A client who has asthma has had peak flow readings in the yellow zone "since last night" & goes to urgent care. The nurse identifies which values as respiratory acidosis with partial compensation.

Please refer to arterial blood gas (ABG) tab for reference ranges

ABG

pH 7.35-7.45

p02 80-100 mmHg

pCO2 35-45 mmHg

PHCO3 22-26 mEq/L

7.47 pC02 30 PHCO3 24 p02 98

pH 7.31 p C02 52 pH PHCO3 30 p02 85

pH 7.29 p C02 57 pHCO3 25 p02 78

pH 7.37 p C02 61 pHCO3 33 p 02 71

Answer and Explanation

The Correct Answer is B

A. pH 7.47, pCO2 30, HCO3 24, pO2 98

pH is alkaline (7.47), and the pCO2 is low (30), indicating respiratory alkalosis, not acidosis. This is not the correct answer.

B. pH 7.31, pCO2 52, HCO3 30, pO2 85

pH is low (7.31), indicating acidosis.

pCO2 is elevated (52), indicating respiratory acidosis.

HCO3 is elevated (30), indicating that the kidneys are attempting to compensate by retaining bicarbonate.

This fits the criteria for respiratory acidosis with partial compensation.

C. pH 7.29, pCO2 57, HCO3 25, pO2 78

pH is low (7.29), indicating acidosis.

pCO2 is elevated (57), suggesting respiratory acidosis.

HCO3 is normal (25), so there is no compensation yet.

This indicates uncompensated respiratory acidosis, not partial compensation.

D. pH 7.37, pCO2 61, HCO3 33, pO2 71

pH is normal (7.37), which does not indicate acidosis.

pCO2 is elevated (61), indicating respiratory acidosis.

HCO3 is elevated (33), indicating that the kidneys are compensating.

However, since the pH is normal, this likely indicates full compensation rather than partial compensation.

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Correct Answer is C

Explanation

A. Call the cardiac catheterization lab and give report to transfer the client: This action is premature. Before considering a transfer to the catheterization lab, the nurse should first assess the patient to determine the severity and nature of the chest pain, which can help identify if the pain is related to a cardiac issue, such as an acute myocardial infarction (MI), and to guide further interventions.

B. Administer atenolol 25 mg po: While beta-blockers like atenolol may be part of the treatment plan for patients with chest pain, administering oral medication (PO) is not appropriate in an emergency situation, especially if the patient is experiencing severe chest pain. Immediate action should focus on assessment and stabilizing the patient before administering medications.

C. Assess vital signs and obtain a 12-lead EKG:The first priority is to assess the patient’s condition. Vital signs provide important information about the patient's hemodynamic status, and obtaining a 12-lead EKG is crucial for diagnosing acute myocardial infarction (MI) or other heart-related conditions. The EKG will help identify any abnormal rhythms or signs of ischemia, which will guide the treatment plan.

D. Call a rapid response: While calling a rapid response may be necessary if the patient's condition worsens or if they become unstable, the first step should be to assess the patient thoroughly. If the patient's condition deteriorates during the assessment, a rapid response may be called.

A. Do not use positive end expiratory pressure (PEEP) B. Use high rates of ventilation C. Place client in Trendelenburg position D. Use low but adequate tidal volume

Correct Answer is D

Explanation

A. Do not use positive end expiratory pressure (PEEP):PEEP is commonly used in ARDS management to prevent alveolar collapse and improve oxygenation. It helps keep the airways open during expiration, which is critical for patients with ARDS.

B. Use high rates of ventilation: High ventilation rates are generally avoided in ARDS as they can increase the risk of ventilator-induced lung injury. ARDS patients require controlled ventilation with careful attention to oxygen levels and carbon dioxide removal, not excessive ventilation rates.

C. Place client in Trendelenburg position: The Trendelenburg position (head down, feet elevated) is not recommended for ARDS patients. This position can increase intracranial pressure and may worsen oxygenation. The prone position is preferred for ARDS management to improve oxygenation.

D. Use low but adequate tidal volume: In ARDS, a low tidal volume strategy (typically 6 mL/kg of ideal body weight) is recommended to minimize ventilator-induced lung injury. It helps prevent overdistension of the alveoli and improves lung protection, which is crucial for ARDS patients.

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Naxlex Comprehensive Predictor Exams

A client presents to the emergency department with complaints of severe chest pain. Which actions should the nurse implement first?

Correct Answer is C

Explanation

What key feature should the nurse be aware of when ventilating clients with acute respiratory distress syndrome (ARDS)?

Correct Answer is D

Explanation

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The nurse administers IV nitroglycerin to a client diagnosed with an acute myocardial infarction. In evaluating the effectiveness of this intervention, the nurse should monitor for

The nurse knows which of the following types of angina is most closely related with an impending myocardial infarction (MI)?

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