moves into the cell, and when they are placed in a
hypertonic solution, which has a greater effective osmolality than the ICF, they shrink
as water is pulled out of the cell.

Question 2

A 34-year-old male client has diagnoses of liver failure, ascites, and hepatic
encephalopathy secondary to alcohol abuse. The client’s family is questioning the care
team as to why his abdomen is so large even though he is undernourished and
emaciated. Which of the following statements most accurately underlies the explanation
that a member of the care team would provide the family?
A) An inordinate amount of interstitial fluid is accumulating his abdomen.
B) The transcellular component of the intracellular fluid compartment contains far
more fluid than normal.
C) Normally small transcellular fluid compartment, or third space, is becoming
enlarged.
D) Gravity-dependent plasma is accumulating in his peritoneal cavity.

Answer 2

Ans: C
Feedback:
Ascites is characterized by an accumulation of fluid in the transcellular component of
the ECF, not ICF. The fluid is not categorized as belonging to the plasma component of
the ECF.

Question 3

Which of the following individuals would be considered to be at risk for the
development of edema? Select all that apply.
A) An 81-year-old man with right-sided heart failure and hypothyroidism
B) A 60-year-old obese female with a diagnosis of poorly controlled diabetes
mellitus
C) A 34-year-old industrial worker who has suffered extensive burns in a job-related
accident
D) A 77-year-old woman who has an active gastrointestinal bleed and consequent
anemia
E) A 22-year-old female with hypoalbuminemia secondary to malnutrition and
anorexia nervosa

Answer 3

Ans: A, C, E
Feedback:
Right-sided heart failure, burns, and low levels of plasma proteins are all associated
with the development of edema. Diabetes and GI bleeds are not identified as
contributors to edema.

Question 4

. Recognizing the prevalence and incidence of dehydration among older adults, a care
aide at a long-term care facility is in the habit of encouraging residents to drink even
though they may not feel thirsty at the time. Which of the following facts underlies the
care aide’s advice?
A) Older adults often experience a decrease in the sensation of thirst, even when
serum sodium levels are high.
B) The metabolic needs for both fluid and sodium in older adults differ from those of
younger individuals.
C) Regulation and maintenance of effective circulating volume by the kidneys is less
effective in the elderly.
D) The renin–angiotensin–aldosterone system (RAAS) is less able to facilitate
sodium clearance in older adults.

Answer 4

Ans: A
Feedback:
The elderly are prone to hypodipsia even when osmolality and serum sodium levels are
elevated, a fact that is compounded by sensory and/or neurological deficits. Hypodipsia
in the elderly is not related to differing metabolic needs, ineffective kidney function, or
compromise of the RAAS

Question 5

The nurse is providing teaching to a student nurse about how antidiuretic hormone
(ADH) plays a central role in the reabsorption of water by the kidneys. The nursing
student is correct to place the following components of the homeostatic action of ADH
in the correct sequence. Use all the options.
A) Stored ADH is released into circulation.
B) ADH is transported along a neural pathway to the posterior pituitary gland.
C) Aquaporins are inserted into tubular cell membranes.
D) ADH is synthesized by cells in the supraoptic and paraventricular nuclei of the
hypothalamus.
E) Serum osmolality increases

Answer 5

Ans: D, B, E, A, C
Feedback:
ADH is produced in the hypothalamus, sequestered in the pituitary, and is released in
response to increased serum osmolality. Its influence on tubular cells is exerted by way
of the insertion of aquaporins in the tubular membrane

Question 6

A patient arrives in the ED very hypovolemic related to excretion of “at least 3 gallon
jugs of urine in the past 24 hours.” He describes the urine as being clear-like water. The
physician suspects diabetes insipidus. The nurse should be prepared to administer which
of the following medications?
A) Desmopressin acetate (DDAVP)
B) Benadryl, an anticholinergic
C) Calcium gluconate
D) Prednisone

Answer 6

Ans: A
Feedback:
Diabetes insipidus is caused by a deficiency of or a decreased response to ADH. The
preferred drug for treating chronic DI is desmopressin acetate (DDAVP).

