ABG ANALYSIS NCLEX EXAM 1

in pain and now experiencing muscle cramps, tingling,

1. George Kent is a 54 year old widower with a history and paraesthesia. Measurement of arterial blood gas

of chronic obstructive pulmonary disease and was reveals pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm Hg,

rushed to the emergency department with increasing and HCO3 25 mmol/L. What does this mean?

shortness of breath, pyrexia, and a productive cough A. Respiratory Alkalosis, Uncompensated

with yellow-green sputum. He has difficulty in B. Respiratory Acidosis, Partially Compensated

communicating because of his inability to complete a C. Metabolic Alkalosis, Uncompensated

sentence. One of his sons, Jacob, says he has been D. Metabolic Alkalosis, Partially Compensated

unwell for three days. Upon examination, crackles and 4. Ricky’s grandmother is suffering from persistent

wheezes can be heard in the lower lobes; he has a vomiting for two days now. She appears to be lethargic

tachycardia and a bounding pulse. Measurement of and weak and has myalgia. She is noted to have dry

arterial blood gas shows pH 7.3, PaCO2 68 mm Hg, mucus membranes and her capillary refill takes >4

HCO3 28 mmol/L, and PaO2 60 mm Hg. How would you seconds. She is diagnosed as having gastroenteritis

interpret this? and dehydration. Measurement of arterial blood gas

A. Respiratory Acidosis, Uncompensated shows pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and

B. Respiratory Acidosis, Partially Compensated HCO3 34 mmol/L. What acid-base disorder is shown?

C. Metabolic Alkalosis, Uncompensated A. Respiratory Alkalosis, Uncompensated

D. Metabolic Acidosis, Partially Compensated B. Respiratory Acidosis, Partially Compensated

2. Carl, an elementary student, was rushed to the C. Metabolic Alkalosis, Uncompensated

hospital due to vomiting and a decreased level of D. Metabolic Alkalosis, Partially Compensated

consciousness. The patient displays slow and deep 5. Mrs. Johansson, who had undergone surgery in the

(Kussmaul breathing), and he is lethargic and irritable post-anesthesia care unit (PACU), is difficult to arouse

in response to stimulation. He appears to be two hours following surgery. Nurse Florence in the

dehydrated—his eyes are sunken and mucous PACU has been administering Morphine Sulfate

membranes are dry—and he has a two week history of intravenously to the client for complaints of post-

polydipsia, polyuria, and weight loss. Measurement of surgical pain. The client’s respiratory rate is 7 per

arterial blood gas shows pH 7.0, PaO2 90 mm Hg, minute and demonstrates shallow breathing. The

PaCO2 23 mm Hg, and HCO3 12 mmol/L; other results patient does not respond to any stimuli! The nurse

are Na+ 126 mmol/L, K+ 5 mmol/L, and Cl- 95 assesses the ABCs (remember Airway, Breathing,

mmol/L. What is your assessment? Circulation!) and obtains ABGs STAT! Measurement of

A. Respiratory Acidosis, Uncompensated arterial blood gas shows pH 7.10, PaCO2 70 mm Hg and

B. Respiratory Acidosis, Partially Compensated HCO3 24 mEq/L. What does this mean?

C. Metabolic Alkalosis, Uncompensated A. Respiratory Alkalosis, Partially Compensated

D. Metabolic Acidosis, Partially, Compensated B. Respiratory Acidosis, Uncompensated

3. A cigarette vendor was brought to the emergency C. Metabolic Alkalosis, Partially Compensated

department of a hospital after she fell into the ground D. Metabolic Acidosis, Uncompensated

and hurt her left leg. She is noted to be tachycardic and 6. Baby Angela was rushed to the Emergency Room

tachypneic. Painkillers were carried out to lessen her following her mother’s complaint that the infant has

pain. Suddenly, she started complaining that she is still been irritable, difficult to breastfeed and has had

diarrhea for the past 3 days. The infant’s respiratory

rate is elevated and the fontanels are sunken. The 7.35, PaCO2 72 mmHg and HCO3 38 mEq/L. What acid-

Emergency Room physician orders ABGs after base disorder is shown?

assessing the ABCs. The results from the ABG results A. Respiratory Acidosis, Uncompensated

show pH 7.39, PaCO2 27 mmHg and HCO3 19 mEq/L. B. Respiratory Acidosis, Fully Compensated

