Case base quiz on acid base disorders

1. Quiz ACID BASE DISORDERS

2. 1. Atul Despande is a 54-year-old widower with a history of chronic obstructive pulmonary disease and
was rushed to the emergency department with increasing shortness of breath, pyrexia, and a
productive cough with yellow-green sputum. He has difficulty communicating because of his inability to
complete a sentence. One of his sons, Jacob, says he has been unwell for three days. Upon examination,
crackles and wheezes can be heard in the lower lobes; he has tachycardia and a bounding pulse.
Measurement of arterial blood gas shows pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L, and PaO2 60
mm Hg. How would you interpret this?
• A. Respiratory Acidosis, Uncompensated
• B. Respiratory Acidosis, Partially Compensated
• C. Metabolic Alkalosis, Uncompensated
• D. Metabolic Acidosis, Partially Compensated

3. 2. Rahul, an elementary student, was rushed to the hospital due to vomiting and a
decreased level of consciousness. The patient displays slow and deep (Kussmaul
breathing), and he is lethargic and irritable in response to stimulation. He appears to be
dehydrated—his eyes are sunken and mucous membranes are dry—and he has a two-week
history of polydipsia, polyuria, and weight loss. Measurement of arterial blood gas shows
pH 7.0, PaO2 90 mm Hg, PaCO2 23 mm Hg, and HCO3 12 mmol/L; other results are Na+
126 mmol/L, K+ 5 mmol/L, and Cl- 95 mmol/L. What is your assessment?
• A. Respiratory Acidosis, Uncompensated
• B. Respiratory Acidosis, Partially Compensated
• C. Metabolic Alkalosis, Uncompensated
• D. Metabolic Acidosis, Partially, Compensated

4. 3. A cigarette vendor was brought to the emergency department of a
hospital after she fell into the ground and hurt her left leg. She is noted to
be tachycardic and tachypneic. Painkillers were carried out to lessen her
pain. Suddenly, she started complaining that she is still in pain and now
experiencing muscle cramps, tingling, and paraesthesia. Measurement of
arterial blood gas reveals pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm Hg, and
HCO3 25 mmol/L. What does this mean?
• A. Respiratory Alkalosis, Uncompensated
• B. Respiratory Acidosis, Partially Compensated
• C. Metabolic Alkalosis, Uncompensated
• D. Metabolic Alkalosis, Partially Compensated

5. 4. Vishal’s grandmother has been suffering from persistent vomiting for
two days now. She appears to be lethargic and weak and has myalgia.
She is noted to have dry mucus membranes and her capillary refill
takes >4 seconds. She is diagnosed as having gastroenteritis and
dehydration. Measurement of arterial blood gas shows pH 7.5, PaO2 85
mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L. What acid-base
disorder is shown?
• A. Respiratory Alkalosis, Uncompensated
• B. Respiratory Acidosis, Partially Compensated
• C. Metabolic Alkalosis, Uncompensated

6. 5. Mrs. Murthy, who had undergone surgery in the post-anesthesia care unit (PACU), is difficult to
arouse two hours following surgery. Nurse Florence in the PACU has been administering Morphine
Sulfate intravenously to the client for complaints of post-surgical pain. The client’s respiratory rate is
7 per minute and demonstrates shallow breathing. The patient does not respond to any stimuli. The
nurse assesses the ABCs (remember Airway, Breathing, Circulation!) and obtains ABGs STAT!
Measurement of arterial blood gas shows pH 7.10, PaCO2 70 mm Hg, and HCO3 24 mEq/L. What
does this mean?
• A. Respiratory Alkalosis, Partially Compensated
• B. Respiratory Acidosis, Uncompensated
• C. Metabolic Alkalosis, Partially Compensated
• D. Metabolic Acidosis, Uncompensated

7. 6. Baby radha was rushed to the Emergency Room following her mother’s
complaint that the infant has 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 Emergency Room physician orders ABGs after
assessing the ABCs. The results from the ABG results show pH 7.39, PaCO2
27 mmHg, and HCO3 19 mEq/L. What does this mean?
• A. Respiratory Alkalosis, Fully Compensated
• B. Metabolic Acidosis, Uncompensated
• C. Metabolic Acidosis, Fully Compensated
• D. Respiratory Acidosis, Uncompensated

8. 7. Mr. Mishra, who underwent post-abdominal surgery, has a nasogastric tube. The
nurse on duty notes that the nasogastric tube (NGT) is draining a large amount (900
cc in 2 hours) of coffee ground secretions. The client is not oriented to person,
place, or time. The nurse contacts the attending physician and STAT ABGs are
ordered. The results from the ABGs show pH 7.57, PaCO2 37 mmHg and HCO3 30
mEq/L. What is your assessment?
• A. Metabolic Acidosis, Uncompensated
• B. Metabolic Alkalosis, Uncompensated
• C. Respiratory Alkalosis, Uncompensated
• D. Metabolic Alkalosis, Partially Compensated

9. 8. Client Z is admitted to the hospital and is to undergo brain surgery. The
client is very anxious and scared of the upcoming surgery. He begins to
hyperventilate and becomes very dizzy. The client loses consciousness and
the STAT ABGs reveal pH 7.61, PaCO2 22 mmHg, and HCO3 25 mEq/L.
What is the ABG interpretation based on the findings?
• A. Metabolic Acidosis, Uncompensated
• B. Respiratory Alkalosis, Partially Compensated
• C. Respiratory Alkalosis, Uncompensated
• D. Metabolic Alkalosis, Partially Compensated

10. 9. Three-year-old kisan is admitted to the hospital with a diagnosis of asthma and
respiratory distress syndrome. The mother of the child reports to the nurse on duty
that she has witnessed slight tremors and behavioral changes in her child over the past
four days. The attending physician orders routine ABGs following an assessment of the
ABCs. The ABG results are pH 7.35, PaCO2 72 mmHg, and HCO3 38 mEq/L. What acid-
base disorder is shown?
• A. Respiratory Acidosis, Uncompensated
• B. Respiratory Acidosis, Fully Compensated
• C. Respiratory Alkalosis, Fully Compensated
• D. Metabolic Alkalosis, Partially Compensated

11. 10. An older person experiencing homelessness 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.
• A. Respiratory Acidosis, Uncompensated
• B. Respiratory Acidosis, Partially Compensated
• C. Metabolic Alkalosis, Uncompensated