Question 7

A patient has been diagnosed with a brain tumor that cannot be removed surgically.
During each office visit, the nurse will be assessing the patient for syndrome of
inappropriate antidiuretic hormone (SIADH). Which of the following assessments
would alert the clinic nurse that the patient may be developing this complication?
A) Complaints that his urine output is decreased, no edema noted in ankles, and
increasing headache
B) Elevated blood glucose levels, dry mucous membranes, and severe projectile
vomiting
C) Fever, diarrhea, and nausea
D) Muscle cramps, pins and needle sensation around the mouth/lips, and unexplained
bruising

Answer 7

Ans: A
Feedback:
SIADH manifests as a dilutional hyponatremia. Decrease urine output, absence of
edema, and headaches are signs of this. Answer choice B relates to s/s of diabetes
insipidus; answer choice C is indicative of common flu s/s; answer choice D is
relates to s/s of hypocalcemia

Question 8

A 77-year-old female hospital patient has contracted Clostridium difficile during her
stay and is experiencing severe diarrhea. Which of the following statements best
conveys a risk that this woman faces?
A) She is susceptible to isotonic fluid volume deficit.
B) She is prone to isotonic fluid volume excess.
C) She could develop third-spacing edema as a result of plasma protein losses.
D) She is at risk of compensatory fluid volume overload secondary to gastrointestinal
water and electrolyte losses.

Answer 8

Ans: A
Feedback:
This woman is at risk of isotonic fluid volume deficit and sodium imbalances as a result
of her diarrhea. She is not likely to develop fluid volume excess or third spacing as
consequences of diarrhea.

Question 9

You are volunteering in the medical tent of a road race on a hot, humid day. A runner
who has collapsed on the road is brought in with the following symptoms: sunken eyes,
a body temperature of 100°F, and a complaint of dizziness while sitting to have his
blood pressure taken (which subsides upon his lying down). These are signs of a fluid
volume deficit. Which of the following treatments should be carried out first?
A) Offer water by mouth.
B) Begin cooling of his body by ice packs.
C) Give him a transfusion of FFP.
D) Give him an electrolyte solution by mouth.

Answer 9

Ans: D
Feedback:
Fluid volume deficit results in postural hypotension (dizziness while upright) due to
decreased blood volume. Sunken eyes and elevated temperature also point to a fluid
volume deficit. The most important action to take is to replace fluid; however, pure
water would be a mistake, since without accompanying electrolytes such as sodium,
hyponatremia (water retention and a decrease in serum osmolality) could result. Thus,
an oral electrolyte solution is recommended; in more severe cases, an IV would be
appropriate.

Question 10

A client is brought to the emergency department with complaints of shortness of breath.
Assessment reveals a full, bounding pulse, severe edema, and audible crackles in lower
lung fields bilaterally. What is the client’s most likely diagnosis?
A) Hyponatremia
B) Fluid volume excess
C) Electrolyte imbalance: hypocalcemia
D) Hyperkalemia

Answer 10

Ans: B
Feedback:
Peripheral and pulmonary edema as well as a bounding pulse and dyspnea are indicators
of fluid volume overload.

Question 11

A 26-year-old male patient with a diagnosis of schizophrenia has been admitted with
suspected hyponatremia after consuming copious quantities of tap water. Given this
diagnosis, what clinical manifestations and lab results should the nurse anticipate the
patient will exhibit?
A) High urine specific gravity, tachycardia, and a weak, thready pulse
B) Low blood pressure, dry mouth, and increased urine osmolality
C) Increased hematocrit and blood urea nitrogen and seizures
D) Muscle weakness, lethargy, and headaches.

