A client presents to the Emergency department with a 4-day history of anorexia, abdominal pain and vomiting. An arterial blood gas (ABG) is drawn with these results pH 7.47(7.35-7.45), PaCO2 35mmHg (35-45mmHg), HCO3 31 mEq/L (22-26 mEq/L). How should the nurse interpret these results?

Uncompensated metabolic acidosis

Uncompensated respiratory acidosis

Uncompensated metabolic alkalosis

Uncompensated respiratory alkalosis

Answer and Explanation

The Correct Answer is C

Uncompensated metabolic acidosis: Metabolic acidosis is characterized by a low pH (<7.35) and a low bicarbonate (HCO3) level (<22 mEq/L). In this ABG, the pH is within the normal range, indicating alkalosis rather than acidosis. Therefore, this interpretation is incorrect.

b. Uncompensated respiratory acidosis: Respiratory acidosis is characterized by a low pH (<7.35) and an elevated PaCO2 (>45 mmHg). In this ABG, the pH is within the normal range, indicating alkalosis rather than acidosis. Therefore, this interpretation is incorrect.

c. Uncompensated metabolic alkalosis: Metabolic alkalosis is characterized by a high pH (>7.45) and an elevated bicarbonate (HCO3) level (>26 mEq/L). In this ABG, the pH is elevated (7.47), and the bicarbonate level is also elevated (31 mEq/L), indicating metabolic alkalosis. Therefore, this interpretation is correct based on the ABG results.

d. Uncompensated respiratory alkalosis: Respiratory alkalosis is characterized by a high pH (>7.45) and a low PaCO2 (<35 mmHg). In this ABG, the pH is elevated (7.47), but the PaCO2 is within the normal range (35 mmHg), indicating metabolic alkalosis rather than respiratory alkalosis. Therefore, this interpretation is incorrect.

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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. 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 presents to the Emergency department with a 4-day history of anorexia, abdominal pain and vomiting. An arterial blood gas (ABG) is drawn with these results pH 7.47(7.35-7.45), PaCO2 35mmHg (35-45mmHg), HCO3 31 mEq/L (22-26 mEq/L). How should the nurse interpret these results?

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a client who has developed metabolic alkalosis. Which intervention would be a priority for the nurse to implement?

Correct Answer is A

Explanation

The nurse is admitting a client diagnosed with mitral valve regurgitation. Which medication would help decrease afterload for this client?

Correct Answer is D

Explanation

A client is admitted for treatment of pulmonary edema. Which medication will the nurse administer to improve the force of cardiac contraction for this client?

A client with a history of heart failure presents to the emergency department with elevated blood pressure, dyspnea and bilateral crackles throughout lung fields. Which intervention would the nurse implement first?

When taking a health history of a client with suspected aortic stenosis, which symptoms would the nurse anticipate? Select all that apply.

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.

The nurse is caring for a client after percutaneous coronary revascularization (PCR) via left groin site. Which assessments would the nurse obtain after the procedure? Select all that apply.

The nurse is preparing discharge teaching for a client following placement of a mechanical aortic valve. Which information regarding warfarin(coumadin) therapy would the nurse include? Select all that apply.

A client has received a tissue valve replacement for treatment of valve disease. Which complication occurs more often with this type of prosthetic valve?

A client with mitral stenosis has now developed atrial fibrillation. Which drug would the nurse anticipate being ordered to manage this new condition?