A nurse is reviewing the arterial blood gas report of a client who is in metabolic acidosis. Which of the following findings should the nurse expect?

pH 7.28 (7.35 to 7.45)

PaCO2, 31 mm Hg (35 to 45 mm Hg)

HCO2 18 mEq/L (21 to 28 mEq/L)

Pa02, 85 mm Hg (72 to 100 mm Hg)

Answer and Explanation

The Correct Answer is A

A) pH 7.28 (7.35 to 7.45): In metabolic acidosis, the pH is typically below the normal range, which is 7.35 to 7.45. A pH of 7.28 indicates acidemia, which is consistent with metabolic acidosis.

B) PaCO2, 31 mm Hg (35 to 45 mm Hg): In metabolic acidosis, the PaCO2 level may be decreased as a compensatory mechanism by the lungs to expel more carbon dioxide and counteract the acidosis. However, a PaCO2 of 31 mm Hg is slightly low but not a direct indicator of metabolic acidosis; it reflects respiratory compensation rather than the primary problem.

C) HCO3 18 mEq/L (21 to 28 mEq/L): In metabolic acidosis, the bicarbonate (HCO3) level is usually low, as it is the primary buffer that decreases in response to the acidosis. An HCO3 of 18 mEq/L is lower than the normal range, indicating a decrease consistent with metabolic acidosis.

D) PaO2, 85 mm Hg (72 to 100 mm Hg): The PaO2 level, which measures oxygen in the blood, is generally not directly affected by metabolic acidosis. While the PaO2 of 85 mm Hg is within the normal range and does not specifically indicate metabolic acidosis, it is more relevant to assessing oxygenation rather than the acid-base balance.

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Correct Answer is C

Explanation

A. Remove one of the weights:
Removing a weight from skeletal traction can compromise the effectiveness of the traction, potentially leading to improper alignment and healing of the fracture. The weights are essential for maintaining the proper alignment and stability of the fractured bone, so altering them without proper medical guidance is not advisable.

B. Tie knots in the ropes near the pulleys to shorten them:
Tying knots in the ropes to shorten them is not a safe or appropriate method for adjusting traction. It can lead to uneven force distribution, poor alignment, and potential injury. Traction adjustments should be made by qualified personnel using proper equipment and methods.

C. Pull the client up in bed:
Pulling the client up in bed helps to ensure that the weights are properly suspended and not resting on the floor. This action helps maintain the effectiveness of the skeletal traction by ensuring that the appropriate amount of force is applied to the fracture. It also prevents potential complications associated with improperly positioned weights.

D. Increase the elevation of the affected extremity:
Increasing the elevation of the affected extremity might be indicated to reduce swelling or improve comfort but does not address the issue of weights resting on the floor. Proper positioning of the weights is crucial for effective traction and must be corrected to ensure optimal treatment outcomes.

A. Client report of nausea B. Client report of incisional pain C. Serosanguineous drainage D. Muscle twitching

Correct Answer is D

Explanation

A. Client report of nausea:
Nausea is a common postoperative symptom that can occur due to anesthesia, pain medications, or other factors. While it is important to manage nausea to ensure the client's comfort and prevent complications like aspiration, it is not as urgent as other potential postoperative complications following a thyroidectomy.

B. Client report of incisional pain:
Incisional pain is expected after surgery and can typically be managed with pain medications. Although it is important to ensure that the client’s pain is adequately controlled, it is not usually indicative of a life-threatening complication and is a normal part of the postoperative healing process.

C. Serosanguineous drainage:
Serosanguineous drainage, a mix of blood and serum, is a typical finding in the early postoperative period and usually indicates normal wound healing. While excessive or unusual drainage should be monitored, small amounts are generally not a cause for immediate concern unless accompanied by signs of infection or other complications.

D. Muscle twitching:
Muscle twitching can indicate hypocalcemia, a potential complication following thyroidectomy due to accidental removal or damage to the parathyroid glands. Hypocalcemia can lead to serious conditions such as tetany or cardiac dysrhythmias. Therefore, muscle twitching is a priority finding that needs immediate reporting and intervention to prevent further complications.

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A nurse is reviewing the arterial blood gas report of a client who is in metabolic acidosis. Which of the following findings should the nurse expect?

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