Week 3 : Adult
When arterial blood gas results for an alert client who is in the postanesthesia care unit (PACU) after abdominal surgery are pH 7.37, PaCO 2 42 mm Hg (5.59 kPa), HCO 3 25 mEq (25 mmol/L), PaO 2 65 mm Hg (8.64 kPa), and SaO 2 90% (0.90), which action would the nurse take? a) Increase the oxygen flow rate. b) Insert an oropharyngeal airway. c) Suction the oropharynx and upper trachea. d) Prepare to transfer the client out of the PACU.
a) Increase the oxygen flow rate Rationale: Because the arterial blood gases indicate mild hypoxemia and normal acid-base balance, the nurse would increase the oxygen flow rate. Insertion of an oropharyngeal airway is unnecessary and contraindicated in an alert client because it will activate the gag reflex. There is no indication that the client needs suctioning. Because the client is hypoxemic, further monitoring and anesthesia recovery are needed before transferring from the PACU.
The arterial blood gas for a 3-month-old infant with diarrhea showed that the pH is 7.30, Pco 2 is 35 mm Hg, and HCO 3 is 17 mEq/L (17 mmol/L). Which complication would the nurse conclude has developed? a) Metabolic acidosis. b) Metabolic alkalosis c) Respiratory acidosis d) Respiratory alkalosis.
a) Metabolic acidosis Rationale: The blood pH indicates acidosis; the bicarbonate (HCO 3) level is further from the expected range than is the partial pressure of carbon dioxide (Pco 2), indicating a metabolic origin (losses from diarrhea), not a respiratory origin. The blood pH indicates acidosis, not alkalosis.
An arterial blood gas report indicates the client's pH is 7.25, PCO 2 is 35 mm Hg, and HCO 3 is 20 mEq/L. Which disturbance would the nurse identify based on these results? a) Metabolic acidosis. b) Metabolic alkalosis c) Respiratory acidosis d) Respiratory alkalosis
a) Metabolic acidosis. Rationale: A low pH and low bicarbonate level are consistent with metabolic acidosis. The pH indicates acidosis, not alkalosis. The CO 2 concentration is within normal limits, which is inconsistent with respiratory acidosis; it is elevated with respiratory acidosis.
An arterial blood gas report indicates that pH is 7.25, Pco2 is 60 mm Hg, and HCO3 is 26 mEq/L (26 mmol/L). Which client is most likely to exhibit these blood gas results? a) a client with pulmonary fibrosis b) a client with uncontrolled type 1 diabetes c) A client who has been vomiting for 3 days d) A client who takes sodium bicarbonate for indigestion
a) a client with pulmonary fibrosis Rationale: The low pH and elevated Pcoz are consistent with respiratory acidosis, which can be caused by pulmonary fibrosis, which impedes the exchange of oxygen and carbon dioxide in the lung. A client with uncontrolled type 1 diabetes most likely will experience metabolic acidosis from excess ketone bodies in the blood. A client who has been vomiting for 3 days most likely will experience metabolic alkalosis from the loss of hydrochloric acid from vomiting. A client who takes sodium bicarbonate for indigestion most likely will experience metabolic alkalosis from an excess of base bicarbonate.
Which arterial blood gas results are associated with diabetic ketoacidosis? a) pH: 7.28; Pco 2: 28; HCO 3: 18 b) pH: 7.30; Pco 2: 54; HCO 3: 28 c) рН: 7.50; Рсо 2: 49; НСО з: 32 d) pH: 7.52; Pco 2: 26; HCO 3: 20
a) pH: 7.28; Pco 2: 28; HCO 3: 18 Rationale: Diabetic ketoacidosis would be associated with metabolic acidosis, which is reflected by a low pH and bicarbonate; a low Pco 2 indicates compensatory hyperventilation. A low pH and elevated Pco 2 reflect hypoventilation and respiratory acidosis. An elevated pH and bicarbonate reflect metabolic alkalosis; an elevated Pco 2 indicates compensatory hypoventilation. An elevated pH and low Pco 2 reflect hyperventilation and respiratory alkalosis
When the nurse is reviewing a client's arterial blood gas results, which finding would the nurse identify as being consistent with respiratory alkalosis? a) A decreased pH, elevated PCO 2 b) An elevated pH, decreased PCO 2 c) A decreased pH, decreased PCO 2 d) An elevated pH, elevated partial pressure of carbon dioxide (PCO 2)
b) An elevated pH, decreased PCO 2 Rationale: In respiratory alkalosis, the pH level is elevated because of loss of hydrogen ions; the PCO 2 level is low because carbon dioxide is lost through hyperventilation. A decreased pH and elevated PCO 2 are respiratory acidosis. A decreased pH and decreased PCO 2 are metabolic acidosis with some compensation. An elevated pH and elevated PCO 2 are partially compensated metabolic alkalosis
Which change in the arterial blood gases would the nurse expect in a client with hyperventilation due to anxiety? a) Respiratory acidosis b) Respiratory alkalosis. c) Respiratory compensation d) Respiratory decompensation
b) Respiratory alkalosis Rationale: Hyperventilation causes excess amounts of carbon dioxide (CO 2) to be eliminated, causing respiratory. alkalosis. Respiratory acidosis is caused by excess CO 2 retained in the lungs from conditions such as hypoventilation or chronic obstructive pulmonary disease (COPD). Respiratory compensation and decompensation are terms not associated with this situation.
