Respiratory Care Anatomy and

Physiology 3rd Edition Will Beachey

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Chapter 10: Acid-Base Regulation
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MULTIPLE CHOICE

1. What is the function of buffers?

a. They force H+ to go inside the cell.
b. They readily combine with HCO3−, removing H+ from solution.
c. They readily combine with H+ ions, removing them from solution.
d. They increase the HCO3− concentration in plasma.

ANS: C
Protein molecules are effective buffers; that is, they readily combine with H+ ions, removing
them from solution.

DIF: Recall REF: 169

2. According to the widely accepted Brønsted-Lowry theory, what is an acid?

a. Any substance that donates an electron (H+) to an aqueous solution
b. Any substance that donates a proton (H+) to an aqueous solution
c. Any substance that accepts a proton (H+), removing it from solution
d. Any substance that accepts an electron (H+), removing it from solution
ANS: B
According to the widely accepted Brønsted-Lowry theory, an acid is any substance that
donates a proton (H+) to an aqueous solution; a base is any substance that accepts a proton,
removing it from solution. By this definition, a hydrogen ion donor is an acid and a hydrogen
ion acceptor is a base.

DIF: Recall REF: 169

3. According to the widely accepted Brønsted-Lowry theory, what is a base?

a. Any substance that donates an electron (H+) to an aqueous solution
b. Any substance that donates a proton (H+) to an aqueous solution
c. Any substance that accepts a proton (H+), removing it from solution
d. Any substance that accepts an electron (H+), removing it from solution
ANS: C
According to the widely accepted Brønsted-Lowry theory, an acid is any substance that
donates a proton (H+) to an aqueous solution; a base is any substance that accepts a proton,
removing it from solution. By this definition, a hydrogen ion donor is an acid and a hydrogen
ion acceptor is a base.

DIF: Recall REF: 169

4. What is the pH of a chemically neutral solution?

a. 6.5
b. 7.0
c. 7.5
d. 8.0
 ANS: B
A chemically neutral solution (neither acidic nor basic) has a pH of 7.0.

DIF: Recall REF: 170

5. Because pH is a logarithmic scale, it is anticipated that a change of one pH unit will result in
what change in [H+]?
a. Twofold change
b. Fivefold change
c. Tenfold change
d. Twentyfold change
ANS: C
Because pH is a logarithmic scale, a change of one pH unit corresponds to a tenfold change in
[H+].

DIF: Recall REF: 170

6. Which of the following is the only volatile acid of physiological significance in the body?
a. Carbonic acid
b. Lactic acid
c. Phosphoric acid
d. Sulfuric acid
ANS: A
The only volatile acid of physiological significance in the body is carbonic acid (H2CO3).

DIF: Recall REF: 171

7. Which of the following are the major mechanisms responsible for maintaining a stable pH in
the face of massive CO2 production?
I. Proteins
II. Ventilation
III. Isohydric buffering
IV. HCO3−
a. I, II, III
b. III, IV
c. I, II, III, IV
d. II, III
ANS: D
Ventilation eliminates carbonic acid, keeping pace with its production. Isohydric buffering
and ventilation are the two major mechanisms responsible for maintaining a stable pH in the
face of massive CO2 production.

DIF: Recall REF: 171

8. Which of the following are examples of a fixed acid?

I. Carbonic acid
II. Lactic acid
III. Phosphoric acid
IV. Sulfuric acid
 a. I, II
b. III, IV
c. II, IV
d. II, III, IV
ANS: D
Catabolism of proteins continually produces fixed acids such as sulfuric and phosphoric acids.
In addition, anaerobic metabolism produces lactic acid, another fixed acid.

DIF: Recall REF: 171

9. Which of the following systems has the greatest buffering capacity?

a. Hb
b. HCO3−
c. Organic phosphates
d. Plasma proteins
ANS: B
The bicarbonate buffer system has the greatest buffering capacity because it is an open
system.

DIF: Recall REF: 172

10. Which of the following variables are computed by the H-H equation?
I. pK
II. pH
III. HCO3−
IV. PCO2
a. I, II
b. III, IV
c. II, IV
d. II, III, IV
ANS: D
The Henderson-Hasselbalch (H-H) equation allows the computation of pH, [HCO3−], or PCO2
if two of these three variables are known. Blood-gas analyzers measure pH and PCO2 and
compute [HCO3−].

DIF: Recall REF: 173

11. Which of the following nonbicarbonate buffers is the most important?

a. Hb
b. HCO3−
c. Organic phosphates
d. Plasma proteins
ANS: A
Table 10-3 lists the nonbicarbonate buffers in the blood. Of these, hemoglobin (Hb) is the
most important because it is the most abundant.