What does this mean? C. Respiratory Alkalosis, Fully Compensated

A. Respiratory Alkalosis, Fully Compensated D. Metabolic Alkalosis, Partially Compensated

B. Metabolic Acidosis, Uncompensated 10. Anne, who is drinking beer at a party, falls and hits

C. Metabolic Acidosis, Fully Compensated her head on the ground. Her friend Liza dials “911”

D. Respiratory Acidosis, Uncompensated because Anne is unconscious, depressed ventilation

7. Mr. Wales, who underwent post-abdominal surgery, (shallow and slow respirations), rapid heart rate, and is

has a nasogastric tube. The nurse on duty notes that profusely bleeding from both ears. Which primary acid-

the nasogastric tube (NGT) is draining a large amount base imbalance is Anne at risk for if medical attention

(900 cc in 2 hours) of coffee ground secretions. The is not provided?

client is not oriented to person, place, or time. The A. Metabolic Acidosis

nurse contacts the attending physician and STAT ABGs B. Metabolic Alkalosis

are ordered. The results from the ABGs show pH 7.57, C. Respiratory Acidosis

PaCO2 37 mmHg and HCO3 30 mEq/L. What is your D. Respiratory Alkalosis

assessment?

A. Metabolic Acidosis, Uncompensated

Answers and Rationale:
B. Metabolic Alkalosis, Uncompensated

C. Respiratory Alkalosis, Uncompensated 1. Answer: B. Respiratory Acidosis, Partially

D. Metabolic Alkalosis, Partially Compensated Compensated

8. Client Z is admitted to the hospital and is to undergo The patient has respiratory acidosis (raised carbon dioxide)

brain surgery. The client is very anxious and scared of resulting from an acute exacerbation of chronic obstructive

the upcoming surgery. He begins to hyperventilate and pulmonary disease, with partial compensation.

becomes very dizzy. The client loses consciousness and

the STAT ABGs reveal pH 7.61, PaCO2 22 mmHg and 2. Answer: D. Metabolic Acidosis, Partially,

HCO3 25 mEq/L. What is the ABG interpretation based Compensated

on the findings? The student was diagnosed having diabetes mellitus. The

A. Metabolic Acidosis, Uncompensated results show that he has metabolic acidosis (low HCO3 -) with

B. Respiratory Alkalosis, Partially Compensated respiratory compensation (low CO2).

C. Respiratory Alkalosis, Uncompensated

D. Metabolic Alkalosis, Partially Compensated 3. Answer: A. Respiratory Alkalosis, Uncompensated

9. Three-year-old Adrian is admitted to the hospital The primary disorder is acute respiratory alkalosis (low CO2)

with a diagnosis of asthma and respiratory distress due to the pain and anxiety causing her to hyperventilate.

syndrome. The mother of the child reports to the nurse There has not been time for metabolic compensation.

on duty that she has witnessed slight tremors and

behavioral changes in her child over the past four days. 4. Answer: C. Metabolic Alkalosis, Uncompensated

The attending physician orders routine ABGs following

an assessment of the ABCs. The ABG results are pH

The primary disorder is uncompensated metabolic alkalosis pneumonia and status asthmaticus. Drugs such as Morphine

(high HCO3 -). As CO2 is the strongest driver of respiration, it and MgSO4 toxicity are also risk factors of respiratory

generally will not allow hypoventilation as compensation for acidosis.

metabolic alkalosis.
ABG ANALYSIS NCLEX EXAM 2

5. Answer: B. Respiratory Acidosis, Uncompensated In acid-base balance the normal plasma PCO2 and
The results show that Mrs. Johansson has respiratory acidosis bicarbonate levels are disturbed. Match the changes in
because of decreased pH and increased PaCO2 which mean these parameters given below with the disorders in the
acidic in nature. Meanwhile, it is uncompensated because drop down list.
HCO3 is within the normal range. 1. Low plasma PaCO2

A. Metabolic Acidosis
6. Answer: C. Metabolic Acidosis, Fully Compensated B. Respiratory Alkalosis
Baby Angela has metabolic acidosis due to decreased HCO3 C. Metabolic Alkalosis
and slightly acidic pH. Her pH value is within the normal D. Respiratory Acidosis
range which made the result fully compensated. 2. High plasma PaCO2

