(Basic Res) Wilkin's - Chapter 8 - Interpretation of ABGs Extra Workbook content [NOT STUDY GUIDE]

Continuous noninvasive assessment of patient oxygenation can be provided by which of the following methods? 1. transcutaneous PO2 2. capnography 3. pulse oximetry 4. indwelling arterial line

1 and 3

Which of the following could you use to assess the adequacy of ventilation in an intubated child receiving mechanical ventilation? 1. transcutaneous PCO2 2. capnography 3. pulse oximetry 4. arterial blood gas

1, 2 and 4

A 17 year old man is brought into the emergency department. Vitals are as follows: pulse, 100 beats/min; respiratory rate, 4 breaths/min; and blood pressure, 100/65 mm Hg. The patient was at a party, where he was discovered by his friends unresponsive. ABG results are as follows: pH 7.29, PaCO2 68 mm Hg, HCO3 29, BE + 1. The patient's acid base status is classified as which of the following? a. uncompensated respiratory acidosis b. partially compensated respiratory acidosis c. compensated respiratory alkalosis d. uncompensated metabolic acidosis

b. partially compensated respiratory acidosis

In performing an Allen test of a patient's left wrist before drawing an arterial sample, you note that her hand remains blanched for more than 25 seconds after releasing pressure on the ulnar artery. Which of the following actions would you take this this time? a. insert a catheter into the brachial artery b. repeat the test on the opposite wrist c. report that the sample cannot be obtained d. proceed with sampling through left radial artery

b. repeat the test on the opposite wrist

Which of the following statements is true regarding the accuracy of the reported results? a. the oxygen is inaccurate b. the pH is reported considerably higher than it should be c. the blood gas results are all accurate d. the reported pH is considerably lower than the given PaCO2 and HCO3 would indicate

b. the pH is reported considerably higher than it should be

What is the best way to assess arterial oxygenation? a. PaO2 b. SaO2 c. CaO2 d. P(A-a)O2

c. CaO2

To evaluate a patient's acid base status, you would recommend which of the following? a. transcutaneous PCO2 b. pulse oximetry c. arterial blood gas d. CO- oximetry

c. arterial blood gas

Before an arterial blood gas (ABG) value is obtained, why should the patient's clotting parameters be evaluated? a. they may affect the patient's PaO2. b. if reduced, they may hinder filling of the syringe with blood during the draw. c. bleeding time may be prolonged if they are abnormal. d. they may affect the accuracy of the sample pH.

c. bleeding time may be prolonged if they are abnormal.

Which of the following is true regarding oxygen carrying capacity? a. it is normal b. it is increased c. it is decreased d. cannot be determined with the given data

c. it is decreased

Which of the following is true regarding the PaO2? a. it is adequate b. it shows mild hypoxemia c. it shows moderate hypoxemia d. it shows severe hypoxemia

c. it shows moderate hypoxemia

A mixed metabolic acidosis and respiratory alkalosis is likely when the pH and HCO3 are low and the PaCO2 is: a. higher than the predicted b. within its reference range c. lower than the predicted d. 20 times the concentration

c. lower than the predicted

What defines acidosis in a human? a. pH < 7.0 b. pH < 7.25 c. pH < 7.35 d. pH < 7.40

c. pH < 7.35

Which of the arterial blood gas acid-base reports represents an error? a. pH= 7.30, PaCO2= 60 mm Hg HCO3= 29 mmol/L b. pH= 7.40, PaCO2= 25mm Hg HCO3= 15 mmol/L c. pH= 7.50, PaCO2= 50 mm Hg HCO3= 20 mmol/L d. pH= 7.60, PaCO2= 35 mm Hg HCO3= 33 mmol/L

c. pH= 7.50, PaCO2= 50 mm Hg HCO3= 20 mmol/L

What is the Henderson-Hasselbalch equation? a. pK= pH - log (PaCO2 x 0.03)/HCO3 b. pK= pH - log HCO3/(PaCO2 x 0.03) c. pK= pH + log HCO3/(PaCO2 x 0.03) d. -pK= pH - logHCO3/(PaCO2 x 0.03)

c. pK= pH + log HCO3/(PaCO2 x 0.03)

