ABG Book Q's

143. A client has the following arterial blood gas values: pH, 7.52; PaO2 , 50 mm Hg (6.7 kPa); PaCO2 , 28 mm Hg (3.72 kPa); HCO3 - , 24 mEq/L (24 mmol/L). Based upon the client's PaO2 , which of the following conclusions would be accurate? 1. The client is severely hypoxic. 2. The oxygen level is low but poses no risk for the client. 3. The client's PaO2 level is within normal range. 4. The client requires oxygen therapy with very low oxygen concentrations.

143. 1. Normal PaO2 level ranges from 80 to 100 mm Hg (10.6 to 13.3 kPa). When PaO2 falls to 50 mm Hg (6.7 kPa), the nurse should be alert for signs of hypoxia and impending respiratory failure. An oxygen level this low poses a severe risk for respiratory failure. The client will require oxygenation at a concentration that maintains the PaO2 at 55 to 60 mm Hg (7.3 to 8 kPa) or more.

103. A recently extubated client has shortness of breath. The nurse reports the client's discomfort to the health care provider and the results of the recently prescribed arterial blood gas analysis. After reviewing the report of the complete blood count (see below), the nurse should also report which of the following to the health care provider? 1. PT. 2. Hemoglobin and hematocrit. 3. WBC. 4. Platelets.

103. 2. The nurse should review the CBC with differential to evaluate the client's hemoglobin and hematocrit, which are abnormal and should be reported to the health care provider. Anemia leads to decreased oxygen-carrying capacity of the blood. A client unable to compensate for the anemia may experience a profound sense of dyspnea. There has been a significant drop in the Hgb and Hct since the previous report, and these should be reported to the physician. A1C is a laboratory test evaluating glycosylated hemoglobin and is in the normal range. This test is used to diagnose diabetes and/or monitor diabetic glucose control over time. Blood culture is obtained to assess infection in the blood. PT is a coagulation study reflecting liver function and clotting time and is in the normal range.

1. A nurse is caring for a client admitted with confusion and lethargy. The client was found at home unresponsive with an empty bottle of aspirin lying next to the bed. Vital signs reveal blood pressure 104/72 mm Hg, heart rate 116/min with regular rhythm, and respiratory rate 42/min and deep. Which of the following arterial blood gas findings should the nurse expect? A. pH 7.68 PaO2 96 mm Hg PaCO2 38 mm Hg HCO3 − 28 mEq/L B. pH 7.42 PaO2 100 mm Hg PaCO2 28 mm Hg HCO3 − 23 mEq/L C. pH 6.98 PaO2 100 mm Hg PaCO2 30 mm Hg HCO3 − 18 mEq/L D. pH 7.58 PaO2 96 mm Hg PaCO2 38 mm Hg HCO3 − 29 mEq/L

A. These arterial blood gases indicate metabolic alkalosis. B. These arterial blood gases indicate respiratory alkalosis. C. CORRECT: An aspirin toxicity would result in arterial blood gas findings of metabolic acidosis. D. These arterial blood gases indicate metabolic alkalosis.

54. The nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, Paco2 of 30 mm Hg (30 mm Hg), and HCO3 - of 20 mEq/L (20 mmol/L). The nurse analyzes these results as indicating which condition? 1. Metabolic acidosis, compensated 2. Respiratory alkalosis, compensated 3. Metabolic alkalosis, uncompensated 4. Respiratory acidosis, uncompensated

Answer: 2 Rationale: The normal pH is 7.35 to 7.45. In a respiratory condition, an opposite effect will be seen between the pH and the Paco2 . In this situation, the p H is at the high end of the normal value and the Pco2 is low. In an alkalotic condition, the pH is elevated. Therefore, the values identified in the question indicate a respiratory alkalosis that is compensated by the kidneys through the renal excretion of bicarbonate. Because the pH has returned to a normal value, compensation has occurred. Test-Taking Strategy: Focus on the data in the question, noting the arterial blood gas results. Remember that in a respiratory imbalance you will find an opposite response between the pH and the Pco2 as indicated in the question. Therefore, you can eliminate the options reflective of a primary metabolic problem. Also, remember that the pH increases in an alkalotic condition and compensation can be evidenced by a normal pH. The correct option reflects a respiratory alkalotic condition and compensation and describes the blood gas values as indicated in the question.

