A nurse is caring for a client with an extensive cardiac history who is sent out from a long-term care facility and has several medication prescriptions. They present to the emergency department with tachycardia and hypotension. The client's arterial blood gas results are noted below. Which of the following acid- base imbalances is the client experiencing?

pH 7.55 (pH 7.35-7.45)

PaCO2 39 (PaCO2 35-45)

PaO2 100 (PaO2 80-100)

HCO3 31 (HCO3 21-28)

Respiratory alkalosis, uncompensated

Metabolic alkalosis, uncompensated

Respiratory acidosis, partially compensated

Metabolic acidosis, partially compensated

Answer and Explanation

The Correct Answer is B

A. Respiratory alkalosis, uncompensated would show an elevated pH with a decreased PaCO₂, typically due to hyperventilation. However, the PaCO₂ here is normal, and the elevated bicarbonate indicates that the cause of alkalosis is metabolic, not respiratory, making this an incorrect choice.
B. Metabolic alkalosis, uncompensated is the correct answer because the pH is elevated above 7.45, and the bicarbonate level is also elevated at 31 mEq/L. The PaCO₂ remains within the normal range, indicating that there has been no respiratory compensation yet, thus fitting the pattern of uncompensated metabolic alkalosis.
C. Respiratory acidosis, partially compensated would present with a low pH and a high PaCO₂, which is not the case here. The client’s pH is elevated and PaCO₂ is normal, eliminating respiratory acidosis from consideration.
D. Metabolic acidosis, partially compensated would show a low pH with a low bicarbonate level, typically accompanied by a compensatory decrease in PaCO₂. This client has an elevated pH and elevated bicarbonate, ruling out metabolic acidosis as a possibility.

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Correct Answer is D

Explanation

A. Administer an expectorant may help loosen secretions in certain conditions but is not a primary intervention for preventing pulmonary complications postoperatively. Preventive strategies focus more on lung expansion and maintaining airway clearance rather than relying solely on pharmacologic aids.
B. Perform range-of-motion exercises is important for preventing musculoskeletal complications like joint stiffness and promoting overall circulation but does not directly prevent pulmonary complications such as atelectasis or pneumonia in postoperative clients.
C. Place suction equipment at the bedside is a safety precaution in case the client develops an airway obstruction but is not an active measure to prevent pulmonary complications. Readiness for suctioning is critical, but promoting lung expansion is more directly preventive.
D. Encourage the use of an incentive spirometer is essential for preventing pulmonary complications such as atelectasis. Using the spirometer promotes deep breathing, opens alveoli, and enhances lung expansion, making it a key preventive intervention after surgery.

A. Initiate chelation therapy with deferoxamine. B. Induce vomiting with syrup of ipecac. C. Perform gastric lavage with activated charcoal, D. Administer N-acetylcysteine.

Correct Answer is C

Explanation

A. Chelation therapy with deferoxamine is used for iron poisoning, not for acetylsalicylic acid (aspirin) overdose. Deferoxamine binds excess iron and promotes its excretion, but it does not counteract the toxic effects of salicylates on the body.
B. Inducing vomiting with syrup of ipecac is not recommended due to the risk of aspiration and limited effectiveness. Current guidelines discourage the use of ipecac for poison management because it can delay more effective treatments like activated charcoal.
C. Performing gastric lavage with activated charcoal is appropriate because activated charcoal binds salicylates in the stomach and intestines, limiting further absorption into the bloodstream. Gastric lavage may be considered if the ingestion was recent and life-threatening toxicity is suspected, followed by activated charcoal administration.
D. Administer N-acetylcysteine is the antidote for acetaminophen (Tylenol) toxicity, not acetylsalicylic acid overdose. N-acetylcysteine replenishes glutathione to detoxify acetaminophen metabolites but does not neutralize or eliminate salicylates.

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is C

Explanation

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