A patient has the folloing ABG results: pH 7.25, PaCO2 32, HCOE 16, base excess 10mEq/L. a. compensated metabolic acidosis b. uncompensated respiratory acidosis c. partially compensated metabolic acidosis d. compensated respiratory acidosis

c. partially compensated metabolic acidosis

The acid status is classified as which of the following? a. uncompensated metabolic alkalosis b. partially compensated metabolic alkalosis c. uncompensated respiratory acidosis d. partially compensated respiratory acidosis

c. uncompensated respiratory acidosis

What is the normal value for PaO2 in the adult patient breathing room air? a. 50 to 60 mmHg b. 60 to 70 mm Hg c. 70 to 80 mm Hg d. 80 to 100 mm Hg

d. 80-100 mm Hg

What test is performed to check the collateral circulation of the radial artery before puncture?____ a. Wilson's test b. Perfusion scan c. Sack's test d. Allen's test

d. Allen's test

A 5 year old patient is admitted to the ER with suspected smoke inhalation. To assess the oxygenation status, you would recommend: a. Standard pulse oximetry b. Arterial sample plus arterial blood gas analysis c. Transcutaneous PO2 d. Arterial sample + CO oximetry

d. Arterial sample + CO oximetry

What is the primary method of transporting oxygen in the blood? a. dissolved in plasma b. bound to plasma proteins c. In the forms of HCO3 d. Bound to hemoglobin

d. Bound to hemoglobin

To measure actual blood O2 saturation, you would recommend: a. transcutaneous PO2 b. pulse oximetry c. arterial blood gas d. CO oximetry

d. CO oximetry

What is the best indicator of tissue oxygenation? a. PaO2 b. SaO2 c. CaO2 d. PO2

d. PO2 (PvO2)

The blood gas results from a patient breathing a confirmed O2 concentration pf 30% indicates a PaO2 of 250 mm Hg. Based on this data, it can be concluded that: a. patient has a larger pulmonary shunt b. PaO2 is in the expected range for this % O2 c. patient must be at high altitude d. PaO2 is in error and should be re-measured

d. PaO2 is in error and should be re-measured

A patient receiving mechanical ventilation requires frequent assessment of oxygenation, ventilation, and acid-base balance. Which of the following would you recommend? a. PtcO2/PtcCO2 monitoring b. continuous pulse oximetry c. continuous capnography d. arterial blood gas sampling through and A-line

d. arterial blood gas sampling through and A-line

Given the following ABG results, interpret the acid base status: pH 7.44, PaCO2 25, HCO3 17, base excess 6 mEq/L a. compensated metabolic acidosis b. uncompensated respiratory alkalosis c. uncompensated respiratory acidosis d. compensated respiratory alkalosis

d. compensated respiratory alkalosis

What is often the first clinical sign that suggests the presence of hypoxemia? a. hypotension b. confusion c. decreased level of consciousness d. exertional dyspnea

d. exertional dyspnea

What shifts the oxyhemoglobin dissociation curve to the left? a. increased PaCO2 b. decreased pH c. increased body temperature d. fetal hemoglobin

d. fetal hemoglobin

What is the negative log of the hydrogen ion concentration is defined as? a. PaCO2 b. Base excess c. Standard HCO3 d. pH

d. pH

What are the causes of metabolic acidosis? a. cardiovascular disease b. renal disease c. hypokalemia d. vomiting

renal disease

What is a decrease in tissue oxygenation called? a. hypoxia b. hypoxemia c. hypercapnia d. acidosis

a. hypoxia

What could cause tissue hypoxia with normal arterial oxygenation? a. inadequate cardiac output b. polycythemia c. leukocytosis d. bradypnea

a. inadequate cardiac output

What is the most common site for arterial puncture? a. radial artery b. ulnar artery c. temporary artery d. femoral artery

a. radial artery

Which of the following infection control precautions would you apply when obtaining an arterial blood gas sample? a. standard precautions plus face shield b. contact precautions plus gown c. droplet precautions plus surgical mask d. airborne precautions plus N95 respirator

a. standard precautions plus face shield

A 35 year old, 54 kg woman with chf enters the ED short of breath. An ABG shows the following results. pH 7.50; PaCO2 30; HCO3 23, base excess+2. The patient's ABG results indicate which of the following. a. uncompensated respiratory alkalosis b. compensated respiratory acidosis c. uncompensated metabolic alkalosis d. uncompensated metabolic acidosis

a. uncompensated respiratory alkalosis

Which of the following ratios of HCO3/PaCO2 would result in a pH of 7.40? a. 24:1 b. 10:0:5 c. 6:0.82 d. 15:1

b. 10:0:5

What ratio of HCO3-/PaCO2 results in a pH of 7.40? a. 24:1 b. 20:1 c. 15:1 d. 6:0.03

b. 20:1

An arterial puncture site normally should be compressed for a minimum of ___ min after the puncture. a. 1 to 2 b. 3 to 5 c. 5 to 7 d. 8 to 10

b. 3 to 5

What is the normal value for arterial pH? a. 7.20 to 7.30 b. 7.35 - 7.45 c. 7.45 to 7. 50 d. > 7.50

b. 7.35 - 7.45

Which of the following is true regarding standard pulse oximeters? a. They measure the fractional saturation of Hb (O2 Hb to total Hb) b. In patients with good perfusion, their accuracy is in the 2% to 4% range. c. Their accuracy increases when the Hb saturation drops below 65%-70% d. In the presence of dyshemoglobins, they tend to underestimate the true SaO2

b. In patients with good perfusion, their accuracy is in the 2% to 4% range.