Answer 11

Ans: D
Feedback:
Weakness, lethargy, and nausea are noted manifestations of hyponatremia. High urine
specific gravity, tachycardia, and a weak, thread pulse are associated with
hypernatremia, while low blood pressure, fever, and increased urine osmolality are
manifestations of fluid volume deficit. Increased hematocrit and blood urea nitrogen and
seizures are also associated with hypernatremia.

Question 12

An ECG technician is performing an ECG on a hospital patient who has developed
hypokalemia secondary to diuretic use. Which of the following manifestations of the
client’s health problem will the technician anticipate on the ECG?
A) Irregular heart rate and a peaked T wave
B) A low T wave and an absent P wave
C) A prominent U wave and a flattened T wave
D) A narrow QRS complex and an absent U wave

Answer 12

Ans: C
Feedback:
ECG changes associated with hypokalemia include a prominent U wave and a flattening
of the T wave. Atrial fibrillation, a low P wave, and the absence of a U wave are not
associated with hypokalemia.

Question 13

A nurse in a medical unit has noted that a client’s potassium level is elevated at 6.1
mEq/L. The nurse has notified the physician, removed the banana from the client’s
lunch tray, and is performing a focused assessment. When questioned by the client for
the rationale for these actions, which of the following explanations is most appropriate?
A) “Your potassium level is high, and so I need you let me know if you feel
numbness, tingling, or weakness.”
B) “Your potassium levels in the blood are higher than they should be, which brings
a risk of changes in the brain function.”
C) “I’ll need to monitor you today for signs of high potassium; tell me if you feel as if
your heart is beating quickly or irregularly.”
D) “The amount of potassium in your blood is too high, but this can be resolved by
changing the intravenous fluid you are receiving.”

Answer 13

Ans: A
Feedback:
Paresthesia and muscle weakness are manifestations of hyperkalemia. Tachycardia and
dysrhythmias are more commonly associated with hypokalemia, and the greatest risks
associated with potassium imbalances are cardiac rather than neurological.
Hyperkalemia is not normally resolved by correction using IV fluid.

Question 14

A renal failure patient with severe hyperkalemia (K+ level 7.2 mEq/L) has just been
admitted to the nursing unit. Given the severity of this situation, the nurse should be
prepared to administer which intravenous infusion stat?
A) Lactated Ringer solution at 150ml/hr to maintain blood glucose levels
B) Regular insulin infusion, rate dependent on lab values
C) Infusion of Solu-Medrol to decrease irritation to the intravascular system
D) Dilaudid via patient-controlled device (PCA) to control pain

Answer 14

Ans: B
Feedback:
The administration of sodium bicarbonate, -adrenergic agonists, or insulin distributes
potassium into the ICF compartment and rapidly decreases the ECF concentration.
Lactated Ringer solution, steroids, or narcotics will not help to lower potassium levels.

Question 15

Vitamin D is integral to the regulation of calcium and phosphate levels. Put the
following steps in the action of vitamin D into the correct sequence. Use all the options.
A) Vitamin D is present in the skin or intestine.
B) Vitamin D is concentrated in the liver.
C) Absorption of calcium from the intestine increases.
D) Vitamin D is transported to the kidneys.
E) Calcitriol is produced.

Answer 15

Ans: A, B, D, E, C
Feedback:
Vitamin D is either synthesized in the skin by ultraviolet exposure or obtained from the
intestines following ingestion. It is then concentrated in the liver and transported to the
kidneys

Question 16

A 52-year-old patient has just passed a kidney stone and has high levels of calcium in
her urine. Blood tests show high levels of calcium in her blood as well. What
subsequent lab results would be most likely to distinguish between primary
hyperparathyroidism and hypercalcemia of malignancy?
A) Parathyroid hormone level
B) Bone scan
C) Plasma phosphate levels
D) Serum magnesium level

Answer 16

Ans: A
Feedback:
Hyperparathyroidism, in which parathyroid hormone is secreted in excess, may be
caused by a parathyroid adenoma. Since parathyroid hormone mobilizes calcium from
bone and promotes its transfer to the extracellular fluid, excess calcium is excreted in
the urine (promoting the development of kidney stones) and is evident in the plasma. In
primary hyperparathyroidism, antibody binding assays of intact PTH would reveal
either normal or elevated parathyroid hormone in the face of hypercalcemia, whereas in
hypercalcemia of malignancy, levels of intact PTH are suppressed.

