In patients with COPD, retaining CO2 can lead to respiratory acidosis. What ABG result is indicative of such a condition?
pH 7.50, PCO2 35 mm Hg, HCO3 24 mEq/L
pH 7.40, PCO2 40 mm Hg, HCO3 24 mEq/L
pH 7.30, PCO2 50 mm Hg, HCO3 24 mEq/L
pH 7.35, PCO2 40 mm Hg, HCO3 22 mEq/L
The Correct Answer is C
A. pH 7.50, PCO2 35 mm Hg, HCO3 24 mEq/L: This result demonstrates an alkaline pH greater than 7.45, which defines alkalosis rather than acidosis. The PCO2 is at the lower limit of normal, suggesting a respiratory cause for the alkalinity. It is the physiological opposite of the state seen in chronic obstructive pulmonary disease.
B. pH 7.40, PCO2 40 mm Hg, HCO3 24 mEq/L: These values represent a perfectly balanced acid-base status within normal reference ranges. The pH is neutral, and the carbon dioxide and bicarbonate levels indicate effective alveolar ventilation and renal compensation. There is no evidence of respiratory failure or acidotic stress.
C. pH 7.30, PCO2 50 mm Hg, HCO3 24 mEq/L: An arterial pH below 7.35 confirms acidosis, while a PCO2 above 45 mm Hg indicates alveolar hypoventilation. In COPD, the inability to expire carbon dioxide leads to its accumulation and the subsequent formation of carbonic acid. This specifically matches the criteria for acute respiratory acidosis.
D. pH 7.35, PCO2 40 mm Hg, HCO3 22 mEq/L: This pH is at the lower limit of normal, and the carbon dioxide level is within the expected range. The bicarbonate is slightly low, which would be more indicative of a metabolic process rather than respiratory retention. It does not reflect the hypercapnia typical of advanced COPD.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Results from nervous system dysfunction: Neuropathic pain is caused by primary lesions or diseases affecting the somatosensory nervous system, such as diabetic neuropathy or postherpetic neuralgia. It involves abnormal processing of sensory input by the peripheral or central nervous systems. This differs from nociceptive pain, which requires intact neural pathways to transmit signals.
B. Originates from tissue damage: This description is characteristic of nociceptive pain, which occurs when specialized nerve endings called nociceptors are activated by noxious stimuli. These stimuli include thermal, mechanical, or chemical trauma to non-neural tissues like skin, bone, or muscle. Neuropathic pain occurs specifically due to damage to the nerves themselves.
C. Can be relieved by physical therapy alone: While physical therapy is a valuable adjunctive treatment for many types of pain, it is rarely sufficient as a monotherapy for chronic neuropathic conditions. Neuropathic pain often requires specialized pharmacological interventions like anticonvulsants or antidepressants to modulate neural signaling. It involves complex pathophysiological changes that physical therapy alone cannot reverse.
D. Is typically responsive to NSAIDs: Nociceptive pain, which is driven by prostaglandin synthesis at the site of tissue injury, responds well to anti-inflammatory medications. Neuropathic pain is generally refractory to standard analgesics and nonsteroidal anti-inflammatory drugs because the underlying mechanism is neural signaling dysfunction. It requires medications that stabilize the neuronal membrane.
Correct Answer is B
Explanation
A. Increase ambient humidity in the room:While humidified air can soothe irritated airways, it is not a primary intervention for acute respiratory distress. Humidity does not provide the pressure or oxygen concentration needed to correct a severe gas exchange deficit. It is a comfort measure used for mild upper respiratory symptoms.
B. Position the patient in a semi-Fowler's position:Elevating the head and torso to a 30 to 45-degree angle promotes better lung expansion and reduces the work of breathing. This position optimizes the V/Q (ventilation-perfusion) ratio and is the first-line nursing action for any patient struggling to breathe. It provides immediate physiological support.
C. Administer analgesics for discomfort:Pain management is important, but it is not the priority when a patient is in respiratory distress. Many analgesics, particularly opioids, can further depress the respiratory drive and worsen the gas exchange deficit. The physical airway and breathing needs must be stabilized before addressing comfort.
D. Start IV fluids:Intravenous fluids are used for hydration or blood pressure support but do not directly improve oxygenation or ventilation. If the respiratory distress is due to pulmonary edema, IV fluids could actually worsen the patient's condition. Fluids should only be started after the respiratory status is evaluated and stabilized.
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