Which diagnosis is suspected by the nurse when the laboratory data for a client with prolonged vomiting reveal arterial blood gases of pH 7.51, Pco 2 of 45 mm Hg, HCO 3 of 58 mEa/L (59 mmol/L), and a serum potassium level of 3.8 mEq/L (3.8 mmol/L)? a) Hypocapnia b) Hyperkalemia c) Metabolic alkalosis d) Respiratory acidosis.
c) Metabolic alkalosis Rationale: Elevated plasma pH and elevated bicarbonate levels support metabolic alkalosis. The arterial carbon dioxide level of 45 mm Hg is within the expected value of 35 mm Hg to 45 mm Hg; no hypocapnia is present. The client's serum potassium level is within the expected level of 3.5 mEq/L to 5 mEq/L (3.5-5 mmol/L). With respiratory acidosis, the pH will be less than 7.35 and the Pco 2 will be elevated.
A client is hospitalized after 4 days of epigastric pain, nausea, and vomiting. The nurse reviews the laboratory test results: plasma pH 7.51, pCO, 50 mm Hg, bicarbonate 58 mEq/L (58 mmol/L), chloride 55 mEq/L (55 mmol/L), sodium 132 mEg/L (132 mmol/L), and potassium 3.8 mEq/L 3.8 mmol/L). Which condition does the nurse determine the results indicate? a) Hypernatremia b) Hyperchloremia c) Metabolic alkalosis d) Respiratory acidosis
c) Metabolic alkalosis Rationale: The normal plasma pH value is 7.35 to 7.45; the client is in alkalosis. The normal plasma bicarbonate value is 23 to 25 mEq/L (23-25 mmol/L); the client has an excess of base bicarbonate, indicating a metabolic cause for the alkalosis. The normal plasma sodium value is 135 to 145 mEq/L (135-145 mmol/L); the client has hyponatremia. The normal plasma chloride value is 95 to 105 mEq/L (95-105 mmol/L); the client has hypochloremia because of vomiting of gastric secretions. With respiratory acidosis, the pH is decreased to less than 7.35.
The nurse is caring for a client with the following arterial blood gas (ABG) values: PO 2 89 mm Hg, PCO 2 35 mm Hg, and pH of 7.37. These findings indicate that the client is experiencing which condition? a) Respiratory alkalosis. b) Poor oxygen perfusion c) Normal acid-base balance d) Compensated metabolic acidosi
c) Normal acid-base balance Rationale: All data are within expected limits; PO 2 is 80 to 100 mm Hg, PCO 2 is 35 to 45 mm Hg, and the pH is 7.35 to 7.45. None of the data are indicators of fluid balance, but of acid-base balance. Oxygen (PO 2) is within the expected limits of 80 to 100 mm Hg. With respiratory alkalosis, the blood pH is greater than 7.45 and the PCO 2 is greatly decreased. With metabolic acidosis, the pH is less than 7.35.
