Olivia
M. Garfield is an anxious nursing student who is very nervous about taking her midterm exams.
She thinks about how her entire future happiness all rests on the results of this one exam.
As she creatively imagines all the terrible things that will happen to her if she fails, she starts to hyperventilate and passes out in her seat.
The instructor obtains an ABG on the student and the results are as follows: pH 7.40, PaCO2 40, HCO3 of 24. What do these ABG results show?
The results are normal.
The results show the student should be intubated.
The results are inconclusive.
Partial compensation.
The Correct Answer is A
Choice A rationale
Normal arterial blood gas (ABG) values are pH 7.35-7.45, $PaCO_2$ 35-45 mmHg, and $HCO_3^-$ 22-26 mEq/L. Olivia's ABG results of pH 7.40, $PaCO_2$ 40 mmHg, and $HCO_3^-$ 24 mEq/L all fall within these normal physiological ranges, indicating no acid-base imbalance despite her anxiety and hyperventilation episode.
Choice B rationale
Intubation is a medical procedure to secure an airway, typically for respiratory failure or severe oxygenation/ventilation issues. Olivia's ABG results are completely normal, indicating effective gas exchange and no respiratory distress requiring intubation. There is no physiological basis in these ABG numbers to warrant such an invasive intervention.
Choice C rationale
Inconclusive results suggest that the data gathered is insufficient or ambiguous to draw a definitive conclusion. However, Olivia's ABG results are clearly within normal physiological parameters. The values are precise and fall squarely within the reference ranges, making them conclusive for normal acid-base status.
Choice D rationale
Partial compensation in acid-base balance occurs when the body's compensatory mechanisms are actively trying to correct a primary imbalance but have not fully restored the pH to normal. Since Olivia's pH, $PaCO_2$, and $HCO_3^-$ are all within normal limits, there is no primary imbalance for which the body needs to compensate, thus ruling out partial compensation. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","D"]
Explanation
Choice A rationale
Patient self-extubation would typically trigger a low-pressure alarm, not a high-pressure alarm, because the ventilator circuit would no longer be connected to the patient's airway, resulting in a sudden drop in airway pressure and a loss of positive pressure ventilation.
Choice B rationale
Disconnection of the tubes, similar to self-extubation, would lead to a low-pressure alarm due to the loss of a closed circuit. The ventilator would detect a rapid decrease in pressure within the system as air escapes, indicating a leak or complete disconnection.
Choice C rationale
Tube displacement, particularly if the endotracheal tube is pushed deeper into the bronchus or becomes kinked, increases airway resistance. This heightened resistance requires the ventilator to exert more pressure to deliver the set tidal volume, thus triggering a high-pressure alarm.
Choice D rationale
The patient biting the endotracheal (ET) tube creates an occlusion within the airway, significantly increasing airway resistance. This increased resistance makes it harder for the ventilator to deliver breaths, leading to a rapid rise in peak inspiratory pressure and activating the high-pressure alarm.
Correct Answer is B
Explanation
Choice A rationale
Administering bicarbonate would address the metabolic component if it were present, but the primary issue here is respiratory acidosis, indicated by the elevated CO2 and low pH. Bicarbonate could worsen the respiratory acidosis by shifting the equilibrium and further depressing respiratory drive in some cases. Normal HCO3 is 22-26 mEq/L.
Choice B rationale
The ABGs indicate respiratory acidosis (pH 7.24, CO2 68 mmHg, HCO3 25 mEq/L). Increasing the respiratory rate and depth allows for greater CO2 exhalation, thereby decreasing the partial pressure of carbon dioxide (PCO2) and raising the pH back towards the physiological normal range of 7.35-7.45. Normal CO2 is 35-45 mmHg.
Choice C rationale
Morphine is an opioid that depresses the central nervous system, including the respiratory drive. Administering morphine would further exacerbate the existing respiratory acidosis by decreasing the patient's respiratory rate and depth, leading to even higher CO2 retention and a further drop in pH.
Choice D rationale
Decreasing the respiratory rate and depth would worsen the patient's hypercapnia, meaning an even higher CO2 level. This would further lower the pH, exacerbating the respiratory acidosis and potentially leading to more severe physiological compromise due to inadequate gas exchange and ventilation.
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