Nokea
The nurse in the emergency department (ED) is caring for a client with dyspnea and coughing up purulent sputum. The nurse reviews the arterial blood gas (ABG) results: pH 7.25 [7.35-7.45], PaO2 93 mmHg [80-100 mmHg], PaCO2 69 mmHg [35-45 mm Hg], HCO3 25 mmol/L [22-28 mEq/L]. The nurse should interpret these results to indicate that the client has
- A. respiratory alkalosis
- B. respiratory acidosis
- C. metabolic alkalosis
- D. metabolic acidosis
Correct Answer: B
Rationale: The ABG shows low pH (7.25) and high PaCO2 (69 mm Hg), indicating respiratory acidosis (B) due to CO2 retention, likely from impaired ventilation due to pneumonia.
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The nurse interprets this ABG result as Laboratory: pH 7.59 [7.35-7.45], PaCO2 30 mmHg [35-45 mm Hg], HCO3- 24 mEq/L [22-28 mEq/L], PaO2 85 mmHg [80-100 mm Hg]
- A. Metabolic acidosis
- B. Respiratory acidosis
- C. Metabolic alkalosis
- D. Respiratory alkalosis
Correct Answer: D
Rationale: High pH (7.59) and low PaCO2 (30 mm Hg) with normal HCO3- indicate uncompensated respiratory alkalosis (D).
The nurse recognizes which of the following are potential causes of metabolic alkalosis? Select all that apply.
- A. Vomiting
- B. Diarrhea
- C. Antacids
- D. Starvation
- E. Hypokalemia
Correct Answer: A,C,E
Rationale: Metabolic alkalosis is caused by an increase in bicarbonate or loss of acid. Vomiting (A) leads to loss of gastric acid, increasing bicarbonate. Antacids (C) neutralize acid, raising bicarbonate levels. Hypokalemia (E) can cause hydrogen ion shifts, contributing to alkalosis. Diarrhea (B) causes bicarbonate loss, leading to acidosis, not alkalosis. Starvation (D) is associated with ketoacidosis, not alkalosis.
Which of the following abnormalities in the arterial blood gas (ABG) would be consistent with a client who has overdosed on clonazepam?
- A. metabolic acidosis
- B. metabolic alkalosis, fully compensated
- C. respiratory alkalosis
- D. respiratory acidosis
Correct Answer: D
Rationale: Clonazepam, a benzodiazepine, depresses the central nervous system, reducing respiratory drive and causing CO2 retention, leading to respiratory acidosis (D). Metabolic acidosis (A), metabolic alkalosis (B), and respiratory alkalosis (C) are not typical.
The nurse is reviewing the arterial blood gas results of a client with chronic obstructive pulmonary disease (COPD) reporting dyspnea. The ABG results: pH 7.18 [7.35-7.45], PaCO2 67 mmHg [35-45 mm Hg], HCO3-
- A. respiratory acidosis
- B. metabolic acidosis
- C. respiratory alkalosis
- D. metabolic alkalosis
Correct Answer: A
Rationale: Low pH (7.18) and high PaCO2 (67 mm Hg) indicate respiratory acidosis (A), common in COPD due to CO2 retention.
Which essential action should the nurse take based on the results? Laboratory: pH 7.30 [7.35-7.45], PaCO2 66 mm Hg [35-45 mm Hg], HCO3 23 mEq/L [22-28 mEq/L], PaO2 77 mm Hg [80-100 mm Hg]
- A. Review the most recent chest radiograph (x-ray)
- B. Apply supplemental oxygen
- C. Instruct the client how to use incentive spirometry
- D. Obtain a prescription to infuse sodium bicarbonate
Correct Answer: B
Rationale: The ABG indicates respiratory acidosis (pH 7.30, PaCO2 66 mm Hg) and hypoxemia (PaO2 77 mm Hg). Supplemental oxygen (B) addresses low PaO2. Chest radiograph (A) and incentive spirometry (C) are secondary. Sodium bicarbonate (D) is for metabolic acidosis, not respiratory.