144. A client has the following arterial blood gas values: pH, 7.52; PaO2 , 50 mm Hg (6.7 kPa); PaCO2 , 28 mm Hg (3.7 kPa); HCO3 - , 24 mEq/L (24 mmol/L). The nurse determines that which of the following is a possible cause for these findings? 1. Chronic obstructive pulmonary disease (COPD). 2. Diabetic ketoacidosis with Kussmaul's respirations. 3. Myocardial infarction. 4. Pulmonary embolus.

144. 4. A PaCO2 of 28 mm Hg (3.7 kPa) and PaO2 of 50 mm Hg (6.7 kPa) are both abnormal; the PaO2 of 50 mm Hg (6.7 kPa) signifies acute respiratory failure. In evaluating possible causes for this disorder, the nurse should consider conditions that lead to hypoxia and hyperventilation, such as pulmonary embolus. COPD is typically associated with respiratory acidosis and elevated PaCO2 . The client with diabetic ketoacidosis most often has metabolic acidosis. A myocardial infarction does not often cause an acid-base imbalance because the primary problem is cardiac in origin

A nurse is obtaining arterial blood gases for a client who has vomited for 24 hr. The nurse should expect which of the following acid‑base imbalances to result from vomiting for 24 hr? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

3. A. Respiratory acidosis is not indicated for this client. B. Respiratory alkalosis is not indicated for this client. C. Metabolic acidosis is not indicated for this client. D. CORRECT: Excessive vomiting causes a loss of gastric acids and an accumulation of bicarbonate in the blood, resulting in metabolic alkalosis.

4. A charge nurse is teaching a group of nurses about conditions related to metabolic acidosis. Which of the following statements by a unit nurse indicates the teaching has been effective? A. "Metabolic acidosis can occur due to diabetic ketoacidosis." B. "Metabolic acidosis can occur in a client who has myasthenia gravis." C. "Metabolic acidosis can occur in a client who has asthma." D. "Metabolic acidosis can occur due to cancer."

4. A. CORRECT: Metabolic acidosis results from an excess production of hydrogen ions, which occurs in diabetic ketoacidosis. B. Respiratory acidosis can occur in a client who has myasthenia gravis. C. Respiratory acidosis can occur in a client who has asthma. D. Respiratory acidosis can occur due to cancer.

5. A nurse is assessing a client who has pancreatitis. The client's arterial blood gases reveal metabolic acidosis. Which of the following are expected findings? (Select all that apply.) A. Tachycardia B. Hypertension C. Bounding pulses D. Hyperreflexia E. Dysrhythmia F. Tachypnea

5. A. Tachycardia is an expected finding for a client who has respiratory acidosis or metabolic alkalosis. B. Hypertension is an expected finding of respiratory acidosis. C. Bounding pulses is an expected finding for respiratory acidosis due to hypertension. D. Hyperreflexia is an expected finding for a client who has metabolic alkalosis. E. CORRECT: Dysrhythmia is an expected finding in a client who has pancreatitis and metabolic acidosis. F. CORRECT: Tachypnea is an expected finding in a client who has pancreatitis and metabolic acidosis.

55. The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client for manifestations of which disorder that the client is at risk for? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis

55. Answer: 2 Rationale: Metabolic alkalosis is defined as a deficit or loss of hydrogen ions or acids or an excess of base (bicarbonate) that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions resulting in hypovolemia, the loss of gastric fluid, excessive bicarbonate intake, the massive transfusion of whole blood, and hyperaldosteronism. Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric acid. The remaining options are incorrect interpretations. Test-Taking Strategy: Focus on the data in the question, a client with a nasogastric tube attached to suction. Remembering that a client receiving nasogastric suction loses hydrochloric acid will direct you to the option identifying an alkalotic condition. Because the question addresses a situation other than a respiratory one, the acid-base disorder would be a metabolic condition.

