Clinical Chemistry-Blood Gases, pH, and Electrolytes Flashcards by H. JG

Which of the following represents the
Henderson–Hasselbalch equation as applied
to blood pH?
A. pH = 6.1 + log HCO3–/PCO2
B. pH = 6.1 + log HCO3–/(0.03 × PCO2)
C. pH = 6.1 + log dCO2/HCO3–
D. pH = 6.1 + log (0.03 × PCO2)/HCO3–

B. pH = 6.1 + log HCO3–/(0.03 × PCO2)

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What is the PO2 of calibration gas containing
20.0% O2, when the barometric pressure is
30 in.?
A. 60 mm Hg
B. 86 mm Hg
C. 143 mm Hg
D. 152 mm Hg

C. 143 mm Hg

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What is the blood pH when the partial pressure
of carbon dioxide (PCO2) is 60 mm Hg and the
bicarbonate concentration is 18 mmol/L?
A. 6.89
B. 7.00
C. 7.10
D. 7.30

C. 7.10

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Which of the following best represents the
reference (normal) range for arterial pH?
A. 7.35–7.45
B. 7.42–7.52
C. 7.38–7.68
D. 6.85–7.56

A. 7.35–7.45

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What is the normal ratio of bicarbonate to
dissolved carbon dioxide (HCO3
–
:dCO2) in
arterial blood?
A. 1:10
B. 10:1
C. 20:1
D. 30:1

C. 20:1

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What is the PCO2 if the dCO2 is 1.8 mmol/L?
A. 24 mm Hg
B. 35 mm Hg
C. 60 mm Hg
D. 72 mm Hg

C. 60 mm Hg

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In the Henderson–Hasselbalch expression
pH = 6.1 + log HCO3
–
/dCO2, the
6.1 represents:
A. The combined hydration and dissociation
constants for CO2 in blood at 37°C
B. The solubility constant for CO2 gas
C. The dissociation constant of H2O
D. The ionization constant of sodium bicarbonate
(NaHCO3)

A. The combined hydration and dissociation
constants for CO2 in blood at 37°C

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Which of the following contributes the most to
the serum total CO2?
A. PCO2
B. dCO2
C. HCO3–
D. Carbonium ion

C. HCO3–

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In addition to sodium bicarbonate, what other
substance contributes most to the amount of base
in the blood?
A. Hemoglobin concentration
B. Dissolved O2 concentration
C. Inorganic phosphorus
D. Organic phosphate

A. Hemoglobin concentration

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Which of the following effects results from
exposure of a normal arterial blood sample to
room air?
A. PO2 increased PCO2 decreased pH increased
B. PO2 decreased PCO2 increased pH decreased
C. PO2 increased PCO2 decreased pH decreased
D. PO2 decreased PCO2 decreased pH decreased

A. PO2 increased PCO2 decreased pH increased

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Which of the following formulas for O2 content is
correct?
A. O2 content = %O2 saturation/100 × Hgb g/dL ×
1.39 mL/g + (0.0031 × PO2)
B. O2 content = PO2 × 0.0306 mmol/L/mm
C. O2 content = O2 saturation × Hgb g/dL
× 0.003 mL/g
D. O2 content = O2 capacity × 0.003 mL/g

A. O2 content = %O2 saturation/100 × Hgb g/dL ×
1.39 mL/g + (0.0031 × PO2)

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The normal difference between alveolar and
arterial PO2 (PAO2–PaO2 difference) is:
A. 3 mm Hg
B. 10 mm Hg
C. 40 mm Hg
D. 50 mm Hg

B. 10 mm Hg

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A decreased PAO2–PaO2 difference is found in:
A. A/V (arteriovenous) shunting
B. V/Q (ventilation/perfusion) inequality
C. Ventilation defects
D. All of these options

C. Ventilation defects

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The determination of the oxygen saturation of
hemoglobin is best accomplished by:
A. Polychromatic absorbance measurements of a
whole-blood hemolysate
B. Near infrared transcutaneous absorbance
measurement
C. Treatment of whole blood with alkaline
dithionite prior to measuring absorbance
D. Calculation using PO2 and total hemoglobin
by direct spectrophotometry

A. Polychromatic absorbance measurements of a
whole-blood hemolysate

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Correction of pH for a patient with a body
temperature of 38°C would require:
A. Subtraction of 0.015
B. Subtraction of 0.01%
C. Addition of 0.020
D. Subtraction of 0.020

A. Subtraction of 0.015

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Select the anticoagulant of choice for blood gas
studies.
A. Sodium citrate 3.2%
B. Lithium heparin 100 U/mL blood
C. Sodium citrate 3.8%
D. Ammonium oxalate 5.0%

B. Lithium heparin 100 U/mL blood

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What is the maximum recommended storage time
and temperature for an arterial blood gas sample
drawn in a plastic syringe?