Question 17

An 81-year-old female has a long-standing diagnosis of hypocalcemia secondary to
kidney disease. She will be moving into an assisted living facility shortly. Which of the
following clinical manifestations would the nursing staff at the facility likely observe in
this patient?
A) Loss of appetite and complaints of nausea
B) Muscular spasms and complaints of tingling in the hands/feet
C) High fluid intake and copious amounts of dilute urine output
D) Lethargy and change in level of consciousness

Answer 17

Ans: B
Feedback:
Muscular spasms and cramping are common manifestations of low serum calcium.
Polydipsia, polyuria, anorexia, lethargy, and stupor are associated with hypercalcemia.

Question 18

A terminally ill cancer patient with metastasis to the bone has been admitted with
elevated calcium levels (hypercalcemic crisis). The patient is very lethargic and
exhibiting muscle flaccidity. The nurse should be prepared to administer (Select all that
apply.)
A) pamidronate, a bisphosphonate.
B) intravenous drip of insulin.
C) furosemide, a loop diuretic.
D) gallium nitrate, a gallium salt of nitric acid.
E) prednisone, a corticosteroid.

Answer 18

Ans: A, D, E
Feedback:
The bisphosphonates (e.g.,pamidronate, zoledronate), which act mainly by inhibiting
osteoclastic activity, provide a significant reduction in calcium levels with relatively few
side effects. Calcitonin also inhibits osteoclastic activity. Gallium nitrate is highly
effective in the treatment of severe hypercalcemia associated with malignancy.
Prednisone, a corticosteroid, inhibits bone resorption.

Question 19

A 56-year-old female hospital patient with a history of alcohol abuse is receiving
intravenous (IV) phosphate replacement. Which of the following health problems will
this IV therapy most likely resolve?
A) The client has an accumulation of fluid in her peritoneal cavity.
B) The client is acidotic and has impaired platelet function
C) The client has an irregular heart rate and a thread pulse.
D) The client has abdominal spasms and hyperactive reflexes.

Answer 19

Ans: B
Feedback:
Phosphate is necessary for the normal function of platelets and the excretion of
hydrogen ions that contribute to acidosis. Phosphate replacement would be unlikely to
resolve ascites and cardiac anomalies, while abdominal spasms and hyperactive reflexes
are more likely consequences of low calcium levels.

Question 20

A patient who has had a prolonged period of nasogastric (NG) suctioning following
colon surgery is experiencing electrolyte imbalances. The magnesium level is low (1.2
mg/dL). Knowing that magnesium deficiency occurs in conjunction with low calcium
levels, the nurse should assess the patient for which of the following clinical
manifestations of hypocalcaemia? Select all that apply.
A) Personality changes
B) Hyperactive reflexes
C) Increase in ventricular arrhythmias
D) Increase in bouts of atrial fibrillation
E) Symptomatic hypotension

Answer 20

Ans: A, B, C
Feedback:
Hypocalcaemia may be evidenced by personality changes and neuromuscular irritability
along with tremors, choreiform movements, and positive Chvostek or Trousseau signs.
Cardiovascular manifestations include tachycardia, hypertension, and ventricular
dysrhythmias.

