NUR 210 (M1) - ABGs

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); HCO -, 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.

1. The client is severely hypoxic. 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.

The charge nurse receives morning laboratory and respiratory data on the clients. Which data requires immediate intervention? 1. ABG results of pH 7.35, Paco2 56, Hco3 29, Pao2 78 for a client diagnosed with COPD. 2. Pulse oximetry reading of 89% on a two-day postsurgical total knee replacement client. 3. Hgb of 9 g/dL and Hct of 28% on a client who is receiving the second unit of blood. 4. B-type natriuretic peptide (BNP) of 100 on a client diagnosed with stage 4 congestive heart failure.

2. Pulse oximetry reading of 89% on a two-day postsurgical total knee replacement client. Rationale: 1. The body has compensated for the abnormally high level of carbon dioxide (acid) in the blood by holding on to the base (Hco3) and the pH is within normal range. This is an expected blood gas for the client with COPD. 2. This pulse oximetry reading indicates an arterial blood oxygen of less than 60. The client should be seen immediately to prevent respiratory failure. 3. This client is receiving blood to correct the lower levels of H&H. 4. A BNP of less than 100 is considered WNL. A BNP of 100 would not be a concern to report for a client in stage 4 of heart failure.

Which of the following compensatory actions by the body would occur if a client were in respiratory acidosis? 1. Excretion of bicarbonate (HCO −) by the kidneys. 2. Retention of HCO − by the kidneys. 3 3. Increase in respiratory rate by the lungs. 4. Decrease in respiratory rate by the lungs.

2. The compensatory mechanism for respiratory acidosis is the renal system. In respiratory acidosis, the kidneys will conserve HCO − in an attempt to correct the acidosis. Excretion of HCO − would exacerbate the body's acidosis. The lungs cannot compensate 33 for a problem that arises in the respiratory system.

The nurse is caring for clients on a medical unit. Which assessment data indicates a critical oxygenation problem for the client? 1. The client with an anterior upper left chest tube is splinting the dressing with a pillow. 2. The male client on oxygen is coughing forcefully, making it hard to catch his breath. 3. The client who is at rest has circumoral cyanosis and is difficult to arouse. 4. The female client complains of shortness of breath while ambulating in the hallway.

3. The client who is at rest has circumoral cyanosis and is difficult to arouse. Rationale: 1. Chest tubes are painful; splinting the insertion site can help to lessen the pain. 2. Coughing indicates the ability to move air in and out of the lungs. This is not a critical issue. 3. This client with a lack of oxygenation at rest, blueness around the mouth, and who is difficult to arouse indicates a decrease in neurological functioning. 4. Dyspnea on exertion is not a critical issue.

A nurse is orienting a newly licensed nurse on conditions related to metabolic acidosis. Which of the following statements by the new nurse indicates the teaching has been effective? a. "Metabolic acidosis can occur due to diabetic ketoacidosis" b. "Metabolic acidosis can occur in a patient who has myasthenia gravis" c. "Metabolic acidosis can occur in a patient who has asthma" d. "Metabolic acidosis can occur due to cancer"

a, metabolic acidosis results from an excess production of hydrogen ions, which occurs in diabetic ketoacidosis, and ketone buildup

A patient who is found unresponsive has arterial blood gases drawn and the results indicate the following: pH is 7.12, PaCO2 is 90mmHg, and HCO3 is 22Meq/L. The nurse interprets the results as indicating which condition?

Respiratory acidosis without compensation

The nurse reviews the ABG's of a client and notes the following: pH 7.45, PaCO2 30 mmhg, HCO3 20mEq/L. The nurse analyzes these results as indicating which condition? Metabolic acidosis, compensated Respiratory alkalosis, compensated Metabolic alkalosis, uncompensated Respiratory acidosis, uncompensated

Respiratory alkalosis, compensated

Which of the following is appropriate for a patient with metabolic alkalosis? a. Monitor serum potassium levels b. Maintain the patient on bed rest c. Have the patient inhale carbon dioxide using a paper bag d. Administer sodium bicarbonate as prescribed

a. With a patient with metabolic alkalosis, the nurse should monitor for hypokalemia. Metabolic alkalosis can cause potassium to shift into the cells, resulting in a decrease of serum potassium. In metabolic alkalosis, the body tries to compensate by conserving carbon dioxide, so there is no need to have the patient inhale carbon dioxide, as would be the case if hyperventilating were occuring. There is already a base bicarbonate excess with this condition, so the nurse should not administer sodium bicarbonate. Unless other symptoms dictate, the patient does not need to be placed on bed rest.

