A nurse is caring for a client who has just experienced a 90-second tonic-clonic seizure. The arterial blood gas values are pH 6.88, PaO2 50 mmHg PaCO2 60 mmHg, and HCO3 22mEq/L. Which action should the nurse take first?
Administer 50mL of sodium bicarbonate IV
Apply oxygen by mask or nasal cannula
Apply a paper bag over the client's nose and mouth
Administer 50mL of 20% glucose and 20 units of regular insulin IV
The Correct Answer is B
Rationale:
A. Sodium bicarbonate may be used to correct acidosis, but oxygenation must be addressed first to prevent further deterioration.
B. The first priority is to improve oxygenation. Administering oxygen by mask or nasal cannula is the most immediate and effective way to increase PaO₂ and support respiratory function.
C. A paper bag is used for respiratory alkalosis, not acidosis—it would worsen hypoxemia.
D. Glucose and insulin are used for hyperkalemia, which is not the current priority.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Rationale:
A. Circumoral numbness and tingling are typically associated with respiratory alkalosis, not acidosis.
B. Muscle flaccidity is more indicative of electrolyte imbalances or late-stage neurologic decline, but not a key early sign of respiratory acidosis.
C. Cool, clammy skin may occur with shock or hypoperfusion, but is not a hallmark sign of respiratory acidosis.
D. Decreased level of consciousness is a key manifestation of acute respiratory acidosis, as rising CO₂ levels depress the central nervous system, leading to confusion, lethargy, and eventually coma if untreated.
Correct Answer is A
Explanation
Rationale:
A. pH 7.41: Normal range is 7.35–7.45. PaCO₂ 45 mm Hg: Normal range is 35–45 mm Hg. HCO₃⁻ 26 mEq/L: Normal range is 22–26 mEq/L. PaO₂ 84 mm Hg: Normal range is 80–100 mm Hg. SaO₂ 97%: Normal range is 95–100%. All values are within normal limits, indicating a balanced acid-base and oxygenation status.
B. pH 7.41: Normal range is 7.35–7.45. PaCO₂ 45 mm Hg: Normal range is 35–45 mm Hg. HCO₃⁻ 26 mEq/L: Normal range is 22–26 mEq/L. PaO₂ 84 mm Hg: Normal range is 80–100 mm Hg. SaO₂ 97%: Normal range is 95–100%. All values are within normal limits, indicating a balanced acid-base and oxygenation status.
C. pH 7.41: Normal range is 7.35–7.45. PaCO₂ 45 mm Hg: Normal range is 35–45 mm Hg. HCO₃⁻ 26 mEq/L: Normal range is 22–26 mEq/L. PaO₂ 84 mm Hg: Normal range is 80–100 mm Hg. SaO₂ 97%: Normal range is 95–100%. All values are within normal limits, indicating a balanced acid-base and oxygenation status.
D. pH 7.41: Normal range is 7.35–7.45. PaCO₂ 45 mm Hg: Normal range is 35–45 mm Hg. HCO₃⁻ 26 mEq/L: Normal range is 22–26 mEq/L. PaO₂ 84 mm Hg: Normal range is 80–100 mm Hg. SaO₂ 97%: Normal range is 95–100%. All values are within normal limits, indicating a balanced acid-base and oxygenation status.
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