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ABG Analysis NCLEX Exam 2

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1. Dave, a 6-year-old boy, was rushed to the hospital following her mothers
complaint that her son has been vomiting, nauseated and has overall
weakness. After series of tests, the nurse notes the laboratory results:
potassium: 2.9 mEq. Which primary acid-base imbalance is this boy at risk
for if medical intervention is not carried out?

A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis

2. An old beggar was admitted to the emergency department due to


shortness of breath, fever, and a productive cough. Upon examination,
crackles and wheezes are noted in the lower lobes; he appears to be
tachycardic and has a bounding pulse. Measurement of arterial blood gas
shows pH 7.2, PaCO2 66 mm Hg, HCO3 27 mmol/L, and PaO2 65 mm Hg. As
a knowledgeable nurse, you know that the normal value for pH is:

A. 7.20
B. 7.30
C. 7.40
D. 7.50

3. Lizas mother is seen in the emergency department at a community


hospital. She admits that her mother is taking many tablets of aspirin
(salicylates) over the last 24-hour period because of a severe headache.
Also, the mother complains of an inability to urinate. The nurse on duty
took her vital signs and noted the following: Temp = 97.8 F; apical pulse =
95; respiration = 32 and deep. Which primary acid-base imbalance is the
gentleman at risk for if medical attention is not provided?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis

4. A patient who is hospitalized due to vomiting and a decreased level of


consciousness displays slow and deep (Kussmaul breathing), and he is
lethargic and irritable in response to stimulation. The doctor diagnosed him
of having dehydration. Measurement of arterial blood gas shows pH 7.0,
PaO2 90 mm Hg, PaCO2 22 mm Hg, and HCO3 14 mmol/L; other results are
Na+ 120 mmol/L, K+ 2.5 mmol/L, and Cl- 95 mmol/L. As a knowledgeable
nurse, you know that the normal value for PaCO2 is:

A. 22 mm Hg
B. 36 mm Hg
C. 48 mm Hg
D. 50 mm Hg

5. A company driver is found at the scene of an automobile accident in a


state of emotional distress. He tells the paramedics that he feels dizzy,
tingling in his fingertips, and does not remember what happened to his car.
Respiratory rate is rapid at 34/minute. Which primary acid-base
disturbance is the young man at risk for if medical attention is not
provided?

A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis

6. An old man was admitted to hospital in a coma. Analysis of the arterial


blood gave the following values: PCO2 16 mm Hg, HCO3- 5 mmol/L and pH
7.1. As a well-rounded nurse, you know that the normal value for HCO3 is:

A. 20 mmol/L
B. 24 mmol/L
C. 29 mmol/L
D. 31 mmol/L
7. In a patient undergoing surgery, it was vital to aspirate the contents of
the upper gastrointestinal tract. After the operation, the following values
were acquired from an arterial blood sample: pH 7.55, PCO2 52 mm Hg and
HCO3- 40 mmol/l. What is the underlying disorder?

A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis

8. A mountaineer attempts an assault on a high mountain in the Andes and


reaches an altitude of 5000 meters (16,400 ft) above sea level. What will
happen to his arterial PCO2 and pH?

A. Both will be lower than normal.


B. The pH will rise and PCO2 will fall.
C. Both will be higher than normal due to the physical exertion.
D. The pH will fall and PCO2 will rise

9. A young woman is found comatose, having taken an unknown number of


sleeping pills an unknown time before. An arterial blood sample yields the
following values: pH 6.90, HCO3- 13 meq/liter and PaCO2 68 mmHg. This
patients acid-base status is most accurately described as:

A. Metabolic Acidosis
B. Respiratory Acidosis
C. Simultaneous Respiratory and Metabolic Acidosis
D. Respiratory Acidosis with Complete Renal Compensation

10. A mother is admitted in the emergency department following


complaints of fever and chills. The nurse on duty took her vital signs and
noted the following: Temp = 100 F; apical pulse = 95; respiration = 20 and
deep. Measurement of arterial blood gas shows pH 7.37, PaO2 90 mm Hg,
PaCO2 40 mm Hg, and HCO3 24 mmol/L. What is your assessment?

A. Hyperthermia
B. Hyperthermia and Respiratory Alkalosis
C. Hypothermia
D. Hypothermia and Respiratory Alkalosis

Answers and Rationale


1. Answer: D. Metabolic Alkalosis

Vomiting, hypokalemia, overdosage of NaHCO3 and NGT suctioning are considered


risk factors of metabolic alkalosis.

2. Answer: C. 7.40

Normal blood pH must be maintained within a narrow range of 7.35-7.45 to ensure


the proper functioning of metabolic processes and the delivery of the right amount
of oxygen to tissues. Acidosis refers to an excess of acid in the blood that causes the
pH to fall below 7.35, and alkalosis refers to an excess of base in the blood that
causes the pH to rise above 7.45.

3. Answer. C. Metabolic Acidosis

Salicylate overdose causes a high anion gap metabolic acidosis in both children and
adults. Adults commonly develop a mixed acid-base disorder as a respiratory
alkalosis due to direct respiratory centre stimulation occurs as well. This second
disorder is uncommon in children.

4. Answer: B. 36 mm Hg

The normal range for PaCO2 is from 35 to 35 mm Hg.

5. Answer: B. Respiratory Alkalosis

Hyperventilation is typically the underlying cause of respiratory alkalosis.


Hyperventilation is also known as overbreathing. When someone is hyperventilating,
they tend to breathe very deeply or very rapidly.

6. Answer: B. 24 mmol/L
The normal value for bicarbonate (HCO3) is 22-26 mmol/L or mEq/L. It may vary
slightly among different laboratories. The given values show the common
measurement range of results for these tests. Some laboratories use different
measurements or may test different specimens.

7. Answer: D. Metabolic Alkalosis

NGT suctioning, vomiting, hypokalemia and overdosage of NaHCO3 are considered


risk factors of metabolic alkalosis.

8. Answer: B. The pH will rise and PCO2 will fall.

The mountaineer will suffer from a respiratory alkalosis. The decline in the PO2 with
altitude will stimulate breathing to offset the hypoxia. Carbon dioxide is driven from
the blood faster than it is produced in the tissues so PCO2 falls and pH rises.

9. Answer: C. Simultaneous Respiratory and Metabolic Acidosis

Whenever the PCO2 and HCO3 are abnormal in opposite directions, ie, one above
normal while the other is reduced, a mixed respiratory and metabolic acid-base
disorder exists. When the PCO2 is elevated and the [HCO3-] reduced, respiratory
acidosis and metabolic acidosis coexist.

10. Answer: A. Hyperthermia

An individual is considered to have hyperthermia if he or she has a temperature of


>37.5 or 38.3 C (99.5 or 100.9 F). Measurement of arterial blood gases are
normal.