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A patient’s blood gas results are as follows:
pH = 7.26
dCO2 = 2.0 mmol/L
HCO3– = 29 mmol/L

These results would be classified as:
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis

C. Respiratory acidosis

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A patient’s blood gas results are:
pH = 7.50
PCO2 = 55 mm Hg
HCO3– = 40 mmol/L

These results indicate:
A. Respiratory acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Metabolic acidosis

B. Metabolic alkalosis

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Which set of results is consistent with
uncompensated respiratory alkalosis?
A. pH 7.70 HCO3 30 mmol/L PCO2 25 mm Hg
B. pH 7.66 HCO3 22 mmol/L PCO2 20 mm Hg
C. pH 7.46 HCO3 38 mmol/L PCO2 55 mm Hg
D. pH 7.36 HCO3 22 mmol/L PCO2 38 mm Hg

B. pH 7.66 HCO3 22 mmol/L PCO2 20 mm Hg

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Which of the following will shift the O2 dissociation
curve to the left?
A. Anemia
B. Hyperthermia
C. Hypercapnia
D. Alkalosis

D. Alkalosis

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In which circumstance will the reporting of
calculated oxygen saturation of hemoglobin
based on PO2, PCO2, pH, temperature, and
hemoglobin be in error?
A. Carbon monoxide poisoning
B. Diabetic ketoacidosis
C. Patient receiving oxygen therapy
D. Assisted ventilation for respiratory failure

A. Carbon monoxide poisoning

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Which would be consistent with partially
compensated respiratory acidosis?
A. pH PCO2 Bicarbonate
increased increased increased
B. pH PCO2 Bicarbonate
increased decreased decreased
C. pH PCO2 Bicarbonate
decreased decreased decreased
D. pH PCO2 Bicarbonate
decreased increased increased

D. pH PCO2 Bicarbonate
decreased increased increased

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Which condition results in metabolic acidosis with
severe hypokalemia and chronic alkaline urine?
A. Diabetic ketoacidosis
B. Phenformin-induced acidosis
C. Renal tubular acidosis
D. Acidosis caused by starvation

C. Renal tubular acidosis

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25. Which of the following mechanisms is responsible for metabolic acidosis? A. Bicarbonate deficiency B. Excessive retention of dissolved CO2 C. Accumulation of volatile acids D. Hyperaldosteronism

A. Bicarbonate deficiency

26. Which of the following disorders is associated with lactate acidosis? A. Diarrhea B. Renal tubular acidosis C. Hypoaldosteronism D. Alcoholism

D. Alcoholism

27. Which of the following is the primary mechanism of compensation for metabolic acidosis? A. Hyperventilation B. Release of epinephrine C. Aldosterone release D. Bicarbonate excretion

A. Hyperventilation

28. The following conditions are all causes of alkalosis. Which condition is associated with respiratory (rather than metabolic) alkalosis? A. Anxiety B. Hypovolemia C. Hyperaldosteronism D. Hypoparathyroidism

A. Anxiety

29. Which of the following conditions is associated with both metabolic and respiratory alkalosis? A. Hyperchloremia B. Hypernatremia C. Hyperphosphatemia D. Hypokalemia

D. Hypokalemia

30. In uncompensated metabolic acidosis, which of the following will be normal? A. Plasma bicarbonate B. PCO2 C. p50 D. Total CO2

B. PCO2

31. Which of the following conditions is classified as normochloremic acidosis? A. Diabetic ketoacidosis B. Chronic pulmonary obstruction C. Uremic acidosis D. Diarrhea

A. Diabetic ketoacidosis

32. Which PCO2 value would be seen in maximally compensated metabolic acidosis? A. 15 mm Hg B. 30 mm Hg C. 40 mm Hg D. 60 mm Hg

A. 15 mm Hg

33. A patient has the following arterial blood gas results: pH = 7.56 PCO2 = 25 mm Hg PO2 = 100 mm Hg HCO3– = 22 mmol/L These results are most likely the result of which condition? A. Improper specimen collection B. Prolonged storage C. Hyperventilation D. Hypokalemia

C. Hyperventilation

34. Why are three levels used for quality control of pH and blood gases? A. Systematic errors can be detected earlier than with two controls B. Analytical accuracy needs to be greater than for other analytes C. High, normal, and low ranges must always be evaluated D. A different level is needed for pH, PCO2, and PO2

