A nurse is reviewing laboratory results for a client who has metabolic alkalosis. Which of the following blood gas values should the nurse expect?

pH 7.36 (7.35 to 7.45), PaCO2 38 mm Hg (35 to 45 mmHg) HCO3 25 mEq/L (22 to 26 mEq/L)

pH 7.48 (7.35 to 7.45), PaCO, 32 mm Hg (35 to 45 mm Hg). HCO3 24 mEq/L (22 to 26 mE q/L)

pH 7.46 (7.35 to 7.45). PaCO2 36 mm Hg (35 to 45 mm Hg). HCO3 29 mEq/L (22 to 26 mEq/L)

pH 7.26 (7.35 to 7.45). PaCO, 35 mm Hg (35 to 45 mm Hg). HCO3 18 mEq/L (22 to 26 mEq/L)

Answer and Explanation

The Correct Answer is C

A) pH 7.36 (7.35 to 7.45), PaCO2 38 mm Hg (35 to 45 mmHg), HCO3 25 mEq/L (22 to 26 mEq/L): This is a normal set of arterial blood gas (ABG) values, with a pH within normal range, a normal PaCO2, and a normal HCO3. It does not suggest metabolic alkalosis.

B) pH 7.48 (7.35 to 7.45), PaCO2 32 mm Hg (35 to 45 mm Hg), HCO3 24 mEq/L (22 to 26 mEq/L): Although the pH is elevated, indicating alkalosis, the PaCO2 is slightly low, and the bicarbonate (HCO3) is within the normal range. This set of values does not indicate metabolic alkalosis, but could indicate respiratory alkalosis or compensated alkalosis.

C) pH 7.46 (7.35 to 7.45), PaCO2 36 mm Hg (35 to 45 mm Hg), HCO3 29 mEq/L (22 to 26 mEq/L): This is consistent with metabolic alkalosis. The elevated pH (alkalosis) combined with an increased bicarbonate level (HCO3 > 26 mEq/L) and a normal PaCO2 suggests metabolic alkalosis, as the kidneys retain bicarbonate to compensate for the condition.

D) pH 7.26 (7.35 to 7.45), PaCO2 35 mm Hg (35 to 45 mm Hg), HCO3 18 mEq/L (22 to 26 mEq/L): This set of values indicates acidosis, not alkalosis. The pH is low, indicating acidosis, and the bicarbonate (HCO3) is also low, which suggests metabolic acidosis. The PaCO2 is normal, which further supports a metabolic origin of the acidosis.

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Correct Answer is ["B","C","E"]

Explanation

A. Chronic health condition: The client has a history of Parkinson’s disease and anxiety, which are relevant but not immediate concerns. Chronic conditions require long-term management rather than urgent intervention.
B. Current level of consciousness: The client is restless and not following commands, which may indicate hypoxia, worsening infection, or sepsis. A change in mental status is a critical finding requiring immediate evaluation.
C. Oxygen saturation level: The oxygen saturation is 89% on room air, which is below the normal range (≥95%). This suggests respiratory compromise, likely due to pneumonia, requiring urgent oxygen support.
D. Heart rate: The client has a heart rate of 104/min, which is mildly elevated and expected due to fever and respiratory distress. However, it is not the most critical concern compared to respiratory distress and altered mental status.
E. Respiratory rate: The respiratory rate is 30/min, indicating tachypnea and increased work of breathing, suggesting respiratory distress or impending respiratory failure. This requires immediate intervention.
F. Tremors: Tremors are a common finding in Parkinson’s disease and do not require immediate intervention.

A. Explain to the client that transfusion reactions are not serious. B. Ensure two nurses confirm the information on the blood label. C. Obtain a large- bore IV catheter. D. Witness the client signing a consent for transfusion. E. Ensure the transfusion tubing is flushed with dextrose 5% in water

Correct Answer is ["B","C","D"]

Explanation

B. Ensure two nurses confirm the information on the blood label: Before initiating a blood transfusion, two nurses must verify the client’s identity, blood type, and compatibility with the donor blood. This step is essential to prevent transfusion reactions due to mismatched blood.

C. Obtain a large-bore IV catheter: A large-bore IV catheter (18–20 gauge) is necessary to facilitate the transfusion of packed red blood cells (PRBCs). A smaller gauge may cause hemolysis or delay administration.

D. Witness the client signing a consent for transfusion: A blood transfusion is an invasive procedure requiring informed consent. The nurse ensures the client understands the risks, benefits, and potential complications before signing the consent form.

Incorrect Options:

A. Explain to the client that transfusion reactions are not serious: This is incorrect because transfusion reactions can range from mild allergic responses to life-threatening anaphylaxis or hemolytic reactions. The nurse should educate the client on symptoms to report, such as fever, chills, or dyspnea.

E. Ensure the transfusion tubing is flushed with dextrose 5% in water: Blood products should only be administered with 0.9% sodium chloride to prevent hemolysis. Using dextrose solutions can cause red blood cell aggregation and clot formation.

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A nurse is reviewing laboratory results for a client who has metabolic alkalosis. Which of the following blood gas values should the nurse expect?

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