A client in the emergency department is being treated for hyperventilation related to anxiety. Which arterial blood gas result would the nurse anticipate for this client? Normal arterial blood gas values pH: 7.35-7.45, PaCO2: 35-45mmHg, HCO3: 22-26mEq/L.

pH 7.49 Pa, CO2 36mmHg, HCO3 31mEq/L

pH 7.47 Pa, CO2 25mmHg, HCO3 26mEq/L

pH 7.32 Pa, CO2 41mmHg, HCO3 22mEq/L

pH 7.30 Pa, CO2 48mmHg, HCO3 26mEq/L

Answer and Explanation

The Correct Answer is B

Based on the expected changes in hyperventilation related to anxiety, option b (pH 7.47, PaCO2 25 mmHg, HCO3 26 mEq/L) is the most consistent with respiratory alkalosis, which occurs due to hyperventilation:

a. pH 7.49, PaCO2 36 mmHg, HCO3 31 mEq/L:

The pH is higher than the normal range, indicating alkalosis.
The PaCO2 is within the normal range (slightly elevated), which is unexpected in hyperventilation where PaCO2 is typically decreased.
The HCO3 is elevated, indicating metabolic alkalosis, which is not typically associated with hyperventilation related to anxiety.

b. pH 7.47, PaCO2 25 mmHg, HCO3 26 mEq/L:

The pH is higher than the normal range, indicating alkalosis.
The PaCO2 is below the normal range, indicating respiratory alkalosis, which is consistent with hyperventilation.
The HCO3 is within the normal range, which can occur as a compensatory mechanism for respiratory alkalosis.

c. pH 7.32, PaCO2 41 mmHg, HCO3 22 mEq/L:

The pH is lower than the normal range, indicating acidosis.
The PaCO2 is within the normal range, which is unexpected in hyperventilation where PaCO2 is typically decreased.
The HCO3 is within the normal range, indicating compensated metabolic acidosis, which is not typically associated with hyperventilation related to anxiety.

d. pH 7.30, PaCO2 48 mmHg, HCO3 26 mEq/L:

The pH is lower than the normal range, indicating acidosis.
The PaCO2 is elevated, indicating respiratory acidosis, which is not typically associated with hyperventilation.
The HCO3 is within the normal range, which can occur as a compensatory mechanism for respiratory acidosis.

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Correct Answer is A

Explanation

Metabolic alkalosis is an acid-base imbalance characterized by excessive loss of acid or excessive gain of bicarbonate produced by an underlying pathologic disorder. It's essential to address this condition promptly.

a. Assess for decreased respiratory rate: Metabolic alkalosis leads to hypoventilation as the body compensates by retaining carbon dioxide. Monitoring respiratory rate is crucial to detect any signs of respiratory distress or inadequate ventilation¹.

- Priority: High

b. Diet teaching to include low protein foods: While dietary adjustments are important, addressing the underlying cause (such as vomiting, diuretic use, or excessive alkali intake) is more critical. Low protein foods alone won't correct metabolic alkalosis.

- Priority: Low

c. Obtain daily weight: Daily weight monitoring is essential for assessing fluid balance, but it doesn't directly address metabolic alkalosis. Other interventions take precedence.

- Priority: Medium.

d. Check blood glucose: Blood glucose levels are not directly related to metabolic alkalosis. Focusing on acid-base balance and electrolyte levels is more relevant.

- Priority: Low

A. Rheumatic fever B. Endocarditis C. Marfan’s syndrome D. Female gender

Correct Answer is A

Explanation

Rheumatic fever: This inflammatory condition can affect various parts of the heart, including the mitral and aortic valves. Repeated episodes of rheumatic fever can lead to scarring and thickening of the heart valves, eventually causing stenosis (narrowing) of the mitral or aortic valve.

b. Endocarditis: This infection of the heart lining or valves can damage the structures, but it's not as directly linked to both mitral and aortic stenosis as rheumatic fever.

c. Marfan’s syndrome:Marfan syndrome is a genetic disorder that can affect connective tissue throughout the body, including the heart valves. It is commonly associated with aortic root dilatation and aortic regurgitation rather than aortic stenosis. While aortic valve involvement can occur in Marfan syndrome, it is not typically associated with mitral stenosis.

d. Female gender: While gender differences exist in the prevalence of certain cardiovascular conditions, such as rheumatic heart disease affecting more females than males, gender alone is not a significant risk factor for the development of either mitral or aortic stenosis.

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A client in the emergency department is being treated for hyperventilation related to anxiety. Which arterial blood gas result would the nurse anticipate for this client? Normal arterial blood gas values pH: 7.35-7.45, PaCO2: 35-45mmHg, HCO3: 22-26mEq/L.

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