A nurse is assessing a patient who has pancreatitis. Their arterial blood gases reveal metabolic acidosis. Which of the following is an expected finding? (select all that apply) Tachycardia Hypertension Bounding pulses Hyperreflexia Dysrhythmia tachypnea

hyperreflexia, dysrhythmia, and tachypnea are expected findings other findings include: Bradycardia, hypotension, and weak peripheral pulses due to arterial dilation and the slowing of electrical conduction through the AV node.

The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client, knowing they are at risk for which acid-base disorder? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

loss of gastric fluid from NGT suction or vomiting causes metabolic alkalosis because of the removal of gastric acid.

A nurse is caring for a patient admitted with confusion and lethargy. The patient was found at home unresponsive with a bottle of aspirin laying next to their bed. Vital signs reveal a BP of 104/72, HR of 116 with a regular rhythm, and a RR of 42/min and deep. What ABG findings should the nurse expect?

metabolic acidosis

An unconscious patient is admitted to the ER. Arterial blood gas measurements reveal a pH of 7.30, a low bicarbonate level, and an elevated potassium level. These results indicate the presence of? a) Metabolic acidosis b) Respiratory acidosis c) compensated respiratory alkalosis d) metabolic alkalosis

metabolic acidosis

The nurse caring for a client with an ileostomy understands that the client is MOST at risk for developing which acid-base disorder? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

metabolic acidosis Intestinal secretions are high in base and the loss of them through diarrhea or ileostomy drainage can result in a metabolic acidosis

A client has a dull headache, is dizzy, and has an increased pulse rate. The results of arterial blood gas analysis are as follows: pH 7.26; partial pressure of carbon dioxide, 50 mm Hg (6.7 kPa); and bicarbonate, 24 mEq/L (24 mmol/L). These findings indicate which of the following acid-base imbalances?

respiratory acidosis

A nurse is caring for a patient who was in a MVC. He is reporting chest pain and difficulty breathing. A chest x-ray reveals the patient has a pneumothorax, and ABGs are obtained. What ABG findings should the nurse expect?

respiratory acidosis

A patient with acute lung disease is at risk for developing respiratory acidosis. The nurse should assess the patient for which signs and symptoms characteristic of this disorder? 1. Bradycardia and hyperactivity 2. Decreased respiratory rate and depth 3. Headache, restlessness and confusion 4. Bradypnea, dizziness and paresthesias

3, When a patient is experiencing respiratory acidosis, the respiratory rate and depth increase in an attempt to compensate. The patient may also experience headache, restlessness, mental status changes such as drowsiness or confusion, visual disturbances, diaphoresis, cyanosis, hyperkalemia, a rapid and irregular pulse, or dysrhythmias.

The client diagnosed with pneumonia has arterial blood gases of pH 7.33, Pao2 94,Paco2 47, Hco3 25. Which intervention should the nurse implement? 1. Administer sodium bicarbonate. 2. Administer oxygen via nasal cannula. 3. Have the client cough and deep breathe. 4. Instruct the client to breathe into a paper bag.

3. Have the client cough and deep breathe. Sodium bicarbonate is administered for metabolic acidosis. The arterial oxygen level is within normal limits (80 to 100); therefore, the client does not need oxygen. The client is retaining CO2, which causes respiratory acidosis, and the nurse should help the client remove the CO2 by instructing the client to cough and deep breathe. Breathing into a paper bag is not recommended for clients in respiratory acidosis.

The client diagnosed with respiratory distress has arterial blood gases of pH 7.45; Paco2 54; Hco3 25; Pao2 52. Which should the nurse implement? Select all that apply. 1. Apply oxygen via nonrebreather mask. 2. Call the rapid response team (RRT). 3. Elevate the head of the bed. 4. Stay with the client. 5. Notify the health-care provider (HCP).

ALL Rationale: The Pao2 level is very low; this client should be placed on a ventilator. The nurse should provide as much oxygen as possible until this can be done. The RRT is called when an individual identifies a situation that requires immediate intervention to prevent the client from going into an arrest situation. Elevating the HOB allows for better lung expansion. The nurse should not leave the client but should direct care from the bedside. The HCP should be notified of the cli- ent's status.

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/minute. The electrocardiogram (ECG) displays tachycardia, with a rate of 120 beats/minute. ABG's are drawn and and the nurse reviews the results, expecting to note which finding? 1. A decreased pH and increased CO2 2. An increased pH and a decreased CO2 3. A decreased pH and a decreased HCO3 4. An increased pH with an increased HCO3

4, patients experiencing nausea & vomiting would most likely present with metabolic alkalosis resulting from the loss of gastric acid-causing the pH & Bicarb to increase.