56. A client with a 3-day history of nausea and vomiting presents to the emergency department. The client is hypoventilating and has a respiratory rate of 10 breaths per minute. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats per minute. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which finding? 1. A decreased pH and an increased Paco2 2. An increased pH and a decreased Paco2 3. A decreased pH and a decreased HCO3 - 4. An increased pH and an increased HCO3 -

56. Answer: 4 Rationale: Clients experiencing nausea and vomiting would most likely present with metabolic alkalosis resulting from loss of gastric acid, thus causing the pH and HCO3 - to increase. Symptoms experienced by the client would include a decrease in the respiratory rate and depth, and tachycardia. Option 1 reflects a respiratory acidotic condition. Option 2 reflects a respiratory alkalotic condition, and option 3 reflects a metabolic acidotic condition. Test-Taking Strategy: Focus on the subject, expected arterial blood gas findings. Note the data in the question and that the client is vomiting. Recalling that vomiting most likely causes metabolic alkalosis will assist in directing you to the correct option.

57. The nurse is caring for a client having respiratory distress related to an anxiety attack. Recent arterial blood gas values are pH = 7.53, Pao2 = 72 mm Hg (72 mm Hg), Paco2 = 32 mm Hg (32 mm Hg), and = 28 mEq/L (28 mmol/L). Which conclusion about the client should the nurse make? 1. The client has acidotic blood. 2. The client is probably overreacting. 3. The client is fluid volume overloaded. 4. The client is probably hyperventilating.

57. Answer: 4 Rationale: The ABG values are abnormal, which supports a physiological problem. The ABGs indicate respiratory alkalosis as a result of hyperventilating, not acidosis. Concluding that the client is overreacting is an inaccurate analysis. No conclusion can be made about a client's fluid volume status from the information provided. Test-Taking Strategy: Focus on the data in the question. Note the ABG values and use knowledge to interpret them. Note that the pH is elevated and the Paco2 is decreased from normal. This will assist you in determining that the client is experiencing respiratory alkalosis. Next, think about the causes of respiratory alkalosis to answer correctly.

58. The nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul's respirations. Which patterns did the nurse observe? Select all that apply. 1. Respirations that are shallow . Respirations that are increased in rate 288 3. Respirations that are abnormally slow 4. Respirations that are abnormally deep 5. Respirations that cease for several seconds

58. Answer: 2, 4 Rationale: Kussmaul's respirations are abnormally deep and increased in rate. 291 These occur as a result of the compensatory action by the lungs. In bradypnea, respirations are regular but abnormally slow. Apnea is described as respirations that cease for several seconds. Test-Taking Strategy: Focus on the subject, the characteristics of Kussmaul's respirations. Use knowledge of the description of Kussmaul's respirations. Recalling that this type of respiration occurs in diabetic ketoacidosis will assist you in answering correctly.

59. A client who is found unresponsive has arterial blood gases drawn and the results indicate the following: pH is 7.12, Paco2 is 90 mm Hg (90 mm Hg), and is 22 mEq/L (22 mmol/L). The nurse interprets the results as indicating which condition? 1. Metabolic acidosis with compensation 2. Respiratory acidosis with compensation 3. Metabolic acidosis without compensation 4. Respiratory acidosis without compensation

59. Answer: 4 Rationale: The acid-base disturbance is respiratory acidosis without compensation. The normal pH is 7.35 to 7.45. The normal Paco2 is 35 to 45 mm Hg (35 to 45 mm Hg). In respiratory acidosis the pH is decreased and the Pco2 is elevated. The normal bicarbonate ) level is 21 to 28 mEq/L (21 to 28 mmol/L). Because the bicarbonate is still within normal limits, the kidneys have not had time to adjust for this acid-base disturbance. In addition, the pH is not within normal limits. Therefore, the condition is without compensation. The remaining options are incorrect interpretations. Test-Taking Strategy: Focus on the data in the question and the subject, interpretation of arterial blood gas results. Remember that in a respiratory imbalance you will find an opposite response between the pH and the Paco2 . Also, remember that the pH is decreased in an acidotic condition and that compensation is reflected by a normal pH