What is the most common physiologic cause of hypoxemia in patients with lung disease? a. hypoventilation b. V/Q mismatch c. hyperventilation d. diffusion defect

b. V/Q mismatch

Which of the following could cause this patient's problem? a. anxiety and fear b. acute airway obstruction c. lactic acid production d. drug overdose

b. acute airway obstruction

The best way to minimize the impact of cell metabolism on analysis of an ABG sample is to: a. use extra heparin in the syringe b. analyze the sample within 30 minutes c. immediately place the sample on ice d. fully expel all air bubbles

b. analyze the sample within 30 minutes

The procedure whereby a blood-measuring instrument is exposed to samples at two or more known levels to ensure accuracy is termed: a. proficiency testing b. analyzer calibration c. pre-analytic validation d. preventive maintenance

b. analyzer calibration

What is the best indicator of metabolic acid-base status? a. plasma HCO3 b. base excess (BE) c. standard HCO3 d. T40 HCO3

b. base excess (BE)

A shift to the right in the oxyhemoglobin dissociation curve has what effect on the affinity of hemoglobin for oxygen? a. increased b. decreased c. no change d. cannot predict the change without a PH

b. decreased

An 80 year old patient has a PaO2 of 71 mm Hg. How would you describe this finding? a. normal for his age b. mild hypoxemia c. moderate hypoxemia d. severe hypoxemia

b. mild hypoxemia

A 32 year old man comes to the emergency department after a traffic accident with the following data: pulse, 118 beats/min; respiratory rate, 27 breaths/min; blood pressure, 100/68 ABG on room air (21%) as follows: pH 7.32; PacO2 70; PaO2 57; HCO3 23; base excess, 0; 86%, CaO2, 15.2 vol%; Hb 13.0; P(A-a)O2, 18. Based on this information, what is the primary cause of the patient's hypoxemia? a. Overall hypoventilation b. V/Q mismatch c. diffusion defect d. shunt

a. Overall hypoventilation

What parameters are the respiratory component of acid-base status? a. PaCO2 b. HCO3 c. PaO2 d. base excess

a. PaCO2

Which of the following is true regarding respiratory alkalosis? a. The PaCO2 is less than 35 mm Hg b. An increase in HCO3 compensates for respiratory alkalosis c. It is called completely compensated if the Ph is 7.52 d. It is called partially compensated if the pH is in normal range

a. The PaCO2 is less than 35 mm Hg

What is the direct effect of an increased PaCO2 on HCO3-? a. causes it to increase b. cause it to decrease c. does not have any effect on it d. complicated because it has an unpredictable effect on bicarbonate

a. causes it to increase

Given the following ABG results, interpret the acid-base status: pH 7.14, PaCO2 55 mm Hg, HCO3 18 mmol/L. a. combined resp. and met. acidosis b. partially compensated resp. acidosis c. mixed resp. acidosis and met. acidosis d. uncompensated met. acidosis

a. combined resp. and met. acidosis

An acute increase in PaCO2 of 10 to 15 mm Hg causes a corresponding increase in plasma HCO3- of how many mEq/L? a. 1 mmol/L b. 2 mmol/L c. 3 mmol/L d. 4 mmol/L

a. 1 mmol/L

For the test of collateral circulation in an Allen's test, "pinking up" of the hand is normal if it occurs within ____ s. a. 10 to 15 b. 15 to 20 c. 20 to 25 d. 25 to 30

a. 10 to 15

What is the normal value for CaO2? a. 16 to 20 mL/dL b. 12 to 16 mL/dL c. 8 to 12 mL/dL d. 4 to 8 mL/dl

a. 16 to 20 mL/dL

A patient has a measured SaO2 of 82%. What is his approximate PaO2? a. 50 mm Hg b. 60 mm Hg c. 70 mm Hg d. 80 mm Hg

a. 50 mm Hg

What is the term hypoxemia mean? or which of the following is a true statement regarding the term hypoxemia? a. It occurs when the patient's paO2 is lower than predicted b. It indicates a condition in which tissue oxygenation is inadequate c. It is always considered a severe disorder d. It is independent of the age of the patient

a. It occurs when the patient's PaO2 is lower than predicted