A nurse is reviewing the arterial blood gas (ABG) result for a client diagnosed with progressive chronic obstructive pulmonary disease (COPD). The nurse should expect which of the following ABG findings for a client diagnosed with progressive COPD?

pH 7.55, PaCO2 30 mm Hg, PaO2 80 mm Hg, HCO3 24 mEq/L

pH 7.30, PaCO2 60 mm Hg, PaO2 70 mm Hg, HCO3 30 mEq/L

pH 7.40, PaCO2 40 mm Hg, PaO2 94 mm Hg, HCO3 22 mEq/L

pH 7.38, PaCO2 45 mm Hg, PaO2 88 mm Hg, HCO3 26 mEq/L

Answer and Explanation

The Correct Answer is B

A. pH 7.55, PaCO2 30 mm Hg, PaO2 80 mm Hg, HCO3 24 mEq/L: This ABG finding indicates respiratory alkalosis, as evidenced by the elevated pH and decreased PaCO2. In progressive COPD, clients typically retain carbon dioxide rather than blow it off, so this finding would not be expected in a patient with chronic respiratory issues.
B. pH 7.30, PaCO2 60 mm Hg, PaO2 70 mm Hg, HCO3 30 mEq/L: This is the most consistent finding for a client with progressive COPD. The low pH indicates acidosis, and the elevated PaCO2 suggests respiratory acidosis due to carbon dioxide retention, a common problem in COPD. The elevated HCO3 indicates a compensatory metabolic response, as the body attempts to retain bicarbonate to buffer the acidosis.
C. pH 7.40, PaCO2 40 mm Hg, PaO2 94 mm Hg, HCO3 22 mEq/L: These values indicate a normal ABG, which would not be expected in a client with progressive COPD. Patients with chronic lung disease typically present with acid-base imbalances due to respiratory failure, so this finding suggests the client is not exhibiting the expected complications of COPD.
D. pH 7.38, PaCO2 45 mm Hg, PaO2 88 mm Hg, HCO3 26 mEq/L: Although these findings show mild acidosis, the PaCO2 is within normal limits, indicating that this patient may not be experiencing significant respiratory failure. In advanced COPD, one would expect to see a higher PaCO2 and more pronounced acidosis, making this option less characteristic of a patient with progressive COPD compared to option B.

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Correct Answer is D

Explanation

A. Limit oral fluids to minimize labored breathing: This action is not appropriate, as adequate hydration is important for thinning mucus secretions, making it easier for the client to expectorate them. Limiting fluids could lead to thicker secretions, which may worsen the client’s respiratory distress and increase the difficulty of clearing secretions. Therefore, this approach is not suitable for a client with pneumonia and respiratory compromise.
B. Perform pursed-lip breathing to expel trapped carbon dioxide from the alveoli: While pursed-lip breathing can help with exhalation and improve oxygenation, it does not directly address the need to mobilize and clear copious secretions. This technique is beneficial in managing dyspnea and improving ventilation but is not the priority action when the client has significant secretions that need to be cleared.
C. Lie in a low Fowler's position to promote lung expansion: A low Fowler's position (30 degrees) is less effective for promoting lung expansion compared to higher Fowler's positions. Semi-Fowler's (30-45 degrees) or high Fowler's (greater than 45 degrees) positions are more beneficial for improving lung expansion and facilitating breathing in clients with respiratory distress. Therefore, this option does not provide the most effective intervention for the client's condition.
D. Perform hourly incentive spirometry to inflate lungs and mobilize secretions: This is the priority action for the nurse to encourage, as incentive spirometry is specifically designed to help inflate the lungs and improve lung function. It promotes deep breathing, which can enhance ventilation, prevent atelectasis, and facilitate the mobilization of secretions. Regular use of incentive spirometry is essential in managing pneumonia and can significantly improve respiratory outcomes for the client.

A. Prepare to assist with intubation of the client B. Place a tracheostomy tray at the client's bedside C. Administer IV prophylaxis for thromboembolism. D. Administer IV prophylaxis for stress ulcers.

Correct Answer is A

Explanation

A. Prepare to assist with intubation of the client: This action should be prioritized for a client diagnosed with acute respiratory distress syndrome (ARDS). ARDS can lead to significant respiratory distress and hypoxemia, requiring advanced airway management. Assisting with intubation ensures that the client receives adequate ventilation and oxygenation, which is critical in managing ARDS effectively. Immediate preparation for intubation is essential to prevent further deterioration of the client’s respiratory status.
B. Place a tracheostomy tray at the client's bedside: While having a tracheostomy tray available can be important in cases of prolonged respiratory failure, this action is not the immediate priority. The focus should be on ensuring proper airway management and oxygenation first. A tracheostomy is typically considered if the client requires long-term ventilation, but initial intervention for ARDS often involves intubation.
C. Administer IV prophylaxis for thromboembolism: While providing prophylaxis for thromboembolism is important in the overall management of patients at risk, especially in those with limited mobility, it is not the first priority in an acute situation. The immediate need is to address the client’s respiratory distress and ensure proper ventilation.
D. Administer IV prophylaxis for stress ulcers: Providing prophylaxis for stress ulcers is also a relevant consideration, particularly in critically ill patients. However, it is not an urgent action compared to securing the airway and ensuring effective oxygenation. Addressing respiratory failure and maintaining airway patency should take precedence in the acute management of ARDS.

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A nurse is reviewing the arterial blood gas (ABG) result for a client diagnosed with progressive chronic obstructive pulmonary disease (COPD). The nurse should expect which of the following ABG findings for a client diagnosed with progressive COPD?

Nursing Test Bank

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Correct Answer is D

Explanation

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Correct Answer is A

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