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 {"dropdown-group-1":"A","dropdown-group-2":"B"}

Explanation

Pneumonia: The client's chest x-ray shows right lower lobe opacity, which is indicative of pneumonia. The presence of thick yellow secretions, coarse crackles, and diminished breath sounds in the right lower lobe further supports this diagnosis. Additionally, the client's increased temperature (39.4°C) and respiratory rate (24/min) are consistent with an infectious process such as pneumonia.

Hypoxia: The client exhibits hypoxia, as evidenced by the oxygen saturation (SaO2) levels of 88% and 92% while receiving 40% humidified oxygen. The dusky appearance of the buccal mucosa is a visible sign of inadequate oxygenation. Hypoxia is a critical condition that can arise from pneumonia due to impaired gas exchange in the lungs.

Angina: Angina refers to chest pain or discomfort due to inadequate blood supply to the heart muscle, typically caused by coronary artery disease. In this case, there is no mention of chest pain or other cardiac symptoms in the client’s notes. Therefore, while angina could be a concern in patients with respiratory distress due to potential cardiac strain, it is not relevant in this scenario based on the provided information.

Stage II Hypertension: Stage II hypertension is characterized by blood pressure readings of 140/90 mm Hg or higher. The client’s blood pressure reading of 128/76 mm Hg does not indicate hypertension; it falls within the normal range. Therefore, this condition is not applicable in this case. While it is important to monitor blood pressure in all patients, it is not relevant to the client’s current respiratory issues.

A. Reports routinely list the identification number of any equipment involved. B. Reports routinely include the client's hospital number. C. Reports routinely are completed within 24 hr after the incident. D. Reports routinely omit the names of witnesses to the occurrence.

Correct Answer is D

Explanation

A. Reports routinely list the identification number of any equipment involved: This practice is appropriate and helps in tracking any equipment-related issues. Including identification numbers can assist in identifying problems with specific devices or tools and does not represent a problem that needs to be reported.
B. Reports routinely include the client's hospital number: Including the client's hospital number in reports is standard practice for maintaining accurate records and ensuring proper tracking of incidents related to specific patients. This does not indicate a problem and is essential for accountability in healthcare reporting.
C. Reports routinely are completed within 24 hr after the incident: Timeliness in completing incident reports is important, and completing them within 24 hours is a best practice. This indicates a proactive approach to addressing incidents and does not represent a problem that needs to be reported to the risk manager.
D. Reports routinely omit the names of witnesses to the occurrence: This is a significant issue that should be reported to the risk manager. Witnesses can provide valuable information about the circumstances surrounding an incident, and their names should be documented for follow-up and investigation. Omitting this information could hinder the thoroughness of the incident review and the organization’s ability to address and prevent future occurrences effectively.

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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?

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A nurse is caring for a client who has a tracheostomy. Exhibits Drag words from the choices below to fill in each blank in the following sentence. The client has manifestations of dropdownanddropdown

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