DIF: Recall REF: 172 | 176

12. Which of the following statements are true of acid excretion?
I. The lungs excrete only volatile acid.
II. The lungs can excrete large quantities of CO2 in minutes.
III. The kidneys excrete primarily fixed acids.
IV. The kidneys remove fixed acids at a much slower pace (hours to days).
a. II, III, IV
b. I, II, III, IV
c. II, IV
d. I, II, III
ANS: B
The lungs and kidneys are the primary acid-excreting organs. The lungs excrete only volatile
acid (i.e., the CO2 arising from dissociating H2CO3), whereas the kidneys excrete primarily
fixed acids. The lungs can excrete large quantities of CO2 in minutes, whereas the kidneys
remove fixed acids at a much slower pace (hours to days).

DIF: Recall REF: 177

13. Which of the following organs is responsible for the physical removal of H+?
a. Kidneys
b. Lungs
c. Intestine
d. Pancreas
ANS: A
The kidneys physically remove H+ from the body.

DIF: Recall REF: 178

14. What is the normal ratio of [HCO3− to dissolved CO2 necessary to maintain a pH of 7.40?
a. 10:1
b. 20:1
c. 30:1
d. 40:1
ANS: B
As long as the ratio of [HCO3− to dissolved CO2 is 20:1, the pH is normal at 7.40.

DIF: Recall REF: 178

15. Which of the following disturbances in the pH may potentially occur in patients with
nasogastric suction catheters?
a. Respiratory alkalosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Metabolic acidosis
ANS: B
Nasogastric suction catheters, often placed in critically ill patients, deplete gastric HCl. A loss
of HCl generates HCO3−, as the following diagram shows:
 Processes that increase the arterial pH by losing fixed acid or gaining HCO3− produce a
condition called metabolic alkalosis.

DIF: Recall REF: 179

16. Which of the following is considered a rapid compensatory mechanism to restore the pH back
to normal levels in the presence of a metabolic acidosis?
a. CO2 retention
b. CO2 elimination
c. HCO3− retention
d. HCO3− elimination

ANS: B
If a nonrespiratory process lowers or raises [HCO3− the lungs compensate for this defect by
eliminating CO2 (hyperventilating) or retaining CO2 (hypoventilating), thus restoring the pH
to the normal range.

DIF: Recall REF: 179

17. In general, when the nonbicarbonate buffer concentration is normal, an acute PaCO2 rise of 10
mm Hg will be associated with which of the following changes?
a. [HCO3− rises by approximately 10 mEq/L.
b. [HCO3− rises by approximately 5 mEq/L.
c. [HCO3− rises by approximately 2 mEq/L.
d. [HCO3− rises by approximately 1 mEq/L.

ANS: D
In general, when the nonbicarbonate buffer concentration is normal, an acute PaCO2 rise of 10
mm Hg causes the [HCO3− to rise by approximately 1 mEq/L; this is a clinically useful rule
of thumb.

DIF: Recall REF: 180

18. In general, when the nonbicarbonate buffer concentration is normal, an acute PaCO2 rise to a
level of 60 mm Hg will be associated with which of the following changes in the [HCO3−]?
a. [HCO3− rises to approximately 34 mEq/L.
b. [HCO3− rises to approximately 31 mEq/L.
c. [HCO3− rises to approximately 26 mEq/L.
d. [HCO3− rises to approximately 25 mEq/L.

ANS: C
In general, when the nonbicarbonate buffer concentration is normal, an acute PaCO2 rise of 10
mm Hg causes the [[HCO3− to rise by approximately 1 mEq/L; this is a clinically useful rule
of thumb.

DIF: Recall REF: 180

19. In general, when the nonbicarbonate buffer concentration is normal, an acute PaCO2 decrease
of 10 mm Hg below 40 mm Hg will be associated with which of the following changes?
a. [HCO3− decreases by approximately 10 mEq/L.
b. [HCO3− decreases by approximately 5 mEq/L.
c. [HCO3− decreases by approximately 2 mEq/L.
d. [HCO3− decreases by approximately 1 mEq/L.

ANS: C
The hydrolysis reaction relationship is not linear; [HCO3− is reduced approximately 1 mEq/L
for every 5 mm Hg PCO2 decrease below 40 mm Hg.

DIF: Recall REF: 181

20. A young, previously healthy drug overdose victim with severely depressed ventilation enters
the emergency room with the following arterial blood gases: pH = 7.22, PaCO2 = 70 mm Hg,
HCO3− = 28 mEq/L. What is the acid-base disturbance of this victim?
a. Uncompensated respiratory acidosis
b. Compensated respiratory acidosis
c. Uncompensated respiratory alkalosis
d. Uncompensated metabolic acidosis
ANS: A
The patient is suffering uncompensated respiratory acidosis as a result of drug-induced
hypoventilation.

DIF: Analysis REF: 182