A. Metabolic Acidosis
7. Answer: B. Metabolic Alkalosis, Uncompensated B. Respiratory Alkalosis
The postoperative client’s ABG results show that he has C. Metabolic Alkalosis
metabolic alkalosis because of an increased pH and HCO3. It D. Respiratory Acidosis
is uncompensated due to the normal PaCO2 which is within 3. Decreased plasma bicarbonate (HCO3-)
35 to 45 mmHg. A. Metabolic Acidosis

B. Respiratory Alkalosis
8. Answer: C. Respiratory Alkalosis, Uncompensated C. Metabolic Alkalosis
The results show that client Z has respiratory alkalosis since D. Respiratory Acidosis
there is an increase in the pH value and a decrease in PaCO2 4. Increased plasma bicarbonate (HCO3-)
which are both basic. It is uncompensated due to the normal A. Metabolic Acidosis
HCO3 which is within 22-26 mEq/L. B. Respiratory Alkalosis

C. Metabolic Alkalosis
9. Answer: B. Respiratory Acidosis, Fully Compensated D. Respiratory Acidosis
The patient has respiratory acidosis (raised carbon dioxide) 5. What two organs in the body serve as a
resulting from asthma and respiratory distress syndrome, compensatory function to maintain acid base balance?
with compensation having normal pH value within 7.35to A. Kidneys and Lungs
7.45, increased PaCO2 which is acidic and increased HCO3 B. Lungs and Spleen
which is basic. C. Heart and Liver

D. Gallbladder and Appendix

10. Answer: C. Respiratory Acidosis 6. Arterial blood gas (ABG) measurement will give the
One of the risk factors of having respiratory acidosis is information needed to determine if the primary
hypoventilation which may be due to brain trauma, coma, and disturbance of acid-base balance is respiratory or
hypothyroidism or myxedema. Other risk factors include metabolic in nature.
COPD, Respiratory conditions such as pneumothorax,
A. True C. Metabolic Acidosis, Partially Compensated

B. False D. Respiratory Alkalosis, Partially Compensated

C. Both Carbonic Acid Excess and Deficit Only 12. pH 7.39, PaCO2 44, HCO3- 26

D. Both Bicarbonate Excess and Deficit Only A. Respiratory Acidosis

7. The major effect of acidosis is overexcitement of the B. Metabolic Acidosis

central nervous system. C. Respiratory Alkalosis

A. True D. Normal

B. False 13. pH 7.55, PaCO2 25, HCO3- 22

C. Maybe A. Respiratory Acidosis, Partially Compensated

D. Both Acidosis and Alkalosis result in overexcitement of the B. Respiratory Alkalosis, Uncompensated

central nervous system. C. Metabolic Alkalosis, Partially Compensated

8. Alkalosis is characterized by overexcitement of the D. Metabolic Acidosis, Uncompensated

nervous system. 14. pH 7.17, PaCO2 48, HCO3- 36

A. True A. Respiratory Acidosis, Uncompensated

B. False B. Metabolic Acidosis, Partially Compensated

C. The major effect of Alkalosis is a depression of the central C. Respiratory Alkalosis, Partially Compensated

nervous system. D. Respiratory Acidosis, Partially Compensated

D. Both Acidosis and Alkalosis result in overexcitement of the 15. pH 7.34, PaCO2 24, HCO3- 20

central nervous system. A. Respiratory Acidosis, Partially Compensated

9. The human body functions optimally in a state of B. Metabolic Acidosis, Partially Compensated

homeostasis. C. Metabolic Acidosis, Uncompensated

A. True D. Metabolic Alkalosis, Partially Compensated

B. False 16. pH 7.64, PaCO2 25, HCO3- 19

C. Maybe A. Respiratory Acidosis, Uncompensated

D. Homeostasis has nothing to do with metabolic balance. B. Respiratory Alkalosis, Partially Compensated

10. Acids have no hydrogen ions and are able to bind in C. Respiratory Alkalosis, Uncompensated

a solution. D. Metabolic Alkalosis, Partially Compensated

A. True 17. pH 7.45, PaCO2 50, HCO3- 30

B. False A. Metabolic Alkalosis, Fully Compensated

C. Acid is a substance that is not capable of donating B. Respiratory Alkalosis, Fully Compensated

hydrogen ions. C. Metabolic Alkalosis, Partially Compensated

D. Acids and bases have nothing to do with hydrogen ions. D. Respiratory Acidosis, Partially Compensated

Match the acid-base status of the following blood 18. pH 7.6, PaCO2 53, HCO3- 38

samples to the disorders in the drop down list. (PaCO2 A. Metabolic Alkalosis, Partially Compensated

