ABG Analysis NCLEX Exam #1 (10

Questions)

Are you an expert in interpreting ABGs? Once you have finished doing this activity, you’ll be
doing actual ABG analysis in the NCLEX with fun and excitement. So here’s a 10-question
practice exam!

Always do your best. What you plant now, you will harvest later.
—Og Mandino

Topics

Included topics in this quiz are:

 ABG Analysis
 Acid-Base Balance/Imbalance
 Respiratory Acidosis/Alkalosis
 Metabolic Acidosis/Alkalosis

Guidelines

Follow the guidelines below to make the most out of this exam:

 Read each question carefully and choose the best answer.

 You are given one minute per question. Spend your time wisely!
 Answers and rationales are given below. Be sure to read them.
 If you need more clarifications, please direct them to the comments section.

Questions

In Text Mode: All questions and answers are given for reading and answering at your own pace.
You can also copy this exam and make a print out.

1. George Kent 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 in
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 a 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

2. Carl, 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

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

4. Ricky’s grandmother is 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
D. Metabolic Alkalosis, Partially Compensated

5. Mrs. Johansson, 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

6. Baby Angela 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

7. Mr. Wales, 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

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

9. Three-year-old Adrian 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

10. Anne, who is drinking beer at a party, falls and hits her head on the ground. Her friend
Liza dials “911” because Anne is unconscious, depressed ventilation (shallow and slow
respirations), rapid heart rate, and is profusely bleeding from both ears. Which primary
acid-base imbalance is Anne at risk for if medical attention is not provided?

A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis

Answers and Rationale

1. Answer: B. Respiratory Acidosis, Partially Compensated

The patient has respiratory acidosis (raised carbon dioxide) resulting from an acute exacerbation
of chronic obstructive pulmonary disease, with partial compensation.

2. Answer: D. Metabolic Acidosis, Partially, Compensated

The student was diagnosed having diabetes mellitus. The results show that he has metabolic
acidosis (low HCO3 -) with respiratory compensation (low CO2).

3. Answer: A. Respiratory Alkalosis, Uncompensated

The primary disorder is acute respiratory alkalosis (low CO2) due to the pain and anxiety
causing her to hyperventilate. There has not been time for metabolic compensation.

4. Answer: C. Metabolic Alkalosis, Uncompensated

The primary disorder is uncompensated metabolic alkalosis (high HCO3 -). As CO2 is the
strongest driver of respiration, it generally will not allow hypoventilation as compensation for
metabolic alkalosis.

5. Answer: B. Respiratory Acidosis, Uncompensated

The results show that Mrs. Johansson has respiratory acidosis because of decreased pH and
increased PaCO2 which mean acidic in nature. Meanwhile, it is uncompensated because HCO3
is within the normal range.

6. Answer: C. Metabolic Acidosis, Fully Compensated

Baby Angela has metabolic acidosis due to decreased HCO3 and slightly acidic pH. Her pH
value is within the normal range which made the result fully compensated.

7. Answer: B. Metabolic Alkalosis, Uncompensated

The postoperative client’s ABG results show that he has metabolic alkalosis because of an
increased pH and HCO3. It is uncompensated due to the normal PaCO2 which is within 35 to 45
mmHg.

8. Answer: C. Respiratory Alkalosis, Uncompensated

The results show that client Z has respiratory alkalosis since there is an increase in the pH value
and a decrease in PaCO2 which are both basic. It is uncompensated due to the normal HCO3
which is within 22-26 mEq/L.

9. Answer: B. Respiratory Acidosis, Fully Compensated

The patient has respiratory acidosis (raised carbon dioxide) resulting from asthma and respiratory
distress syndrome, with compensation having normal pH value within 7.35to 7.45, increased
PaCO2 which is acidic and increased HCO3 which is basic.

10. Answer: C. Respiratory Acidosis

One of the risk factors of having respiratory acidosis is hypoventilation which may be due to
brain trauma, coma, and hypothyroidism or myxedema. Other risk factors include COPD,
Respiratory conditions such as pneumothorax, pneumonia and status asthmaticus. Drugs such as
Morphine and MgSO4 toxicity are also risk factors of respiratory acidosis.