A nurse is caring for a client with diabetic ketoacidosis. Which arterial blood gas result is most consistent with this condition?

pH 7.48, PaCO2 40 mmHg, HCO3- 24 mEq/L

pH 7.30, PaCO2 30 mmHg, HCO3- 18 mEq/L

pH 7.50, PaCO2 45 mmHg, HCO3- 30 mEq/L

pH 7.35, PaCO2 38 mmHg, HCO3- 22 mEq/L

Answer and Explanation

The Correct Answer is B

Choice A reason: pH 7.48, PaCO2 40 mmHg, HCO3- 24 mEq/L indicates alkalosis, not acidosis. Diabetic ketoacidosis (DKA) causes metabolic acidosis due to ketone accumulation, lowering pH and bicarbonate. Normal PaCO2 and HCO3- rule out DKA, as compensatory hyperventilation would lower PaCO2 in response to acidosis.

Choice B reason: pH 7.30, PaCO2 30 mmHg, HCO3- 18 mEq/L indicates metabolic acidosis with respiratory compensation. In DKA, ketone production lowers pH and bicarbonate, while hyperventilation reduces PaCO2 to compensate. These values align with DKA’s acid-base imbalance, reflecting the body’s attempt to correct acidosis through increased respiration.

Choice C reason: pH 7.50, PaCO2 45 mmHg, HCO3- 30 mEq/L indicates metabolic alkalosis, not acidosis. DKA causes acidosis from ketone accumulation, not alkalosis. Elevated bicarbonate and normal PaCO2 suggest a different condition, like vomiting-induced alkalosis, making this inconsistent with the metabolic acidosis seen in DKA.

Choice D reason: pH 7.35, PaCO2 38 mmHg, HCO3- 22 mEq/L indicates normal acid-base balance. DKA results in metabolic acidosis with low pH and bicarbonate due to ketone production. Normal values do not reflect the acidotic state of DKA, where compensatory mechanisms would alter PaCO2 and HCO3- significantly.

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Correct Answer is C

Explanation

Choice A reason: Fever in a discharge-ready client suggests a new infection, which is concerning but not immediately life-threatening. The ABCD-E framework prioritizes airway and breathing issues. While fever requires evaluation, it is less urgent than respiratory distress, as it does not acutely compromise vital functions like oxygenation.

Choice B reason: Confusion in early dementia is common and concerning but not an immediate threat to life. The ABCD-E framework prioritizes airway, breathing, and circulation. Confusion may indicate worsening dementia or another issue, but it is less urgent than a client with acute respiratory distress, like wheezing.

Choice C reason: Wheezing in a pneumonia client indicates airway obstruction or bronchospasm, compromising breathing (B in ABCD-E). This is a life-threatening emergency requiring immediate intervention to ensure oxygenation. Respiratory distress takes priority over fever, confusion, or low urine output, as it directly affects a vital function critical for survival.

Choice D reason: Low urine output (50 mL/4 hours) in a postoperative client suggests possible hypovolemia or renal issues, affecting circulation (C in ABCD-E). While serious, it is less urgent than airway or breathing problems. Respiratory distress, like wheezing, takes precedence, as it poses an immediate threat to life.

A. A 47-year-old who had a colon resection yesterday and is reporting pain B. A 20-year-old 2 days postoperative who refuses to ambulate C. A newly admitted 88-year-old with a 2-day history of vomiting and loose stools D. A 60-year-old who is 3 days post-myocardial infarction and has been stable

Correct Answer is C

Explanation

Choice A reason: Postoperative pain in a 47-year-old is concerning but not immediately life-threatening unless severe or accompanied by other symptoms (e.g., hemorrhage). Pain management is important, but fluid and electrolyte imbalances from vomiting and diarrhea in an elderly client pose a greater immediate risk, requiring urgent assessment.

Choice B reason: Refusal to ambulate in a 20-year-old postoperative client risks complications like thrombosis but is not an acute emergency. Immobility requires intervention, but dehydration and electrolyte imbalances in an elderly client with vomiting and diarrhea are more urgent, as they can rapidly lead to life-threatening hypovolemia.

Choice C reason: An 88-year-old with vomiting and diarrhea for 2 days is at high risk for dehydration, electrolyte imbalances, and hypovolemia, especially given age-related reduced physiological reserves. This can lead to shock or organ failure, making it the highest priority for immediate assessment to stabilize fluid and electrolyte status.

Choice D reason: A stable 60-year-old post-myocardial infarction client is not an immediate priority unless new symptoms arise. Stability suggests no acute changes in cardiac status. Vomiting and diarrhea in an elderly client pose a greater immediate risk due to potential rapid deterioration from fluid loss.

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A nurse is caring for a client with diabetic ketoacidosis. Which arterial blood gas result is most consistent with this condition?

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