60. The nurse notes that a client's arterial blood gas (ABG) results reveal a pH of 7.50 and a Paco2 of 30 mm Hg (30 mm Hg). The nurse monitors the client for which clinical manifestations associated with these ABG results? Select all that apply. 1. Nausea 2. Confusion 3. Bradypnea 4. Tachycardia 5. Hyperkalemia 6. Lightheadedness

60. Answer: 1, 2, 4, 6 Rationale: Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentration that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cause overstimulation of the respiratory system. Clinical manifestations of respiratory alkalosis include lethargy, lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, epigastric pain, and numbness and tingling of the extremities. Hyperventilation (tachypnea) 292 occurs. Bradypnea describes respirations that are regular but abnormally slow. Hyperkalemia is associated with acidosis. Test-Taking Strategy: Focus on the subject, the interpretation of ABG values. Note the data in the question to determine that the client is experiencing respiratory alkalosis. Next, it is necessary to think about the pathophysiology that occurs in this acid-base condition and recall the manifestations that occur.

61. The nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis. Which result validates the nurse's findings? 1. pH 7.25, Paco2 50 mm Hg (50 mm Hg) 2. pH 7.35, Paco2 40 mm Hg (40 mm Hg) 3. pH 7.50, Paco2 52 mm Hg (52 mm Hg) 4. pH 7.52, Paco2 28 mm Hg (28 mm Hg

61. Answer: 1 Rationale: Atelectasis is a condition characterized by the collapse of alveoli, preventing the respiratory exchange of oxygen and carbon dioxide in a part of the lungs. The normal pH is 7.35 to 7.45. The normal Paco2 is 35 to 45 mm Hg (35 to 45 mm Hg). In respiratory acidosis, the pH is decreased and the Paco2 is elevated. Option 2 identifies normal values. Option 3 identifies an alkalotic condition, and option 4 identifies respiratory alkalosis. Test-Taking Strategy: Focus on the subject, the arterial blood gas results in a client with atelectasis. Remember that in a respiratory imbalance you will find an opposite response between the pH and the Paco2 . Also, remember that the pH is decreased in an acidotic condition. First eliminate option 2 because it reflects a normal blood gas result. Options 3 and 4 identify an elevated pH, indicating an alkalotic condition. The correct option is the only one that reflects an acidotic condition.

2. A nurse is caring for a client who was in a motor‑vehicle accident. The client reports chest pain and difficulty breathing. A chest x‑ray reveals the client has a pneumothorax. Which of the following arterial blood gas findings should the nurse expect? A. pH 7.06 PaO2 86 mm Hg PaCO2 52 mm Hg HCO3 − 24 mEq/L B. pH 7.42 PaO2 100 mm Hg PaCO2 38 mm Hg HCO3 − 23 mEq/L C. pH 6.98 PaO2 100 mm Hg PaCO2 30 mm Hg HCO3 − 18 mEq/L D. pH 7.58 PaO2 96 mm Hg PaCO2 38 mm Hg HCO3 − 29 mEq/L

A. CORRECT: A pneumothorax can cause alveolar hypoventilation and increased carbon dioxide levels, resulting in a state of respiratory acidosis. B. These ABGs are within the expected reference range and reflect homeostasis. C. Metabolic acidosis is not indicated for this client. D. Metabolic alkalosis is not indicated for this client.

62. The nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a Paco2 of 30 mm Hg (30 mm Hg). The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition? 1. Sodium level of 145 mEq/L (145 mmol/L) . Potassium level of 3.0 mEq/L (3.0 mmol/L) 3. Magnesium level of 1.8 (0.74 mmol/L) 4. Phosphorus level of 3.0 mg/dL (0.97 mmol/L)

62. Answer: 2 Rationale: Respiratory alkalosis is defined as a deficit of carbonic acid or a decrease in hydrogen ion concentration that results from the accumulation of base or from a loss of acid without a comparable loss of base in the body fluids. This occurs in conditions that cause overstimulation of the respiratory system. Some clinical manifestations of respiratory alkalosis include lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea, vomiting, diarrhea, epigastric pain, and numbness and tingling of the extremities. All three incorrect options identify normal laboratory values. The correct option identifies the presence of hypokalemia. Test-Taking Strategy: Note the strategic words, most likely. Focus on the data in the question and use knowledge about the interpretation of arterial blood gas values to determine that the client is experiencing respiratory alkalosis. Next, recall the manifestations that occur in this condition and the normal laboratory values. The only abnormal laboratory value is the potassium level, the correct option.

