Anna's mother has been suffering from persistent vomiting for two days now. She appears to be lethargic and weak and has myalgia. She is noted to have dry mucus membranes and her capillary refill takes >4 seconds. She is diagnosed as having gastroenteritis and dehydration. Measurement of arterial blood gas shows pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L.

What acid-base disorder is shown?

Respiratory Acidosis. Partially Compensated

Metabolic Alkalosis, Partially Compensated

Respiratory Alkalosis. Uncompensated

Metabolic Alkalosis, Uncompensated

Answer and Explanation

The Correct Answer is B

A.   Respiratory Acidosis, both compensated and uncompensated, is characterized by an elevated PaCO2, which is not present in this case.
B.   The elevated pH (7.5) and HCO3 (34 mmol/L) indicate metabolic alkalosis. The elevated pH and the slightly elevated PaCO2 (40 mm Hg) suggest the partially compensated state, which is the respiratory compensation attempting to correct the alkalosis.
C.   The fact that the PaCO2 is not low rules out respiratory alkalosis.
D.   The arterial blood gas values indicate a high pH (7.5), a normal PaCO2 (40 mm Hg), and an elevated HCO3 (34 mmol/L), which are indicative of metabolic alkalosis. However, the elevated pH and the slightly elevated PaCO2 (40 mm Hg) suggest a partially compensated state.

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Correct Answer is B

Explanation

A. This is incorrect because the pH is indicative of alkalosis, not acidosis, and the body has not compensated.
B. The arterial blood gas (ABG) values provided indicate a pH of 7.6, which is above the normal range (7.35-7.45), suggesting alkalosis. The PaCO2 is low at 31 mm Hg, indicating hyperventilation, which is a respiratory process. Since the HCO3 is normal at 25 mmol/L, it suggests that the metabolic system is not the cause of the alkalosis. The body has not had time to compensate for the high pH with renal adjustments to the bicarbonate level, which would be seen in a partially compensated state.
C. This is incorrect because the bicarbonate level is normal, suggesting the metabolic system is not the cause.
D. This is incorrect because the bicarbonate level is normal, suggesting the metabolic system is not the cause.

A. Dextran 40 B. Dextrose 5 in water C. Dextrose 10% in water D. 25% albumin

Correct Answer is B

Explanation

A. Dextran 40 is a plasma volume expander and not used for correcting hypernatremia.
B. Hypernatremia indicates a deficit of water relative to sodium. Providing hypotonic solutions like Dextrose 5 in water helps to dilute the sodium concentration in the body fluids, effectively treating hypernatremia.
C. Dextrose 10% in water is a hypertonic solution and would exacerbate hypernatremia by increasing the concentration of sodium in the body fluids.
D. 25% albumin is a hypertonic solution and would exacerbate hypernatremia by increasing the concentration of sodium in the body fluids.

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Naxlex Comprehensive Predictor Exams

Correct Answer is B

Explanation

A nurse is planning care for a client who has hypernatremia. Which of the following IV solutions should the nurse plan to initiate?

Correct Answer is B

Explanation

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