Metabolic Acidosis | Arterial Blood Gas NCLEX & Nursing School Exams Like A Boss

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METABOLIC ACIDOSIS NCLEX QUIZ QUESTIONS

Question 1: The nurse is caring for a patient who has been vomiting for the last 3 days. The patient is experiencing irritability, muscle weakness, and muscle cramping. Upon assessment, the patient arterial blood gas results are as follows: pH 7.35, PaCO2 30, HCO3 18. What condition is manifesting based on the ABG results?

1. Uncompensated Metabolic Acidosis
2. Compensated Metabolic Acidosis
3. Uncompensated Metabolic Alkalosis
4. Compensated Metabolic Alkalosis

 

Question 2: The nurse is caring for a patient post ingestion of ethylene glycol. Recent arterial blood gas values show pH 7.25, PaO2 75 mmHg, PaCO2 30 mmHg, and HCO3 35 mmHg. What conclusion would the nurse come to regarding these findings?

1. The patient has an abundance of acid in their blood
2. The patient is overreacting
3. The patient has developed fluid overload
4. The patient is hyperventilating secondary to the anxiety

 

Question 3: The nurse is reviewing a patient’s arterial blood gas results as follows: pH 7.25, PaCO2 35 mmHg, and HCO3 30 mmHg. What clinical manifestations might the nurse observe associated with these ABG results? SELECT ALL THAT APPLY

1. Lethargy
2. Confusion
3. Bradypnea
4. Nausea/vomiting
5. Hypokalemia
6. Dizziness

 

Question 4: The nurse is caring for a diabetic ketoacidosis patient. The arterial blood gas results as follows: pH 7.30, PaCO2 40 mmHg, and HCO3 18 mmHg. The nurse has assessed that the patient is experiencing metabolic acidosis. What laboratory values would the nurse expect to find as a result of the respiratory alkalosis?

1. Sodium level of 140 mEq/L
2. Potassium level of 6.0 mEq/L
3. Magnesium level of 2.0
4. Phosphorous level of 2.9 mg/dL

 

Question 5: Potential causes for metabolic acidosis include all of the following, except:

1. Elevated anion gap metabolic acidosis
2. Diuretics
3. Diabetic Ketoacidosis
4. Massive whole blood transfusions
5. Severe diarrhea

 

Question 6: Tony, a pediatric patient, presents to the emergency room with vomiting and decreased level of consciousness. The patient exhibits slow and deep (Kussmaul breathing) respirations, and he is lethargic. He appears to be dehydrated and has had polydipsia, polyuria, and weight loss for the last two weeks. An arterial blood gas has been obtained and the shows the following results: pH 7.0, PaCO2 25 mmHg, HCO3 11 mmHg, and PaO2 90 mmHg. What is the nurse’s assessment?

1. Uncompensated Respiratory Acidosis
2. Partially compensated Respiratory Acidosis
3. Uncompensated Metabolic Alkalosis
4. Partially Compensated Metabolic Acidosis

 

METABOLIC ACIDOSIS NCLEX QUIZ ANSWERS

Question 1: The nurse is caring for a patient who has been vomiting for the last 3 days. The patient is experiencing irritability, muscle weakness, and muscle cramping. Upon assessment, the patient arterial blood gas results are as follows: pH 7.35, PaCO2 30, HCO3 18. What condition is manifesting based on the ABG results?

1. Uncompensated Metabolic Acidosis
2. Compensated Metabolic Acidosis
3. Uncompensated Metabolic Alkalosis
4. Compensated Metabolic Alkalosis

Normal ABG levels include pH is between 7.35 – 7.45, PaCO2 35 – 45, HCO3 21 – 28. The HCO3 is less than 21 making it acidotic. The PaCO2 is less than 35 making it alkalotic. This shows the body working to compensate for the acid base imbalance. The pH is normal making the results fully compensated. The pH is less than 7.40 showing a shift towards an acidotic state. The HCO3 is also acidotic showing this is a metabolic issue. The results show a compensated metabolic acidosis.