Question 21

A male patient with a history of heavy alcohol use has been admitted to hospital for
malnutrition and suspected pancreatitis. The patient’s diagnostic workup suggests
alcoholic ketoacidosis as a component of his current health problems. He is somewhat
familiar with the effect that drinking has had on his nutrition and pancreas but is
wholly unfamiliar with the significance of acid–base balance. How best could his care
provider explain the concept to him?
A) “The chemical processes that take place throughout your body are thrown off very
easily when your body is too acidic or not acidic enough.
B) “The multitude of chemical reactions that take place in your body depend on your
body fluids being slightly acidic.”
C) “The healthy function of your kidneys and your lungs requires a specific level of
pH in your body.”
D) “Your body is highly dependent on what food and fluid you consume to keep itself
at a functioning level of slight nonacidity.”

Answer 21

Ans: A
Feedback:
Metabolic activity is highly contingent on a narrow range of pH. Normal pH is slightly
basic, not acidic, and appropriate pH is maintained by the lungs and kidneys, not vice
versa. The action of the respiratory and renal systems, not particular food or fluid intake,
has the most salient effect on the acid–base balance.

Question 22

When explaining how carbon dioxide combines with water to form carbonic acid as part
of acid–base lecture, the faculty instructor emphasized that which enzyme is needed as a
catalyst for this reaction?
A) Carbonic anhydrase
B) Phenylalanie hdroxylase
C) Hydrolases
D) Trypsin

Answer 22

Ans: A
Feedback:
Although CO2 is a gas and not an acid, a small percentage of the gas combines with
water to form H2CO3. The reaction that generates H2CO3 from CO2 and water is
catalyzed by an enzyme called carbonic anhydrase

Question 23

A 31-year-old client with a diagnosis of end-stage liver failure has been admitted to t he
intensive care unit of a hospital. Arterial blood sampling indicates that the man has a n
acid–base imbalance. Which of the following situations is most likely to result in an
inappropriate pH?
A) Conservation or formation of new HCO 3
– by the kidneys
B) Low albumin and plasma globulin levels
C) Transcompartmental exchange of H+ a nd potassium ions
D) Renal excretion of HCO 3
– in the presence of excess base

Answer 23

Ans: B
Feedback:
Albumin and plasma globulins are key protein buffers in the vascular compartment;
consequently, a low albumin level, as is common in liver failure, is apt to result in
acid–base imbalances. Answer choices A, C, and D all convey normal physiological
processes that help to maintain pH.

Question 24

A patient with ESRD comes into the emergency department in severe acidosis. The
nurse notes that the respiratory rate is 36 breaths/minute. The nurse understands the
pathophysiology of this response and explains t o the student nurse that the patient’s
A) anxiety level is high, and the body i s trying t o release endorphins.
B) chemoreceptors in the carotid and aortic bodies have noticed the pH change a nd
altered the ventilator rate.
C) kidneys are not able to buffer the acid and require the help from the lungs.
D) lungs are trying to excrete hydrogen.

Answer 24

Ans. B
Feedback:
The second line of defense against acid–base disturbances is the control of extracellular
CO2 by the lungs. Blood PCO2 and pH are important regulators of ventilation.
Chemoreceptors in the brain stem and the peripheral chemoreceptors in the carotid and
aortic bodies sense changes in PCO2 and pH and alter the ventilatory rate

Question 25

Place the following stages of the hydrogen ion elimination and bicarbonate conservatio n
in the proximal tubules of the nephrons in the ascending chronological order. Use all the
options.
A) CO2 and H2O are produced.
B) H+ is secreting into the tubular fluid.
C) Carbonic acid is produced.
D) H+ combines with filtere d HCO 3–

Answer 25

Ans: B, D, C, A
Feedback:
Renal regulation of pH involves the secretion of hydrogen ions into the tubular fluid, t he
combining of hydrogen ions with bicarbonate yielding carbonic acid, followe d by the
decomposition of carbonic acid into carbon dioxide and water.