63. The nurse is caring for a client with several broken ribs. The client is most likely to experience what type of acid-base imbalance? 1. Respiratory acidosis from inadequate ventilation 2. Respiratory alkalosis from anxiety and hyperventilation 3. Metabolic acidosis from calcium loss due to broken bones 4. Metabolic alkalosis from taking analgesics containing

63. Answer: 1 Rationale: Respiratory acidosis is most often caused by hypoventilation. The client with broken ribs will have difficulty with breathing adequately and is at risk for hypoventilation and resultant respiratory acidosis. The remaining options are incorrect. Respiratory alkalosis is associated with hyperventilation. There are no data in the question that indicate calcium loss or that the client is taking analgesics containing base products. Test-Taking Strategy: Note the strategic words, most likely. Focus on the data in the question. Think about the location of the ribs to determine that the client will have difficulty breathing adequately. This will assist in directing you to the correct option. Remembering that hypoventilation results in respiratory acidosis will direct you to the correct option.

72. The nurse reviews an arterial blood gas report for a client with chronic obstructive pulmonary disease (COPD). The results are: pH 7.35; PCO2 62 (8.25 kPa); PO2 70 (9.31 kPa) (34 mmol/L); HCO3 34. The nurse should first: 1. Apply a 100% nonrebreather mask. 2. Assess the vital signs. 3. Reposition the client. 4. Prepare for intubation.

72. 2. Clients with chronic COPD have CO2 retention and the respiratory drive is stimulated when the PO2 decreases. The heart rate, respiratory rate, and blood pressure should be evaluated to determine if the client is hemodynamically stable. Symptoms, such as dyspnea, should also be assessed. Oxygen supplementation, if indicated, should be titrated upward in small increments. There is no indication that the client is experiencing respiratory distress requiring intubation

80. A client's arterial blood gas values are as follows: pH, 7.31; PaO2 , 80 mm Hg; PaCO2 , 65 mm Hg; HCO3 - , 36 mEq/L. The nurse should assess the client for: 1. Cyanosis. 2. Flushed skin. 3. Irritability. 4. Anxiety

80. 2. The high PaCO2 level causes flushing due to vasodilation. The client also becomes drowsy and lethargic because carbon dioxide has a depressant effect on the central nervous system. Cyanosis is a sign of hypoxia. Irritability and anxiety are not common with a PaCO2 level of 65 mm Hg but are associated with hypoxia

89. A 34-year-old female with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/min, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, which action should the nurse take to initiate care of the client? 1. Initiate oxygen therapy as prescribed and reassess the client in 10 minutes. 2. Draw blood for an arterial blood gas. 3. Encourage the client to relax and breathe slowly through the mouth. 4. Administer bronchodilators as prescribed

89. 4. In an acute asthma attack, diminished or absent breath sounds can be an ominous sign indicating lack of air movement in the lungs and impending respiratory failure. The client requires immediate intervention with inhaled bronchodilators, IV corticosteroids, and, possibly, IV theophylline. Administering oxygen and reassessing the client 10 minutes later would delay needed medical intervention, as would drawing blood for an arterial blood gas analysis. It would be futile to encourage the client to relax and breathe slowly without providing the necessary pharmacologic intervention.

90. A client experiencing a severe asthma attack has the following arterial blood gas results: pH 7.33; PCO2 48 (6.4 kPa); PO2 58 (7.7 kPa); HCO3 26 (26 mmol/L). Which of the following prescriptions should the nurse perform first? 1. Albuterol nebulizer. 2. Chest x-ray. 3. Ipratropium inhaler. 4. Sputum culture.

90. 1. The arterial blood gas reveals a respiratory acidosis with hypoxia. A quick-acting bronchodilator, albuterol, should be administered via nebulizer to improve gas exchange. Ipratropium is a maintenance treatment for bronchospasm that can be used with albuterol. A chest x-ray and sputum sample can be obtained once the client is stable.