A patient's arterial blood gas (ABG) results show a pH of 7.35, PaCO2 of 40 mmHg, and HCO3- of 21 mEq/L. What type of acid-base imbalance is present and how would you classify it?

Respiratory alkalosis, fully compensated

Metabolic acidosis, partially compensated

Respiratory acidosis, fully compensated

Metabolic acidosis, fully compensated

Answer and Explanation

The Correct Answer is B

A. Respiratory alkalosis, fully compensated: pH is low normal (7.35), and the bicarbonate (HCO3-) level is low (21 mEq/L), indicating metabolic acidosis, not respiratory alkalosis. Respiratory alkalosis would present with a high pH and low PaCO2.
B. Metabolic acidosis, partially compensated: The pH is slightly acidic (7.35), and the bicarbonate level is low (21 mEq/L), indicating metabolic acidosis. The PaCO2 level is normal, suggesting partial compensation by the respiratory system, but the body has not fully compensated for the acidosis yet.
C. Respiratory acidosis, fully compensated: Respiratory acidosis would present with an elevated PaCO2 and a low pH, which is not the case here. The PaCO2 is normal at 40 mmHg, so this option is incorrect.
D. Metabolic acidosis, fully compensated: While the client does have metabolic acidosis, the respiratory system has not fully compensated for the acidosis, as evidenced by the normal PaCO2 level. Therefore, the compensation is partial, not full.

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Correct Answer is C

Explanation

A. Muscle dysfunction: While muscle weakness, particularly of respiratory muscles, can occur with advanced COPD due to deconditioning and hypoxia, it is more of a complication than a direct associated risk.
B. Poor nutrition: Poor nutrition is a consequence of increased energy demands from labored breathing and appetite loss, but it is not the most specific associated risk when compared to infection risk.
C. Increased risk for pneumonia: Clients with COPD have impaired airway clearance, mucus retention, and structural lung damage, all of which increase susceptibility to respiratory infections like pneumonia. This is a major cause of exacerbation and hospitalization.
D. Weight loss: Weight loss may occur in COPD due to increased energy expenditure and decreased appetite, but like poor nutrition, it is a consequence rather than a primary associated risk factor.

A. Notify the rapid response team due to the client’s clinical signs of a tension pneumothorax B. Reassure the client and administer prescribed analgesics for pain relief C. Encourage the client to take deep breaths and use incentive spirometry D. Elevate the head of the bed and increase oxygen to 4 L/min via nasal cannula E. Document the findings and re-evaluate in 15 minutes

Correct Answer is A

Explanation

A. Notify the rapid response team due to the client’s clinical signs of a tension pneumothorax: The client presents with acute right-sided chest pain, dyspnea, hypotension, unilateral decreased breath sounds, hyperresonance, and agitation—classic signs of a tension pneumothorax, a life-threatening emergency requiring immediate intervention. Rapid response activation ensures rapid access to advanced airway and chest decompression support.
B. Reassure the client and administer prescribed analgesics for pain relief: The pain is a symptom of a serious underlying condition—possibly a collapsed lung. Administering pain medication could delay life-saving intervention.
C. Encourage the client to take deep breaths and use incentive spirometry: This intervention is appropriate for postoperative atelectasis, but it is contraindicated in tension pneumothorax. Increasing intrathoracic pressure through deep breaths may worsen the pneumothorax.
D. Elevate the head of the bed and increase oxygen to 4 L/min via nasal cannula: While increasing oxygen and elevating the head can help improve oxygenation, they do not treat the underlying cause. These supportive measures may be used after emergency intervention has been initiated.
E. Document the findings and re-evaluate in 15 minutes: Delaying intervention in this situation is unsafe. A tension pneumothorax can rapidly lead to cardiovascular collapse, so waiting even a few minutes may result in deterioration or death.

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A patient's arterial blood gas (ABG) results show a pH of 7.35, PaCO2 of 40 mmHg, and HCO3- of 21 mEq/L. What type of acid-base imbalance is present and how would you classify it?

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