A nurse is caring for a client who has metabolic alkalosis as a result of prolonged nasogastric suctioning. The nurse should expect which of the following arterial blood gas values?

pH 7.50, PaCO2 40 mm Hg, HCO3- 30 mEq/L.

pH 7.35, PaCO2 35 mm Hg, HCO3- 24 mEq/L.

pH 7.25, PaCO2 50 mm Hg, HCO3- 26 mEq/L.

pH 7.30, PaCO2 30 mm Hg, HCO3- 18 mEq/L.

Answer and Explanation

The Correct Answer is A

Choice A reason:

pH 7.50, PaCO2 40 mm Hg, HCO3- 30 mEq/L. This choice is correct because it shows a high pH, a normal PaCO2, and a high HCO3-, which are consistent with metabolic alkalosis. Metabolic alkalosis occurs when there is a loss of acid or a gain of base in the body fluids, such as from prolonged nasogastric suctioning. The kidneys try to compensate by excreting more bicarbonate, but this process is slow and incomplete.

Choice B reason:

pH 7.35, PaCO2 35 mm Hg, HCO3- 24 mEq/L. This choice is incorrect because it shows normal values for pH, PaCO2, and HCO3-, which indicate no acid-base imbalance. A client with metabolic alkalosis would have an elevated pH and bicarbonate level.

Choice C reason:

pH 7.25, PaCO2 50 mm Hg, HCO3- 26 mEq/L. This choice is incorrect because it shows a low pH, a high PaCO2, and a normal HCO3-, which are consistent with respiratory acidosis. Respiratory acidosis occurs when there is impaired gas exchange or hypoventilation, leading to an accumulation of carbon dioxide in the blood. The kidneys try to compensate by retaining more bicarbonate, but this process is slow and incomplete.

Choice D reason:

pH 7.30, PaCO2 30 mm Hg, HCO3- 18 mEq/L. This choice is incorrect because it shows a low pH, a low PaCO2, and a low HCO3-, which are consistent with metabolic acidosis. Metabolic acidosis occurs when there is a gain of acid or a loss of base in the body fluids, such as from diabetic ketoacidosis or diarrhea. The lungs try to compensate by increasing the rate and depth of breathing to expel more carbon dioxide, but this process is fast and limited.

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Correct Answer is C

Explanation

Choice A reason:

U waves are not a sign of high potassium level, but rather of low potassium level (hypokalemia) Hypokalemia can cause ST segment depression, T wave flattening or inversion, and prominent U waves.

Choice B reason:

Absent P waves are not a sign of high potassium level, but rather of a severe conduction block or atrial fibrillation. High potassium level can cause P wave widening or flattening, and PR prolongation, but not complete disappearance of P waves.

Choice C reason:

Elevated T waves are the most common and earliest sign of high potassium level (hyperkalemia) Hyperkalemia can cause tall, peaked, symmetric T waves that may merge with the QRS complex. This is the correct answer.

Choice D reason:

Inverted QRS complexes are not a sign of high potassium level, but rather of ventricular arrhythmias or myocardial infarction. High potassium level can cause QRS widening and bizarre QRS morphology, but not inversion.

A. Crystalloid. B. Colloid. C. Hypertonic. D. Hypotonic.

Correct Answer is B

Explanation

Choice A reason:

Crystalloid solutions are fluids that contain electrolytes and can diffuse across semipermeable membranes. They are used to treat dehydration, electrolyte imbalances, and hypovolemia. However, they are not as effective as colloids in expanding the intravascular volume and maintaining the blood pressure. Therefore, choice A is incorrect.

Choice B reason:

Colloid solutions are fluids that contain large molecules such as proteins, starches, or gelatin that cannot cross the capillary membrane. They exert an osmotic pressure that draws fluid from the interstitial and intracellular spaces into the intravascular space. They are used to treat hypovolemic shock, burns, and hemorrhage. Albumin is a type of colloid solution that is derived from human plasma and contains 5% or 25% protein. It increases the plasma volume and the blood pressure by increasing the oncotic pressure. Therefore, choice B is correct.

Choice C reason:

Hypertonic solutions are fluids that have a higher osmolarity than the blood plasma. They draw water out of the cells and into the intravascular space. They are used to treat hyponatremia, cerebral edema, and severe dehydration. However, they can cause fluid overload, hypertension, and cellular dehydration if given in excess. Therefore, choice C is incorrect.

Choice D reason:

Hypotonic solutions are fluids that have a lower osmolarity than the blood plasma. They provide free water and electrolytes to the cells and the interstitial space. They are used to treat hypernatremia, cellular dehydration, and fluid loss due to burns or diuresis. However, they can cause fluid shifts from the intravascular space to the interstitial and intracellular spaces, resulting in hypovolemia, hypotension, and edema. Therefore, choice D is incorrect.

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A nurse is caring for a client who has metabolic alkalosis as a result of prolonged nasogastric suctioning. The nurse should expect which of the following arterial blood gas values?

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