values are in mm Hg and bicarbonate values in B. Metabolic Alkalosis, Fully Compensated

mmol/l). C. Respiratory Acidosis, Partially Compensated

11. pH 7.57, PaCO2 22, HCO3- 17 D. Respiratory Alkalosis, Fully Compensated

A. Respiratory Acidosis, Partially Compensated 19. pH 7.5, PaCO2 19, HCO3- 22

B. Respiratory Alkalosis, Uncompensated A. Respiratory Alkalosis, Partially Compensated

B. Metabolic Alkalosis, Partially Compensated

C. Respiratory Acidosis, Uncompensated The carbonic acid concentration is controlled by the amount of

D. Respiratory Alkalosis, Uncompensated carbon dioxide excreted by the lungs. The bicarbonate

20. pH 7.4, PaCO2 59, HCO3- 35 concentration is controlled by the kidneys, which selectively

A. Respiratory Acidosis, Uncompensated retain or excrete bicarbonate in response to the body’s needs.

B. Metabolic Alkalosis, Uncompensated

C. Respiratory Acidosis, Fully Compensated 6. Answer: A. True

D. Metabolic Alkalosis, Partially Compensated ABG’s are blood tests that are useful in identifying the cause

and extent of the acid-base disturbance and in guiding and

monitoring treatment.
Answers and Rationale:

1. Answer: B. Respiratory Alkalosis 7. Answer: B. False

Excessive pulmonary ventilation decreases hydrogen ion The major effect is a depression of the central nervous

concentration and thus causes respiratory alkalosis. It can system, as evidenced by disorientation followed by coma.

become dangerous when it leads to cardiac dysrhythmias

caused partly by a decrease in serum potassium levels. 8. Answer: A. True

The muscles may go into a state of tetany and convulsions.

2. Answer: D. Respiratory Acidosis

An excess of carbon dioxide (hypercapnia) can cause carbon 9. Answer: A. True

dioxide narcosis. In this condition, carbon dioxide levels are The maintenance of acid-base balance, which in one part of

so high that they no longer stimulate respirations but depress homeostasis, is evidenced by an arterial plasma pH value of

them. 7.35-7.45. Many mechanisms in the body work together to

achieve and maintain this delicate narrow range of pH that is

3. Answer: A. Metabolic Acidosis essential for normal cell function.

The body compensates by using body fat for energy,

producing abnormal amounts of ketone bodies. In an effort to 10. Answer: B. False

neutralize the ketones and maintain the acid-base balance of Acids are substances having one or more hydrogen ions that

the body, plasma bicarbonate is exhausted. This condition can can be liberated into a solution.

develop in anyone who does not eat an adequate diet and Bases are substances that can bind hydrogen ions in a

whose body fat must be burned for energy. Symptoms solution.

include headache and mental dullness. 11. Answer: D. Respiratory Alkalosis, Partially

Compensated

4. Answer: C. Metabolic Alkalosis 12. Answer: D. Normal

In metabolic alkalosis, breathing becomes depressed in an 13. Answer: B. Respiratory Alkalosis, Uncompensated

effort to conserve carbon dioxide for combination with water 14. Answer: D. Respiratory Acidosis, Partially

in the blood to raise the blood level of carbonic acid. Compensated

Symptoms include confusion, dizziness, numbness or tingling 15. Answer: B. Metabolic Acidosis, Partially

of fingers or toes. Compensated

16. Answer: B. Respiratory Alkalosis, Partially

5. Answer: A. Kidneys and Lungs Compensated

17. Answer: A. Metabolic Alkalosis, Fully Compensated

18. Answer: A. Metabolic Alkalosis, Partially

Compensated

19. Answer: D. Respiratory Alkalosis, Uncompensated

20. Answer: C. Respiratory Acidosis, Fully Compensated