A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and Po 2 of 60 mm Hg. These blood gas results require nursing attention because they indicate which condition? a) Metabolic acidosis b) Metabolic alkalosis c) Respiratory acidosis d) Respiratory alkalosis
c) Respiratory acidosis Rationale: The normal blood pH range is 7.35 to 7.45; therefore, a blood pH of 7.25 indicates acidosis. The parameter for respiratory function is CO 2, and the acceptable range of arterial Pco 2 is 35 to 45 mm Hg; therefore, 60 mm Hg is elevated, resulting in respiratory acidosis. HCO 3 is the parameter for metabolic functions. A pH of 7.25 is acidic, indicating acidosis and not alkalosis
Which type of acid-base imbalance would the nurse expect in a child admitted with a severe asthma exacerbation? a) Metabolic alkalosis caused by excessive production of acid metabolites b) Respiratory alkalosis caused by accelerated respirations and loss of carbon dioxide c) Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid d) Metabolic acidosis caused by the kidneys' inability to compensate for increased carbonic acid formation
c) Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid Rationale: The restricted ventilation accompanying an asthma attack limits the body's ability to blow off carbon dioxide. As carbon dioxide accumulates in the body fluids, it reacts with water to produce carbonic acid; the result is respiratory acidosis. The problem basic to asthma is respiratory, not metabolic. Respiratory alkalosis is caused by the exhalation of large amounts of carbon dioxide; asthma attacks cause carbon dioxide retention. Asthma is a respiratory problem, not a metabolic one; metabolic acidosis can result from an increase of nonvolatile acids or from a loss of base bicarbonate.
A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and a partial pressure of carbon dioxide (PCO 2) of 60 mm Hg. Which complication would the nurse suspect the client is experiencing? a) Metabolic acidosis. b) Metabolic alkalosis c) Respiratory acidosis. d) Respiratory alkalosis
c) Respiratory acidosis. Rationale: The pH indicates acidosis; the PCO 2 level is the parameter for respiratory function. The expected PCO 2 is 40 mm Hg. These results do not indicate a metabolic disorder or indicate respiratory alkalosis.
Which blood gas report most likely reflects the acid-base balance of an infant with severe dehydration? a) pH of 7.50 and Pcoz of 34 mm Hg b) pH of 7.23 and Pcoz of 70 mm Hg vO c) pH of 7.20 and HCO3 of 20 mEq/L (20 mmol/L) d) pH of 7.56 and HCO3 of 30 mEq/L (30 mmol/L)
c) pH of 7.20 and HCO3 of 20 mEq/L (20 mmol/L) Rationale: Low blood pH and bicarbonate levels indicate metabolic acidosis, which occurs with severe dehydration because the reduced urine output causes retention of hydrogen ions. The other options include findings that indicate respiratory alkalosis, respiratory acidosis, and metabolic alkalosis, respectively.
A preterm infant with respiratory distress syndrome has blood drawn for an arterial blood gas analysis. Which test result would the nurse anticipate for this infant? a) Increased Po 2. b) Lowered HCO 3. c) Decreased Pco 2. d) Decreased blood pH
d) Decreased blood pH Rationale: In addition to increased Pco 2, hypoxia from inadequate oxygen/carbon dioxide exchange leads to anaerobic metabolism with an accumulation of acid by-products; both lower blood pH. Po 2 is decreased, because inadequate lung surface area is available for diffusion of gases. Acidosis, not alkalosis, is present; bicarbonate (HCO 3) will be normal or increased in the body's attempt to compensate. Pco 2 increases, because inadequate lung surface area is available for the diffusion of gases.
A client's arterial blood gas report indicates the pH is 7.52, PCO 2 is 32 mm Hg, and HCO 3 is 24 mEq/L. Which does the nurse identify as a possible cause of these results? a) Airway obstruction b) Inadequate nutrition c) Prolonged gastric suction d) Excessive mechanical ventilation
d) Excessive mechanical ventilation Rationale: The high pH and low carbon dioxide level are consistent with respiratory. alkalosis, which can be caused by mechanical ventilation that is too aggressive. Airway obstruction causes carbon dioxide buildup, which leads to respiratory acidosis. Inadequate nutrition causes excess ketones, which can lead to metabolic acidosis. Prolonged gastric suction causes loss of hydrochloric acid, which can lead to metabolic alkalosis
Which arterial blood gas finding would be expected in a child with an acute asthma exacerbation? a) High oxygen level b) Increased alkalinity c) Decreased bicarbonate d) Increased carbon dioxide level
d) Increased carbon dioxide level Rationale Gas exchange is limited because of narrowing and swelling of the bronchi; the carbon dioxide level increases. The oxygen level will be decreased, not increased. The pH will decrease; the child is in respiratory acidosis, not alkalosis. The bicarbonate level will be increased to compensate for acidosis.