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 D

Explanation

Brain natriuretic peptide (BNP): BNP is a hormone released by the heart in response to increased ventricular pressure and volume overload. It is typically elevated in conditions such as heart failure. While monitoring BNP levels may provide information about cardiac function and volume status, it is not specifically ordered for managing a mechanical valve.

b. Cardiac enzymes: Cardiac enzymes, such as troponin and creatine kinase (CK), are markers of myocardial damage and are typically elevated in conditions such as myocardial infarction. They are not specifically ordered for managing a mechanical valve unless there are signs or symptoms suggestive of myocardial ischemia or infarction.

c. Blood urea nitrogen and creatinine:- Monitoring blood urea nitrogen (BUN) and creatinine levels is important for assessing renal function, especially in individuals at risk of renal impairment due to factors such as medications or underlying conditions. While renal function is important in overall cardiac management, these tests are not specifically ordered for managing a mechanical valve unless there are concerns about renal function due to medications such as anticoagulants.

d. PT/INR (Prothrombin Time/International Normalized Ratio): PT/INR monitoring is crucial for managing patients with mechanical heart valves, as these valves are thrombogenic and increase the risk of thromboembolic events such as stroke or valve thrombosis. Warfarin, an oral anticoagulant, is commonly prescribed to maintain therapeutic anticoagulation. PT/INR monitoring helps ensure that the patient is within the target therapeutic range to prevent both thrombotic and bleeding complications associated with the mechanical valve.

A. Dopamine B. Warfarin C. Digoxin D. Lisinopril

Correct Answer is D

Explanation

a. Dopamine: Dopamine is a medication that primarily acts as a vasopressor and inotropic agent. While it can increase cardiac contractility and improve cardiac output, it does not directly decrease afterload. In fact, dopamine may increase systemic vascular resistance (afterload) at higher doses.

b. Warfarin: Warfarin is an anticoagulant medication used to prevent blood clot formation, particularly in individuals with certain cardiac conditions such as atrial fibrillation or mechanical heart valves. While warfarin is important for preventing thromboembolic events in individuals with mitral valve regurgitation, it does not directly affect afterload.

c. Digoxin: Digoxin is a medication that primarily acts as a positive inotropic agent by increasing myocardial contractility. While it can improve cardiac function, particularly in individuals with heart failure, it does not directly decrease afterload.

d. Lisinopril: Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor medication that reduces blood pressure by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. By reducing angiotensin II levels, lisinopril dilates blood vessels and decreases systemic vascular resistance (afterload), thus reducing the workload on the heart. Therefore, lisinopril is the medication that would help decrease afterload for a client with mitral valve regurgitation.

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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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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.