Question 26

. Following several days in an acidotic state, a hospital patient has returned to desired pH.
Which of the following processes could have contributed to the resolution of the
patient’s health problem?
A) Exchange of Na+ and H+ ions
B) Selective renal secretion and reabsorption of CO2
C) The phosphate and ammonia buffer systems in the renal tubules
D) Excretion of HCO 3
– by the kidneys

Answer 26

Ans. C
Feedback:
The phosphate and ammonia buffer systems are secondary, but important, processes that
contribute to the maintenance of appropriate pH. The kidneys must reabsorb nearly all the body’s stores of HCO 3
– to maintain homeostasis, and they are not involved in CO 2
control. Hydrogen–potassium exchange, not hydrogen–sodium exchange, is a
component of acid–base control.

Question 27

When trying to explain the role of potassium and hydrogen related to acid–base balance,
which of the following statements is accurate?
A) Hypokalemia stimulates H+ secretion.
B) Hyperkalemia will cause the reabsorption of HCO3.
C) Acidosis causes an increase in K+ elimination.
D) Alkalosis tends to increase H+ elimination

Answer 27

Ans: A
Feedback:
Hypokalemia is a potent stimulus for H+ secretion and HCO3 reabsorption. Acidosis
tends to increase H+ elimination and decrease K+ elimination, with a resultant increase
in plasma potassium levels, whereas alkalosis tends to decrease H+ elimination and
increase K+ elimination, with a resultant decrease in plasma K+ levels.

Question 28

A client with poorly controlled diabetes mellitus presents to the emergency department
with suspected ketoacidosis. Which of the following diagnostic results would most
likely confirm this diagnosis?
A) Low O2 levels, increased anion gap, base excess
B) High ammonia levels, decreased anion gap, high potassium
C) Increased anion gap, base deficit
D) Decreased anion gap, decreased urine ammonium level

Answer 28

Ans: C
Feedback:
Increased CO2 levels, an increased anion gap, and a base deficit are all associated with
an acidotic state. Base excess, low oxygen, high potassium, high ammonia, and
decreased anion gap would not suggest acidosis.

Question 29

. A patient who has just had her first postoperative dinner out to celebrate her recovery
from an intestinal bypass is brought to the emergency room by her spouse. He reports
that the patient seems disoriented and is slurring her words. The patient did not have any
alcohol with her pasta dinner. Which of the following might be the cause of her
symptoms?
A) Ketoacidosis
B) Lactic acidosis
C) Hypercapnia
D) Hypothalemia

Answer 29

Ans: B
Feedback:
A unique form of lactic acidosis, called D-lactic acidosis, can occur in persons with
intestinal disorders that involve the generation and absorption of D-lactic acid. D-lactic
acidosis can occur in persons with jejunoileal bypass, in which there is impaired
reabsorption of carbohydrate in the small intestine. Persons with D-lactic acidosis
experience episodic periods of metabolic acidosis often brought on by eating a meal
high in carbohydrates. Manifestations include confusion, cerebellar ataxia, slurred
speech, and loss of memory. They may complain of feeling (or may appear) intoxicated.

Question 30

The nurse is caring for a patient with ketoacidosis, who is complaining of increasing
lethargy and occasional confusion following several weeks of rigid adherence to a
carbohydrate-free diet. The nurse understands which of the following phenomena is
most likely occurring?
A) High-fat, low-carbohydrate dietary intake is associated with respiratory acidosis.
B) In the absence of carbohydrate energy sources, her body is metabolizing fat and
releasing ketoacids.
C) Metabolism of dietary fats without the buffer action of carbohydrates results in the
catabolism of ketoacids.
D) Decreased carbohydrate intake induces insulin deficiency and consequent
ketoacidosis.