A. Systematic errors can be detected earlier than with two controls

35. A single-point calibration is performed between each blood gas sample in order to: A. Correct the electrode slope B. Correct electrode and instrument drift C. Compensate for temperature variance D. Prevent contamination by the previous sample

B. Correct electrode and instrument drift

36. In which condition would hypochloremia be expected? A. Respiratory alkalosis B. Metabolic acidosis C. Metabolic alkalosis D. All of these options

C. Metabolic alkalosis

37. Given the following serum electrolyte data, determine the anion gap. Na = 132 mmol/L Cl = 90 mmol/L HCO3– = 22 mmol/L A. 12 mmol/L B. 20 mmol/L C. 64 mmol/L D. Cannot be determined from the information provided

B. 20 mmol/L

38. Which of the following conditions will cause an increased anion gap? A. Diarrhea B. Hypoaldosteronism C. Hyperkalemia D. Renal failure

D. Renal failure

39. Alcoholism, liver failure, and hypoxia induce acidosis by causing: A. Depletion of cellular NAD+ B. Increased excretion of bicarbonate C. Increased retention of PCO2 D. Loss of carbonic anhydrase

A. Depletion of cellular NAD+

40. Which of the following is the primary mechanism causing respiratory alkalosis? A. Hyperventilation B. Deficient alveolar diffusion C. Deficient pulmonary perfusion D. Parasympathetic inhibition

A. Hyperventilation

41. Which condition can result in acidosis? A. Cystic fibrosis B. Vomiting C. Hyperaldosteronism D. Excessive O2 therapy

D. Excessive O2 therapy

42. Which of the following conditions is associated with an increase in ionized calcium (Cai) in the blood? A. Alkalosis B. Hypoparathyroidism C. Hyperalbuminemia D. Malignancy

D. Malignancy

43. Which of the following laboratory results is consistent with primary hypoparathyroidism? A. Low calcium; high inorganic phosphorus Pi B. Low calcium; low Pi C. High calcium; high Pi D. High calcium; low Pi

A. Low calcium; high inorganic phosphorus Pi

44. Which of the following conditions is associated with hypophosphatemia? A. Rickets B. Multiple myeloma C. Renal failure D. Hypervitaminosis D

A. Rickets

45. Which of the following tests is consistently abnormal in osteoporosis? A. High urinary calcium B. High serum Pi C. Low serum calcium D. High urine or serum N-telopeptide of type 1 collagen

D. High urine or serum N-telopeptide of type 1 collagen

46. Which of the following is a marker for bone formation? A. Osteocalcin B. Tartrate resistant acid phosphatase (TRAP) C. Urinary pyridinoline and deoxypyridinoline D. Urinary C-telopeptide and N-telopeptide crosslinks (CTx and NTx)

A. Osteocalcin

47. What role do CTx and NTx play in the management of osteoporosis? A. Increased urinary excretion is diagnostic of early stage disease B. Increased levels indicate a low risk of developing osteoporosis C. Decreased urinary excretion indicates a positive response to treatment D. The rate of urinary excretion correlates with the stage of the disease

C. Decreased urinary excretion indicates a positive response to treatment

48. What role does vitamin D measurement play in the management of osteoporosis? A. Vitamin D deficiency must be demonstrated to establish the diagnosis B. Vitamin D is consistently elevated in osteoporosis C. A normal vitamin D level rules out osteoporosis D. Vitamin D deficiency is a risk factor for developing osteoporosis

D. Vitamin D deficiency is a risk factor for developing osteoporosis

49. Which statement best describes testing recommendations for vitamin D? A. Vitamin D testing should be reserved only for those persons who demonstrate hypercalcemia of an undetermined cause B. Vitamin D testing should be specific for the 1,25(OH)D3 form C. Testing should be for total vitamin D when screening for deficiency D. Vitamin D testing should not be performed if the patient is receiving a vitamin D supplement

C. Testing should be for total vitamin D when screening for deficiency

50. The serum level of which of the following laboratory tests is decreased in both VDDR and VDRR? A. Vitamin D B. Calcium C. Pi D. Parathyroid hormone

C. Pi

51. Which of the following is the most accurate measurement of Pi in serum? A. Rate of unreduced phosphomolybdate formation at 340 nm B. Measurement of phosphomolybdenum blue at 680 nm C. Use of aminonaptholsulfonic acid to reduce phosphomolybdate D. Formation of a complex with malachite green dye

