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Hemostasis, Fluids and Electrolytes

Acid-Base Balance Disorders Practice Questions

25 free Acid-Base Balance Disorders practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.

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Question 1 of 25 Medium

Which ABG pattern suggests metabolic alkalosis?

  1. A pH 7.49, PaCO₂ 44 mmHg, HCO₃⁻ 30 mEq/L
  2. B pH 7.30, PaCO₂ 30 mmHg, HCO₃⁻ 16 mEq/L
  3. C pH 7.25, PaCO₂ 50 mmHg, HCO₃⁻ 20 mEq/L
  4. D pH 7.52, PaCO₂ 28 mmHg, HCO₃⁻ 22 mEq/L

Correct answer: pH 7.49, PaCO₂ 44 mmHg, HCO₃⁻ 30 mEq/L

pH is high (alkalosis), HCO₃⁻ is elevated (30 mEq/L) so it indicates metabolic alkalosis; PaCO₂ is within near normal indicating little respiratory involvement.

Question 2 of 25 Medium

In metabolic alkalosis the typical compensatory respiratory response is:

  1. A Increased respiratory rate and depth
  2. B Decreased respiratory rate and depth (hypoventilation)
  3. C No change in the patient's ventilation
  4. D Immediate renal compensation without respiratory change

Correct answer: Decreased respiratory rate and depth (hypoventilation)

In metabolic alkalosis the body compensates by hypoventilating (to retain CO₂) which lowers pH back toward normal.

Question 3 of 25 Easy

A patient with metabolic acidosis due to diabetic ketoacidosis will likely demonstrate which breathing pattern?

  1. A Bradypnea with slow, infrequent breaths
  2. B Kussmaul respirations (deep and rapid)
  3. C Periods of apnea with no breathing
  4. D Shallow, slow respirations with low volume

Correct answer: Kussmaul respirations (deep and rapid)

The body tries to blow off CO₂ to compensate for metabolic acidosis; in DKA this results in Kussmaul respirations (deep, rapid breathing).

Question 4 of 25 Easy

Which condition is likely to cause metabolic alkalosis?

  1. A pH 7.30, PaCO₂ 32 mmHg, HCO₃⁻ 16 mEq/L
  2. B pH 7.52, PaCO₂ 28 mmHg, HCO₃⁻ 22 mEq/L
  3. C pH 7.40, PaCO₂ 60 mmHg, HCO₃⁻ 36 mEq/L
  4. D pH 7.36, PaCO₂ 52 mmHg, HCO₃⁻ 29 mEq/L

Correct answer: pH 7.30, PaCO₂ 32 mmHg, HCO₃⁻ 16 mEq/L

Metabolic acidosis shows a low pH with a low bicarbonate (HCO₃⁻). pH 7.30 with HCO₃⁻ 16 mEq/L indicates metabolic acidosis; the low PaCO₂ (32 mmHg) reflects respiratory compensation by hyperventilation.

Question 5 of 25 Medium

Which ABG pattern suggests metabolic acidosis?

  1. A pH 7.46, PaCO₂ 55 mmHg, HCO₃⁻ 33 mEq/L
  2. B pH 7.52, PaCO₂ 28 mmHg, HCO₃⁻ 22 mEq/L
  3. C pH 7.40, PaCO₂ 60 mmHg, HCO₃⁻ 36 mEq/L
  4. D pH 7.36, PaCO₂ 52 mmHg, HCO₃⁻ 29 mEq/L

Correct answer: pH 7.46, PaCO₂ 55 mmHg, HCO₃⁻ 33 mEq/L

pH is low (acidosis) and HCO₃⁻ is low (metabolic cause) while PaCO₂ is nearly normal, indicating metabolic acidosis.

Question 6 of 25 Medium

The nurse is teaching a patient about the “ROME” mnemonic for ABG interpretation. Which statement describes it correctly?

  1. A Respiratory Opposite, Metabolic Equal: PaCO₂ moves opposite pH and HCO₃ moves with pH
  2. B Respiratory Opposite, Metabolic Equal: both PaCO₂ and HCO₃ move opposite to the pH
  3. C Respiratory Opposite, Metabolic Equal: both PaCO₂ and HCO₃ move in the same direction as pH
  4. D Respiratory Opposite, Metabolic Equal: only HCO₃ ever changes in respiratory disorders

Correct answer: Respiratory Opposite, Metabolic Equal: PaCO₂ moves opposite pH and HCO₃ moves with pH

The “ROME” method instructs that in respiratory disorders PaCO₂ moves opposite the pH, while in metabolic disorders HCO₃⁻ moves in the same direction as the pH.

Question 7 of 25 Medium

What is the most likely diagnosis based on ABG results of pH 7.30, PaCO₂ 50 mmHg, HCO₃⁻ 24 mEq/L?