 

Question 2: The nurse is caring for a patient post ingestion of ethylene glycol. Recent arterial blood gas values show pH 7.25, PaO2 75 mmHg, PaCO2 30 mmHg, and HCO3 35 mmHg. What conclusion would the nurse come to regarding these findings?

1. The patient has an abundance of acid in their blood
2. The patient is overreacting
3. The patient has developed fluid overload
4. The patient is hyperventilating secondary to the anxiety

The arterial blood gas results are abnormal and supports the problem related to ingestion of poisons, toxins, and/or acids. The arterial blood gas indicates metabolic acidosis due to ingestion of ethylene glycol (antifreeze). Concluding the patient is overacting is inaccurate and insensitive. There is not enough information to conclude the patient is developing fluid overload. Hyperventilation would cause a respiratory alkalosis not metabolic acidosis.

 

Question 3: The nurse is reviewing a patient’s arterial blood gas results as follows: pH 7.25, PaCO2 35 mmHg, and HCO3 30 mmHg. What clinical manifestations might the nurse observe associated with these ABG results? SELECT ALL THAT APPLY

1. Lethargy
2. Confusion
3. Bradypnea
4. Nausea/vomiting
5. Hypokalemia
6. Dizziness

Metabolic Acidosis is characterized by a total concentration of buffer base that is lower than normal, with a relative increase in the hydrogen ion concentration, resulting from loss of too much base and/or retention of too much acid. Clinical manifestations can include lethargy, confusion, dizziness, headache, coma, decreased blood pressure, dysrhythmias, clammy skin, nausea, vomiting, diarrhea, abdominal pain, hyperkalemia, and rapid respirations.

 

Question 4: The nurse is caring for a diabetic ketoacidosis patient. The arterial blood gas results as follows: pH 7.30, PaCO2 40 mmHg, and HCO3 18 mmHg. The nurse has assessed that the patient is experiencing metabolic acidosis. What laboratory values would the nurse expect to find as a result of the respiratory alkalosis?

1. Sodium level of 140 mEq/L
2. Potassium level of 6.0 mEq/L
3. Magnesium level of 2.0
4. Phosphorous level of 2.9 mg/dL

Metabolic Acidosis is characterized by an excess in carbonic acid or hydrogen ion concentration. The acid base balance system will exchange hydrogen ions for potassium ions in order to maintain balance. Hydrogen ions will be pulled in of the cells and potassium electrolytes will be pulled out of the cell causing a increase in serum potassium.  

 

Question 5: Potential causes for metabolic acidosis include all of the following, except:

1. Elevated anion gap metabolic acidosis
2. Diuretics
3. Diabetic Ketoacidosis
4. Massive whole blood transfusions
5. Severe diarrhea

Elevated anion gaps are characterized by an increase in acid ions in metabolic acidosis. Diabetic ketoacidosis results from an insufficient supply of insulin causing increased fat metabolism leading to an excess accumulation of ketones or acids. Severe diarrhea cause an increase loss of alkaline secretions causing an acidosis. Diuretics and massive whole blood transfusion are related to metabolic alkalosis.

 

Question 6: Tony, a pediatric patient, presents to the emergency room with vomiting and decreased level of consciousness. The patient exhibits slow and deep (Kussmaul breathing) respirations, and he is lethargic. He appears to be dehydrated and has had polydipsia, polyuria, and weight loss for the last two weeks. An arterial blood gas has been obtained and the shows the following results: pH 7.0, PaCO2 25 mmHg, HCO3 11 mmHg, and PaO2 90 mmHg. What is the nurse’s assessment?

1. Uncompensated Respiratory Acidosis
2. Partially compensated Respiratory Acidosis
3. Uncompensated Metabolic Alkalosis
4. Partially Compensated Metabolic Acidosis

The pediatric patient is exhibiting signs and symptoms of diabetes mellitus. The results of the ABG shows metabolic acidosis due to the low pH and low HCO3. The respiratory component, low CO2 shows the body is attempting to compensate for the changes in acid base balance.