ABG ANALYSIS NCLEX EXAM 1
A cigarette vendor was brought to the
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.
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.
ABG ANALYSIS NCLEX EXAM 2
In acid-base balance the normal plasma
PCO2 and bicarbonate levels are
disturbed. Match the changes in these
parameters given below with the
disorders in the drop down list.
1. Low plasma PaCO2
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
2. High plasma PaCO2
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
3. Decreased plasma bicarbonate
(HCO3-)
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
4. Increased plasma bicarbonate
(HCO3-)
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
5. What two organs in the body serve as
a compensatory function to maintain
acid base balance?
A. Kidneys and Lungs
B. Lungs and Spleen
C. Heart and Liver
D. Gallbladder and Appendix
6. Arterial blood gas (ABG)
measurement will give the information
needed to determine if the primary
disturbance of acid-base balance is
respiratory or metabolic in nature.
A. True
B. False
C. Both Carbonic Acid Excess and Deficit
Only
D. Both Bicarbonate Excess and Deficit Only
7. The major effect of acidosis is
overexcitement of the central nervous
system.
A. True
B. False
C. Maybe
D. Both Acidosis and Alkalosis result in
overexcitement of the central nervous
system.
8. Alkalosis is characterized by
overexcitement of the nervous system.
A. True
B. False
C. The major effect of Alkalosis is a
depression of the central nervous system.
D. Both Acidosis and Alkalosis result in
overexcitement of the central nervous
system.
9. The human body functions optimally
in a state of homeostasis.
A. True
B. False
C. Maybe
D. Homeostasis has nothing to do with
metabolic balance.
10. Acids have no hydrogen ions and are
able to bind in a solution.
A. True
B. False
C. Acid is a substance that is not capable of
donating hydrogen ions.
D. Acids and bases have nothing to do with
hydrogen ions.
Match the acid-base status of the
following blood samples to the disorders
in the drop down list. (PaCO2 values are
in mm Hg and bicarbonate values in
mmol/l).
11. pH 7.57, PaCO2 22, HCO3- 17
A. Respiratory Acidosis, Partially
Compensated
B. Respiratory Alkalosis, Uncompensated
C. Metabolic Acidosis, Partially Compensated
D. Respiratory Alkalosis, Partially
Compensated
12. pH 7.39, PaCO2 44, HCO3- 26
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Respiratory Alkalosis
D. Normal
13. pH 7.55, PaCO2 25, HCO3- 22
A. Respiratory Acidosis, Partially
Compensated
B. Respiratory Alkalosis, Uncompensated
C. Metabolic Alkalosis, Partially Compensated
D. Metabolic Acidosis, Uncompensated
14. pH 7.17, PaCO2 48, HCO3- 36
A. Respiratory Acidosis, Uncompensated
B. Metabolic Acidosis, Partially Compensated
C. Respiratory Alkalosis, Partially
Compensated
D. Respiratory Acidosis, Partially
Compensated
15. pH 7.34, PaCO2 24, HCO3- 20
A. Respiratory Acidosis, Partially
Compensated
B. Metabolic Acidosis, Partially Compensated
C. Metabolic Acidosis, Uncompensated
D. Metabolic Alkalosis, Partially Compensated
16. pH 7.64, PaCO2 25, HCO3- 19
A. Respiratory Acidosis, Uncompensated
B. Respiratory Alkalosis, Partially
Compensated
C. Respiratory Alkalosis, Uncompensated
D. Metabolic Alkalosis, Partially Compensated
17. pH 7.45, PaCO2 50, HCO3- 30
A. Metabolic Alkalosis, Fully Compensated
B. Respiratory Alkalosis, Fully Compensated
C. Metabolic Alkalosis, Partially Compensated
D. Respiratory Acidosis, Partially
Compensated
18. pH 7.6, PaCO2 53, HCO3- 38
A. Metabolic Alkalosis, Partially Compensated
B. Metabolic Alkalosis, Fully Compensated
C. Respiratory Acidosis, Partially
Compensated
D. Respiratory Alkalosis, Fully Compensated
19. pH 7.5, PaCO2 19, HCO3- 22
A. Respiratory Alkalosis, Partially
Compensated
B. Metabolic Alkalosis, Partially Compensated
C. Respiratory Acidosis, Uncompensated
D. Respiratory Alkalosis, Uncompensated
20. pH 7.4, PaCO2 59, HCO3- 35
A. Respiratory Acidosis, Uncompensated
B. Metabolic Alkalosis, Uncompensated
C. Respiratory Acidosis, Fully Compensated
D. Metabolic Alkalosis, Partially Compensated
Answers and Rationale:
1. Answer: B. Respiratory Alkalosis
Excessive pulmonary ventilation decreases
hydrogen ion concentration and thus causes
respiratory alkalosis. It can become
dangerous when it leads to cardiac
dysrhythmias caused partly by a decrease in
serum potassium levels.
2. Answer: D. Respiratory Acidosis
An excess of carbon dioxide (hypercapnia)
can cause carbon dioxide narcosis. In this
condition, carbon dioxide levels are so high
that they no longer stimulate respirations
but depress them.
3. Answer: A. Metabolic Acidosis
The body compensates by using body fat for
energy, producing abnormal amounts of
ketone bodies. In an effort to neutralize the
ketones and maintain the acid-base balance
of the body, plasma bicarbonate is
exhausted. This condition can develop in
anyone who does not eat an adequate diet
and whose body fat must be burned for
energy. Symptoms include headache and
mental dullness.
4. Answer: C. Metabolic Alkalosis
In metabolic alkalosis, breathing becomes
depressed in an effort to conserve carbon
dioxide for combination with water in the
blood to raise the blood level of carbonic
acid. Symptoms include confusion, dizziness,
numbness or tingling of fingers or toes.
5. Answer: A. Kidneys and Lungs
The carbonic acid concentration is controlled
by the amount of carbon dioxide excreted by
the lungs. The bicarbonate concentration is
controlled by the kidneys, which selectively
retain or excrete bicarbonate in response to
the body’s needs.
6. Answer: A. True
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.

7. Answer: B. False
The major effect is a depression of the
central nervous system, as evidenced by
disorientation followed by coma.

8. Answer: A. True
The muscles may go into a state of tetany
and convulsions.

9. Answer: A. True
The maintenance of acid-base balance, which
in one part of homeostasis, is evidenced by
an arterial plasma pH value of 7.35-7.45.
Many mechanisms in the body work together
to achieve and maintain this delicate narrow
range of pH that is essential for normal cell
function.

10. Answer: B. False

Acids are substances having one or more
hydrogen ions that can be liberated into a
solution.
Bases are substances that can bind hydrogen
ions in a solution.
11. Answer: D. Respiratory Alkalosis,
Partially Compensated
12. Answer: D. Normal
13. Answer: B. Respiratory Alkalosis,
Uncompensated
14. Answer: D. Respiratory Acidosis,
Partially Compensated
15. Answer: B. Metabolic Acidosis,
Partially Compensated
16. Answer: B. Respiratory Alkalosis,
Partially 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