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AB G AN ALYSIS N C L E X E XA M 1
still in pain and now experiencing muscle cramps,
1. George Kent is a 54 year old widower with a history
tingling, and paraesthesia. Measurement of arterial
of chronic obstructive pulmonary disease and was
blood gas reveals pH 7.6, PaO2 120 mm Hg, PaCO2 31
rushed to the emergency department with increasing
mm Hg, 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
4. R i ck y ’ s g r a n d m o t h e r is s u f f e r i n g f r o m p er s i s t e n t
and wheezes can be heard in the lower lobes; he has
vomiting for two days now. She appears to be lethargic
a tachycardia and a bounding pulse. Measurement of
a n d w e a k a n d h a s m y a l g i a . S h e is n o t e d t o h a v e d r y
arterial blood gas shows pH 7.3, PaCO2 68 mm Hg,
m u c u s m e m b r a n e s a n d h e r ca p i l la ry ref ill t a k e s > 4
HCO3 28 mmol/L, and PaO2 60 mm Hg. How would
s e c o n d s . S h e is d i a g n o s e d a s h a v i n g g a s t r o e n t e r i t i s
you interpret this?
a n d d e h y d r a t i o n . M e a s u r e m e n t of a rte r ial b l o o d g a s
A. Respiratory Acidosis, Uncompensated
s h o w s p H 7. 5, P a O 2 8 5 m m H g , P a C O 2 4 0 m m H g ,
B. Respiratory Acidosis, Partially Compensated
a n d HCO3 34 mmol/L. What acid-base disorder is
C. Metabolic Alkalosis, Uncompensated
shown?
D. Metabolic Acidosis, Partially Compensated
A. Respiratory Alkalosis, Uncompensated
2. C ar l , a n e l e m e n t a r y s t u d e n t , w a s r u s h e d t o t h e
B. Respiratory Acidosis, Partially Compensated
h o s p i t a l d u e t o v o m i t i n g a n d a d e c r e a s e d le vel o f
C. Metabolic Alkalosis, Uncompensated
co n s c io u s n e s s . T h e p a t i e n t d i s p la ys s l o w a n d d e e p
D. Metabolic Alkalosis, Partially Compensated
(Kussmaul breathing), and he is lethargic and irritable
5. Mrs. Johansson, who had undergone surgery in the
in resp onse to stimulation. H e a ppear s to be
post-anesthesia care unit (PACU), is difficult to arouse
dehydrated—his eyes are sunken and mu cous
two hours following surgery. Nurse Florence in the
membranes are dry—and he has a two week history of
P A C U h as b ee n admin istering M o r ph i n e Sulfate
polydipsia, polyuria, and weight loss. Measurement of
i n t r a v e n o u s l y t o t h e cl ient fo r c o m p l a i n t s o f p o s t -
a rt e r ia l b l o o d g a s s h o w s p H 7 . 0 , P a O 2 9 0 m m H g ,
su rg ic a l p a i n . T h e cl ient ’ s r e s p i r a t o r y r a t e is 7 p e r
PaCO2 23 mm Hg, and HCO3 12 mmol/L; other results
min ut e a n d dem o ns tr ates shallow breathing. Th e
are Na+ 126 mmol/L, K+ 5 mmol/L, and Cl- 95
p a t i e n t d o e s n o t r e s p o n d t o a n y st im ul i ! T h e n u r s e
mmol/L. W h a t is y o u r a s s e s s m e n t ?
assesses t he AB Cs ( r e m em be r Airwa y, Breathing,
A. Respiratory Acidosis, Uncompensated
Circulation!) and obtains ABGs STAT! Measurement of
B. Respiratory Acidosis, Partially Compensated
ar t er ia l b l o o d g a s s h o w s p H 7 . 1 0 , P a C O 2 7 0 m m H g
C. Metabolic Alkalosis, Uncompensated
a n d H C O 3 2 4 m E q / L . W h a t d o e s th is m e a n ?
D. Metabolic Acidosis, Partially, Compensated
A. Respiratory Alkalosis, Partially Compensated
3. A cigarette vendor was brought to the emergency
B. Respiratory Acidosis, Uncompensated
department of a hospital after she fell into the ground
C. Metabolic Alkalosis, Partially Compensated
and hurt her left leg. She is noted to be tachycardic
D. Metabolic Acidosis, Uncompensated
and tachypneic. Painkillers were carried out to lessen
6. Baby Angela was rushed to the Emergency Room
her pain. Suddenly, she started complaining that she is
following her mother’s complaint that the infant has
been irritable, difficult to breastfeed and has had
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