Answer 30

Ans: B
Feedback:
Low-carbohydrate diets can induce the fat metabolism and consequent metabolic
acidosis that is more commonly associated with diabetic ketoacidosis. The acidotic state
is not classified as respiratory in nature and does not involve a buffer role for
carbohydrates or insulin deficiency

Question 31

A 14-year-old boy, appearing to be intoxicated, is brought to the emergency room by
ambulance. The EMTs report that the boy has denied consuming anything out of the
ordinary, but an open antifreeze container was found in the boy’s room. Which of the
following is likely to be used to treat the patient’s symptoms?
A) Gastric lavage
B) Syrup of ipecac
C) Fomepizole
D) Sodium bicarbonate

Answer 31

Ans: C
Feedback:
Ethylene glycol is found in products ranging from antifreeze and deicing solutions to
carpet and fabric cleaners. It tastes sweet and is intoxicating—the factors that contribute
to its abuse potential. A lethal dose is approximately 100 mL. It is rapidly absorbed
from the intestine, making treatment with either gastric lavage or syrup of ipecac
ineffective. Fomepizole, with specific indications for ethylene glycol poisoning, was
recently approved by the U.S. Food and Drug Administration.

Question 32

A patient who overdosed on aspirin is brought to the emergency department. The nurse
caring for this patient should anticipate which of the following clinical manifestations?
Select all that apply.
A) Respiratory rate of 40
B) BP 100/72
C) ABG report: pH 7.50, PC02 31mmHg, HCO3 level 19 mmol/L.
D) Urine output approximately 100 mL/hour
E) Bilateral crackles (fluid) in the lungs

Answer 32

Ans: A, C
Feedback:
The salicylates cross the blood–brain barrier and directly stimulate the respiratory
center, causing hyperventilation and respiratory alkalosis (answer choices A and C). The
blood pressure is at normal range, and the urine output is normal or excessive depending
on fluid intake. Bilateral crackles (fluid) in the lungs are usually a sign of heart failure

Question 33

Which of the following individuals are at risk of developing metabolic alkalosis? Select
all that apply.
A) A 70-year-old woman who has taken two tablespoons of baking soda to settle her
“sour stomach”
B) A hospital patient who is on nasogastric suction following gastric surgery
C) A 20-year-old male who has been regularly inducing himself to vomit following
binge eating
D) A 33-year-old male patient who is on mechanical ventilation in the intensive care
unit following a head injury
E) A 58-year-old alcoholic male who has been foregoing food for several weeks
while drinking heavily
F) A 60-year-old female who has chronic renal failure secondary to hypertension

Answer 33

Ans: A, B, C
Feedback:
Ingestion of bicarbonate, gastric suction, and vomiting are causes of metabolic alkalosis.
Patients on mechanical ventilation are at risk of respiratory alkalosis, while heavy
alcohol use and renal failure are associated with acidosis.

Question 34

A 55-year-old male client with a history of cardiovascular disease has been admitted to
the intensive care unit after recovering from cardiogenic shock. In the hours since
admission, the client’s arterial blood gases indicate acidosis, most likely acute lactic
acidosis. Which of the following signs, symptoms, and diagnostic findings might his
care team anticipate before the acid-base balance is restored? Select all that apply.
A) Decreased pH
B) Cardiac dysrhythmias
C) Decreased alertness and cognition
D) Hypoventilation
E) Nausea and vomiting

Answer 34

Ans: A, B, C, E
Feedback:
As with any form of acidosis, pH is apt to be lower than normal. Metabolic acidosis is
also associated with dysrhythmias, decreased alertness, and nausea and vomiting.
Respiration is likely to be increased in both rate and depth.

Question 35

A nurse is providing care for a client who has been diagnosed with metabolic alkalosis
after several days of antacid use. Which of the following treatments should the nurse
prepare to give?
A) Intravenous or oral administration of free hydrogen ions
B) Intravenous administration of KCl solution
C) Administration of oxygen and NaHCO3 solution
D) Supplementary oxygen and possible mechanical ventilation

Answer 35

Ans: B
Feedback:
KCl administration facilitates the renal retention of hydrogen ions, resulting in lowering
of pH. It is not possible to administer free H+ ions, and sodium bicarbonate would
exacerbate her condition. Mechanical ventilation is indicated in cases of respiratory
acidosis

