A patient's arterial blood gas (ABG) values include a pH of 7.48, a PaCO2 of 38, and an HCO3- of 30. Around which acid-base imbalance would the nurse plan the patient's care?

Choice A rationale:

Hypertensive crisis is characterized by severely elevated blood pressure, usually above 180/120 mm Hg. The given differences in blood pressure (a decrease of 20 mm Hg in systolic BP) do not indicate hypertensive crisis.

Choice B rationale:

An auscultatory gap refers to a temporary disappearance of sounds normally heard over the brachial artery during blood pressure measurement. This phenomenon can lead to inaccurate readings and might cause a delay in recognizing the true blood pressure values. In this case, the decrease in systolic BP when changing positions indicates the presence of an auscultatory gap, requiring the nurse to be vigilant during blood pressure measurements.

Choice C rationale:

Resistant hypertension is a term used when blood pressure remains above goal despite concurrent use of three antihypertensive agents of different classes. The given scenario does not indicate resistant hypertension but rather suggests a technical issue during blood pressure measurement due to the auscultatory gap.

Choice A rationale:

Metabolic acidosis is characterized by a low pH (<7.35) and a low bicarbonate level (<22 mEq/L) The given arterial blood gas (ABG) values indicate a pH of 7.48 (which is alkalotic), a PaCO2 of 38 (within the normal range of 35-45 mm Hg), and an HCO3- of 30 (which is elevated) These values indicate metabolic alkalosis, not metabolic acidosis.

Choice B rationale:

Metabolic alkalosis is characterized by a high pH (>7.45) and an elevated bicarbonate level (>26 mEq/L) The given ABG values indicate a pH of 7.48 (which is alkalotic) and an elevated HCO3- of 30, indicating metabolic alkalosis. This condition can result from excessive loss of acids (e.g., vomiting) or excessive intake of bicarbonate or alkali substances.

Choice C rationale:

Respiratory acidosis is characterized by a low pH (<7.35) and a high PaCO2 (>45 mm Hg) The given ABG values indicate a normal pH of 7.48 and a PaCO2 of 38 (within the normal range), ruling out respiratory acidosis.

Choice D rationale:

Respiratory alkalosis is characterized by a high pH (>7.45) and a low PaCO2 (<35 mm Hg) The given ABG values indicate a pH of 7.48 (which is alkalotic) and a PaCO2 of 38 (within the normal range), ruling out respiratory alkalosis.