A. Rate of unreduced phosphomolybdate formation at 340 nm

52. What is the percentage of serum calcium that is ionized (Cai)? A. 30% B. 45% C. 60% D. 80%

B. 45%

53. Which of the following conditions will cause erroneous Cai results? Assume that the samples are collected and stored anaerobically, kept at 4°C until measurement, and stored for no longer than 1 hour. A. Slight hemolysis during venipuncture B. Assay of whole blood collected in sodium oxalate C. Analysis of serum in a barrier gel tube stored at 4°C until the clot has formed D. Analysis of whole blood collected in sodium heparin, 20 U/mL (low-heparin tube

B. Assay of whole blood collected in sodium oxalate

54. Which of the following conditions is associated with a low serum magnesium? A. Addison’s disease B. Hemolytic anemia C. Hyperparathyroidism D. Pancreatitis

D. Pancreatitis

55. When measuring calcium with the complexometric dye o-cresolphthalein complexone, magnesium is kept from interfering by: A. Using an alkaline pH B. Adding 8-hydroxyquinoline C. Measuring at 450 nm D. Complexing to EDTA

B. Adding 8-hydroxyquinoline

56. Which electrolyte measurement is least affected by hemolysis? A. Potassium B. Calcium C. Pi D. Magnesium

B. Calcium

57. Which of the following conditions is associated with hypokalemia? A. Addison’s disease B. Hemolytic anemia C. Digoxin intoxication D. Alkalosis

D. Alkalosis

58. Which of the following conditions is most likely to produce an elevated plasma potassium? A. Hypoparathyroidism B. Cushing’s syndrome C. Diarrhea D. Digitalis overdose

D. Digitalis overdose

59. Which of the following values is the threshold critical value (alert or action level) for low plasma potassium? A. 1.5 mmol/L B. 2.0 mmol/L C. 2.5 mmol/L D. 3.5 mmol/L

C. 2.5 mmol/L

60. Which electrolyte is least likely to be elevated in renal failure? A. Potassium B. Magnesium C. Inorganic phosphorus D. Sodium

D. Sodium

61. Which of the following is the primary mechanism for vasopressin (ADH) release? A. Hypovolemia B. Hyperosmolar plasma C. Renin release D. Reduced renal blood flow

B. Hyperosmolar plasma

62. Which of the following conditions is associated with hypernatremia? A. Diabetes insipidus B. Hypoaldosteronism C. Burns D. Diarrhea

A. Diabetes insipidus

63. Which of the following values is the threshold critical value (alert or action level) for high plasma sodium? A. 150 mmol/L B. 160 mmol/L C. 170 mmol/L D. 180 mmol/L

B. 160 mmol/L

64. Which of the following conditions is associated with total body sodium excess? A. Renal failure B. Hyperthyroidism C. Hypoparathyroidism D. Diabetic ketoacidosis

A. Renal failure

65. Which of the following conditions is associated with hyponatremia? A. Diuretic therapy B. Cushing’s syndrome C. Diabetes insipidus D. Nephrotic syndrome

A. Diuretic therapy

66. Which of the following conditions involving electrolytes is described correctly? A. Pseudohyponatremia occurs only when undiluted samples are measured B. Potassium levels are slightly higher in heparinized plasma than in serum C. Hypoalbuminemia causes low total calcium but does not affect Cai D. Hypercalcemia may be induced by low serum magnesium

C. Hypoalbuminemia causes low total calcium but does not affect Cai

67. Which of the following laboratory results is usually associated with cystic fibrosis? A. Sweat chloride greater than 60 mmol/L B. Elevated serum sodium and chloride C. Elevated fecal trypsin activity D. Low glucose

A. Sweat chloride greater than 60 mmol/L

68. When performing a sweat chloride collection, which of the following steps will result in analytical error? A. Using unweighed gauze soaked in pilocarpine nitrate on the inner surface of the forearm to stimulate sweating B. Collecting more than 75 mg of sweat in 30 minutes C. Leaving the preweighed gauze on the inside of the arm exposed to air during collection D. Rinsing the collected sweat from the gauze pad using chloride titrating solution

C. Leaving the preweighed gauze on the inside of the arm exposed to air during collection

69. Which electrolyte level best correlates with plasma osmolality? A. Sodium B. Chloride C. Bicarbonate D. Calcium

A. Sodium

70. Which formula is most accurate in predicting plasma osmolality? A. Na + 2(Cl) + BUN + glucose B. 2(Na) + 2(Cl) + glucose + urea C. 2(Na) + (glucose ÷ 18) + (BUN ÷ 2.8) D. Na + Cl + K + HCO3

C. 2(Na) + (glucose ÷ 18) + (BUN ÷ 2.8)

Clinical Chemistry-Blood Gases, pH, and Electrolytes Flashcards

(70 cards)