  1. A a. Metabolic acidosis
  2. B b. Metabolic alkalosis
  3. C c. Respiratory acidosis
  4. D d. Respiratory alkalosis

Correct answer: c. Respiratory acidosis

The pH is low (<7.35 = acidosis) and PaCO₂ is elevated while HCO₃⁻ is near normal, indicating a respiratory cause (respiratory acidosis).

Question 8 of 25 Easy

What is a common cause of metabolic alkalosis?

  1. A Diabetic ketoacidosis with ketone buildup
  2. B Vomiting or gastric suctioning
  3. C Hypoventilation with CO2 retention
  4. D Lactic acid accumulation in tissues

Correct answer: Vomiting or gastric suctioning

Loss of gastric acid through vomiting or suctioning causes an increase in bicarbonate concentration, leading to metabolic alkalosis.

Question 9 of 25 Medium

In a patient hyperventilating due to anxiety with ABG showing pH 7.50, PaCO₂ 30 mmHg, HCO₃⁻ 24 mEq/L, what is the likely acid-base disorder?

  1. A a. Respiratory acidosis
  2. B b. Metabolic acidosis
  3. C c. Metabolic alkalosis
  4. D d. Respiratory alkalosis

Correct answer: d. Respiratory alkalosis

pH is high, PaCO₂ is low, indicating respiratory alkalosis due to hyperventilation.

Question 10 of 25 Hard

Which compensation pattern is correct for metabolic acidosis?

  1. A a. pH low, HCO₃⁻ low, PaCO₂ low
  2. B b. pH low, HCO₃⁻ low, PaCO₂ high
  3. C c. pH high, HCO₃⁻ high, PaCO₂ high
  4. D d. pH high, HCO₃⁻ high, PaCO₂ low

Correct answer: a. pH low, HCO₃⁻ low, PaCO₂ low

In metabolic acidosis, the bicarbonate is low, and the lungs compensate by blowing off CO₂ leading to low levels across the board.

Question 11 of 25 Medium

A patient with chronic COPD and ABG results of pH 7.36, PaCO₂ 52 mmHg, HCO₃⁻ 29 mEq/L likely has which condition?

  1. A Encourage strict fluid restriction
  2. B Watch for signs of hypocalcemia
  3. C Increase tidal volume on ventilation
  4. D Promote rapid, shallow breathing

Correct answer: Watch for signs of hypocalcemia

The pH is near normal but PaCO₂ is elevated, and HCO₃⁻ is elevated indicating chronic respiratory acidosis with renal compensation.

Question 12 of 25 Easy

Which symptom is most characteristic of metabolic acidosis?

  1. A a. Tetany and muscle cramps
  2. B b. Headache, deep rapid respirations, confusion
  3. C c. Slow shallow respirations and numbness
  4. D d. Tremors, tingling lips, dizziness

Correct answer: b. Headache, deep rapid respirations, confusion

In metabolic acidosis, patients may have headache, confusion, and exhibit deep, rapid respirations as compensatory mechanisms.

Question 13 of 25 Hard

Which condition is likely to cause respiratory acidosis?

  1. A a. Anxiety with hyperventilation
  2. B b. Over-use of antacids
  3. C c. Hypoventilation from opioid overdose
  4. D d. Excessive vomiting

Correct answer: c. Hypoventilation from opioid overdose

Respiratory acidosis results from CO₂ retention due to hypoventilation, such as in opioid overdose.

Question 14 of 25 Easy

For a patient with metabolic alkalosis, what is a nursing priority?

  1. A a. Encourage fluid restriction
  2. B b. Watch for signs of hypocalcemia (e.g., tetany, cramps)
  3. C c. Increase tidal volume ventilation
  4. D d. Promote rapid shallow breathing

Correct answer: b. Watch for signs of hypocalcemia (e.g., tetany, cramps)

Signs of hypocalcemia like tetany need to be monitored in metabolic alkalosis due to neuromuscular changes.

Question 15 of 25 Hard

How would you interpret ABG results of pH 7.22, PaCO₂ 38 mmHg, HCO₃⁻ 15 mEq/L?

  1. A a. Respiratory acidosis
  2. B b. Metabolic acidosis
  3. C c. Metabolic alkalosis
  4. D d. Respiratory alkalosis

Correct answer: b. Metabolic acidosis

pH and HCO₃⁻ are low while PaCO₂ is nearly normal, indicating metabolic acidosis.

Question 16 of 25 Medium

In respiratory alkalosis, how do the kidneys compensate?

  1. A Retaining HCO3 to buffer acid
  2. B Excreting HCO3 and retaining H+
  3. C Excreting H+ ions exclusively
  4. D Excreting Na+ along with HCO3

Correct answer: Excreting HCO3 and retaining H+

The kidneys compensate by excreting bicarbonate and retaining hydrogen ions to lower pH in respiratory alkalosis.

Question 17 of 25 Medium

What ABG pattern is suggestive of metabolic alkalosis?

