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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Increase the oxygen flow rate. The client is experiencing worsening hypoxia, tachypnea, and dyspnea, indicating progressive respiratory distress due to pulmonary embolism (PE). Increasing the oxygen flow rate is the priority to improve oxygenation, reduce the work of breathing, and prevent further hypoxemia. Providing supplemental oxygen helps stabilize the client while preparing for further interventions. The client’s rapidly deteriorating condition, suggests potential hemodynamic instability. Immediate provider notification ensures urgent evaluation for interventions such as anticoagulation, thrombolytics, or intensive monitoring.
B. Increase the oxygen flow rate, then elevate the head of the bed. While elevating the head of the bed can assist breathing by improving lung expansion, it does not address the underlying pathophysiology of PE. Notifying the provider is more critical, as the client may need immediate pharmacologic or procedural interventions to prevent further deterioration.
C. Administer pain medication, then notify the healthcare provider. Pain relief is important, but in acute respiratory distress, oxygenation and circulatory stability take precedence. Narcotics can depress respiratory drive and worsen hypoxia, making them a lower priority until the client’s respiratory status is stabilized.
D. Encourage deep breathing exercises, then check capillary refill. Deep breathing is beneficial for lung expansion but is not an effective treatment for acute PE. The priority is ensuring oxygenation and immediate medical intervention rather than focusing on routine assessments like capillary refill, which do not directly address the emergency.
E. Elevate the head of the bed, then apply compression stockings. Elevating the head of the bed may help ease breathing, but it is a supportive measure rather than a primary intervention. Compression stockings are used for DVT prevention, not for managing an active embolism, making them inappropriate as a priority action in this scenario.
Correct Answer is B
Explanation
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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