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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.
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The nurse should recognize that the client is experiencing which acid-base imbalance? Laboratory: pH 7.30 [7.35-7.45], PaCO2 58 mm Hg [35-45 mm Hg], HCO3 29 mEq/L [22-28 mEq/L], PaO2 91 mm Hg [80-100 mm Hg]
- A. respiratory acidosis, partially compensated
- B. respiratory acidosis, fully compensated
- C. metabolic acidosis, partially compensated
- D. metabolic acidosis, fully compensated
Correct Answer: A
Rationale: Low pH (7.30) and high PaCO2 (58 mm Hg) indicate respiratory acidosis. Elevated HCO3- (29 mEq/L) suggests partial compensation (A), as pH is not normalized.
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.
Which of the following arterial blood gas (ABG) results would the nurse expect if the client's condition is left untreated?
- A. pH 7.50, PCO2 48, PaO2 70, HCO3 44, SaO2 88%
- B. pH 7.28, PCO2 53, PaO2 55, HCO3 28, SaO2 82%
- C. pH 7.36, PCO2 44, PaO2 66, HCO3 28, SaO2 84%
- D. pH 7.48, PCO2 48, PaO2 70, HCO3 24, SaO2 86%
Correct Answer: B
Rationale: Untreated ARDS causes severe hypoxemia and CO2 retention, leading to respiratory acidosis. Option B (pH 7.28, PaCO2 53, PaO2 55, SaO2 82%) reflects this.
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 emergency department (ED) nurse cares for a client who reports persistent nausea and vomiting for three days. Which acid-base imbalance would the nurse expect based on the client's manifestations?
- A. A decreased pH and an elevated CO2
- B. An elevated pH and a decreased CO2
- C. A decreased pH and a decreased HCO3-
- D. An increased pH with an increased HCO3-
Correct Answer: D
Rationale: Persistent vomiting causes loss of gastric acid, increasing HCO3- and pH, leading to metabolic alkalosis (D).