  1. A a. pH 7.49, PaCO₂ 44 mmHg, HCO₃⁻ 30 mEq/L
  2. B b. pH 7.30, PaCO₂ 30 mmHg, HCO₃⁻ 16 mEq/L
  3. C c. pH 7.25, PaCO₂ 50 mmHg, HCO₃⁻ 20 mEq/L
  4. D d. pH 7.52, PaCO₂ 28 mmHg, HCO₃⁻ 22 mEq/L

Correct answer: a. pH 7.49, PaCO₂ 44 mmHg, HCO₃⁻ 30 mEq/L

High pH, elevated HCO₃⁻, and near normal PaCO₂ indicate metabolic alkalosis.

Question 18 of 25 Easy

What breathing pattern is likely in a patient with metabolic acidosis due to diabetic ketoacidosis?

  1. A Increased respiratory rate to blow off CO2
  2. B Decreased respiratory rate and depth
  3. C Unaffected ventilation pattern
  4. D Immediate renal compensation only

Correct answer: Decreased respiratory rate and depth

Diabetic ketoacidosis leads to Kussmaul respirations, characterized by deep and rapid breathing in an attempt to compensate for acidosis.

Question 19 of 25 Medium

For ABG pH 7.40, PaCO₂ 60 mmHg, HCO₃⁻ 36 mEq/L, what interpretation is most accurate?

  1. A a. Normal ABG
  2. B b. Fully compensated respiratory acidosis
  3. C c. Partially compensated metabolic alkalosis
  4. D d. Mixed disorder

Correct answer: b. Fully compensated respiratory acidosis

The pH is normal, but PaCO₂ is high, and HCO₃⁻ is elevated, indicating fully compensated respiratory acidosis.

Question 20 of 25 Medium

What is a nursing intervention for a patient with respiratory acidosis?

  1. A a. Encourage rapid deep breathing
  2. B b. Administer oxygen and assist ventilation if needed
  3. C c. Restrict fluids
  4. D d. Administer sodium bicarbonate immediately

Correct answer: b. Administer oxygen and assist ventilation if needed

Treatment for respiratory acidosis focuses on improving ventilation, oxygenation, and assisting breathing to address hypoventilation.

Question 21 of 25 Medium

In metabolic alkalosis, what is the typical compensatory respiratory response?

  1. A a. Increased respiratory rate
  2. B b. Decreased respiratory rate and depth (hypoventilation)
  3. C c. Unaffected ventilation
  4. D d. Immediate renal compensation only

Correct answer: b. Decreased respiratory rate and depth (hypoventilation)

The body compensates by hypoventilating to retain CO₂, lowering pH back toward normal in metabolic alkalosis.

Question 22 of 25 Medium

A patient with severe pneumonia and ABG results of pH 7.32, PaCO₂ 52 mmHg, HCO₃⁻ 26 mEq/L likely has which acid-base disorder?

  1. A a. Metabolic acidosis
  2. B b. Respiratory acidosis
  3. C c. Metabolic alkalosis
  4. D d. Respiratory alkalosis

Correct answer: b. Respiratory acidosis

Low pH and elevated PaCO₂ with normal HCO₃⁻ indicate respiratory acidosis in this context.

Question 23 of 25 Medium

For ABG pH 7.46, PaCO₂ 55 mmHg, HCO₃⁻ 33 mEq/L, what does this suggest?

  1. A a. Uncompensated respiratory alkalosis
  2. B b. Fully compensated respiratory acidosis
  3. C c. Partially compensated metabolic alkalosis
  4. D d. Metabolic acidosis

Correct answer: c. Partially compensated metabolic alkalosis

The ABG values indicate partially compensated metabolic alkalosis with both respiratory and metabolic components.

Question 24 of 25 Hard

What electrolyte change is anticipated in a patient with metabolic acidosis from renal failure?

  1. A a. Hypokalemia
  2. B b. Hyperkalemia
  3. C c. Hypocalcemia only
  4. D d. Hypernatremia only

Correct answer: b. Hyperkalemia

Metabolic acidosis involving renal failure often leads to hyperkalemia due to potassium shifts.

Question 25 of 25 Easy

Which statement correctly describes the 'ROME' mnemonic for ABG interpretation?

  1. A a. Respiratory Opposite, Metabolic Equal – meaning PaCO₂ moves opposite pH, HCO₃ moves same direction as pH
  2. B b. Respiratory Opposite, Metabolic Equal – meaning both PaCO₂ and HCO₃ move opposite to pH
  3. C c. Respiratory Opposite, Metabolic Equal – meaning both move in same direction as pH
  4. D d. Respiratory Opposite, Metabolic Equal – meaning only HCO₃ changes in respiratory disorders

Correct answer: a. Respiratory Opposite, Metabolic Equal – meaning PaCO₂ moves opposite pH, HCO₃ moves same direction as pH

The 'ROME' method relates how PaCO₂ moves opposite to pH in respiratory disorders while HCO₃⁻ moves in the same direction as pH in metabolic disorders.

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