Acid Base NCLEX Review

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This week, we will be covering the Acid Base Module from our Online NCLEX Review. The topics covered in this review are Acid Base Physiology, Acid Base Interpretation, and Acid Base Imbalances.

Acid Base Physiology

The priorities for Acid Base are Assessment and Management

Assessment parameters to detect acid base imbalances

• Vital signs
• Level of consciousness
• Respiratory effort
• Lung sounds

Management treats cause of the problem and the imbalance

• IV fluid
• Medications
• Respiratory interventions

The flashcard above shows acid base physiology. One area that is not covered in detail here, though, is the effects on potassium.

1. Hydrogen and potassium will always exchange for each other in the cell.
2. When the patient becomes acidotic, some of the hydrogen moves into the cell and pushes the potassium out.
3. As acidosis is corrected, or when the patient is in alkalosis, the hydrogen will move out of the cell and potassium will move back in.

 

Acid Base Interpretation

An easy way for you to remember acid base interpretation during your NCLEX is to use the acronym ROME.

R = Respiratory

pH ↑ PCO2 ↓ = Respiratory alkalosis

O = Opposite

pH ↓ PCO2 ↑ = Respiratory acidosis

M = Metabolic

pH ↑  HCO3 ↑ = Metabolic alkalosis

E = Equal

pH ↓  HCO3 ↓ = Metabolic acidosis

You can also remember the “Quick and dirty” rule: If the pH and Bicarbonate are Both in the same direction, then it is a metabolic problem.

For more information, check out this video.

 

Acid Base Imbalances

So, let’s conclude with a sample question that you can expect during your NCLEX Exam.

Pause here (Don’t cheat!!) and read this slide before scrolling down to get the answer.

 

 

Got your answer? Read the slide below for the answer and explanation.

Metabolic acidosis is increased production of H+ by the body or the inability to form bicarbonate (HCO3) in the kidneys.

Metabolic Acidosis Assessment:

• ↑ Respiratory rate (Kussmaul’s)
• ↑ Potassium
• ↓ Blood pressure
• ↓ LOC and disorientation
• Headache

Potential causes are:

• Infection
• Diarrhea
• Renal failure
• Malnutrition
• Diabetic ketoacidosis
• Late shock
• Aspirin overdose

The nurse should treat the cause and may need to give bicarbonate in some situations.

 

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