Question 36

A hospital patient’s arterial blood gases indicate normal levels of oxygen and increased
carbon dioxide. The patient’s respiratory rate is 12 breaths/minute (normal 14 to 20
breaths/minute) with all other vital signs within normal range. While not evident from
assessment and diagnostics, the patient’s kidneys are minimizing both H+ excretion and
HCO 3
– reabsorption. What is this client’s most likely diagnosis?
A) Respiratory alkalosis
B) Metabolic acidosis
C) Respiratory acidosis
D) Metabolic alkalosis

Answer 36

Ans: D
Feedback:
In response to increased bicarbonate, the client is hypoventilating to increase carbon
dioxide partial pressure. As well, renal compensation is aimed at lowering pH by both
reducing H+ excretion and HCO3
– reabsorption. The given data are incongruent with the
other major acid–base imbalances.

Question 37

A 77-year-old female diagnosed with chronic obstructive pulmonary disease (COPD) is
experiencing impaired gas exchange and CO2 retention, despite a rapid respiratory rate.
Which of the following pathophysiological principles would her health care team expect
if her compensatory mechanisms are working?
A) Arterial blood gas sampling indicates a pH in the range of 7.45 to 7.55.
B) Her kidneys are likely to reabsorb H+ and secrete HCO 3–
C) Her body will produce excess metabolic CO2.
D) Her kidneys will adapt with an increase in plasma HCO 3
– and her pH will
decrease

Answer 37

Ans: D
Feedback:
Respiratory acidosis is accompanied by renal adaptation with a more marked increase in
plasma HCO – and a lesser decrease in pH. Her pH is likely below 7.35, and the likely
renal response involves the reabsorption of HCO – and secretion of H+
. Excess CO
production is not a common manifestation of obstructive lung disease.

Question 38

The ICU nurse is concerned with her patient’s arterial blood gas (ABG) results—
especially the pH 7.30; and PCO2 49 mm Hg. The nurse interprets these ABG results to
mean respiratory acidosis. The nurse knows which of the following are clinical
manifestations of respiratory acidosis? Select all that apply.
A) Headache with complaints of blurred vision
B) Muscle twitching
C) Hyperactive deep tendon reflexes
D) Complaints of paresthesia sensations around the lips/mouth
E) Numbness in the fingers and toes

Answer 38

Ans: A, B
Feedback:
Carbon dioxide readily crosses the blood–brain barrier, exerting its effects by changing
the pH of brain fluids. Elevated levels of CO2 produce vasodilation of cerebral blood
vessels, causing headache, blurred vision, irritability, muscle twitching, and
psychological disturbances. Distracters C and D are related to hypocalcaemia.
Numbness in the fingers and toes correlates with respiratory alkalosis.

Question 39

A 55-year-old woman has presented to the emergency department following a panic
attack. Her blood pressure, respiratory rate, and heart rate are all highly elevated, while
her temperature and oxygen saturation are within normal ranges. What is the woman’s
body most likely doing to address the changes in pH associated with her situation?
A) Her kidneys will limit the amount of bicarbonate that they reabsorb.
B) She will be retaining Cl– ions in an effort to lower pH.
C) Her respiratory center will attempt to lower her CO2 levels.
D) The patient’s kidneys will excrete more hydrogen ions than they normally do

Answer 39

Ans: A
Feedback:
Renal compensation for respiratory alkalosis involves decreased bicarbonate
reabsorption. Manipulation of Cl– ions is not a compensatory mechanism that the body
is capable of, and increased CO2 levels and decreased H+
would compensate for her
acid–base imbalance

Question 40

In the neurotrauma unit, a teenager with a closed head injury related to an automobile
accident is experiencing high intracranial pressure (ICP). He is intubated and is on a
ventilator. One treatment for this is to allow him to progress into which acid–base
imbalance in an attempt to lower ICP?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis

Answer 40

Ans: D
Feedback:
Respiratory alkalosis is seen as a treatment with the ventilator with intubated people
experiencing high intracranial pressure (ICP) in order to attempt to lower the ICP.