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The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is currently receiving mechanical ventilation. After reviewing the client's arterial blood gas (ABG), the nurse identifies this ABG as Laboratory: pH 7.24 [7.35-7.45], PaCO2 48 mm Hg [35-45 mm Hg], HCO3 23 mEq/L [22-28 mEq/L], PaO2 90 mm Hg [80-100 mm Hg]
- A. metabolic alkalosis
- B. metabolic acidosis
- C. respiratory alkalosis
- D. respiratory acidosis
Correct Answer: D
Rationale: The ABG shows low pH (7.24) and elevated PaCO2 (48 mm Hg), indicating respiratory acidosis (D) due to CO2 retention, common in COPD. HCO3 is normal, suggesting no compensation.
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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.
The nurse should interpret these results to indicate that the client has? Laboratory: pH 7.30 [7.35-7.45], PaCO2 50 mmHg [35-45 mm Hg], HCO3- 24 mEq/L [22-28 mEq/L]
- A. Respiratory Acidosis
- B. Respiratory Alkalosis
- C. Metabolic Acidosis
- D. Metabolic Alkalosis
Correct Answer: A
Rationale: Low pH (7.30) and high PaCO2 (50 mm Hg) with normal HCO3- indicate uncompensated respiratory acidosis (A).
The nurse is reviewing a client's arterial blood gas (ABG) results who has a nasogastric tube (NGT) attached to continuous suction. The ABG results reveal the following: pH 7.50 [7.35-7.45], PaCO2 42 mmHg [35-45 mm Hg], HCO3- 35 mEq/L [22-28 mEq/L]. The nurse should interpret these results to indicate that the client has
- A. respiratory acidosis
- B. respiratory alkalosis
- C. metabolic acidosis
- D. metabolic alkalosis
Correct Answer: D
Rationale: High pH (7.50) and elevated HCO3- (35 mEq/L) with normal PaCO2 indicate metabolic alkalosis (D), likely due to loss of gastric acid from NGT suction.
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.
The nurse should recognize that the client is experiencing Laboratory: pH 7.19 [7.35-7.45], PaCO2 36 mm Hg [35-45 mm Hg], HCO3 12 mEq/L [22-28 mEq/L], PaO2 90 mm Hg [80-100 mm Hg]
- A. compensated metabolic acidosis
- B. uncompensated metabolic acidosis
- C. compensated respiratory acidosis
- D. uncompensated respiratory alkalosis
Correct Answer: B
Rationale: Low pH (7.19) and low HCO3- (12 mEq/L) with normal PaCO2 indicate uncompensated metabolic acidosis (B). No compensation is evident as PaCO2 is normal.