Practice Question
A patient presents with hyperventilation after having severe diarrhea for 3 days. The nurse knows that this is due to which acid-base imbalance? Explain why the patient has presented this way.
Answer Choices:
Correct Answer:
Metabolic acidosis
Rationale:
🟣 Severe diarrhea leads to loss of bicarbonate (HCO₃⁻) from the intestines, especially from the lower GI tract where bicarbonate is abundant.
🟣 Loss of bicarbonate, a major base, results in a decrease in blood pH, producing metabolic acidosis.
🟣 To compensate, the body increases respiratory rate and depth (Kussmaul-type respirations) to blow off CO₂, which is an acidic component, helping to raise pH.
🟣 The patient’s hyperventilation is a respiratory compensatory response, not the primary problem, and is appropriate for metabolic acidosis.
🟣 This pattern — diarrhea → loss of HCO₃⁻ → metabolic acidosis → compensatory hyperventilation — clearly supports metabolic acidosis as the correct imbalance.
Metabolic Alkalosis
🟣 Metabolic alkalosis is usually associated with loss of acid (e.g., vomiting, nasogastric suction) or excessive bicarbonate intake, not loss of bicarbonate.
🟣 In diarrhea, the problem is loss of base (HCO₃⁻), which causes acidosis, not alkalosis.
🟣 Patients with metabolic alkalosis often present with hypoventilation, as the body tries to retain CO₂ (an acid) to lower pH.
🟣 The hyperventilation observed in this patient does not fit a metabolic alkalosis pattern.
🟣 Therefore, this option is incorrect because it does not match the GI loss pattern and respiratory compensation seen in diarrhea.
Respiratory Acidosis
🟣 Respiratory acidosis occurs when there is hypoventilation and retention of CO₂, such as in COPD, drug overdose, or respiratory muscle weakness.
🟣 This patient is hyperventilating, which would lower CO₂ rather than retain it, making respiratory acidosis unlikely.
🟣 The primary disturbance here is metabolic (loss of bicarbonate from diarrhea), not a primary ventilation failure.
🟣 Respiratory acidosis would typically show elevated CO₂ and low pH without an obvious metabolic base loss.
🟣 Because the cause and clinical presentation do not align with respiratory acidosis, this option is incorrect.
Respiratory Alkalosis
🟣 Respiratory alkalosis is caused by primary hyperventilation (e.g., anxiety, pain, fever, early sepsis), leading to excessive CO₂ loss and increased pH.
🟣 Although the patient is hyperventilating, this hyperventilation is a compensatory mechanism for a metabolic problem, not the primary cause.
🟣 The underlying issue is bicarbonate loss from diarrhea, which defines the condition as metabolic acidosis, not respiratory alkalosis.
🟣 In acid–base analysis, the primary disturbance is what defines the disorder; compensation does not rename the imbalance.
🟣 Thus, this option is incorrect because it misidentifies a compensatory respiratory response as the primary disorder.
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This question is from SDAP FALL 25 EXAM2 which contains 34 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: Examplify Exam(s)
- Domain: Medical-Surgical
- Answer Choices: 4