Ricky's grandmother 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, Pa 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/VL. What acid-base disorder is shown?
Metabolic Acidosis, with Partial Compensation.
Respiratory Acidosis, with Partial Compensation.
Respiratory Alkalosis, Uncompensated.
Metabolic Alkalosis, Uncompensated.
The Correct Answer is D
Choice A rationale
Metabolic acidosis is characterized by a primary reduction in serum bicarbonate, typically below 22 mmol/L, which drives the pH below the normal range of 7.35. While compensation mechanisms would involve a decrease in PaCO2, the provided arterial blood gas values demonstrate an elevated pH and elevated bicarbonate, which are inconsistent with metabolic acidosis.
Choice B rationale
Respiratory acidosis is primarily defined by an increase in arterial carbon dioxide (PaCO2), above the normal range of 45 mm Hg, leading to a decrease in blood pH below 7.35. Compensation would involve an increase in bicarbonate. The given values, particularly the elevated pH and normal PaCO2, do not align with the characteristics of respiratory acidosis.
Choice C rationale
Respiratory alkalosis is characterized by a primary decrease in PaCO2, below the normal range of 35 mm Hg, leading to an elevated pH above 7.45. Uncompensated means the bicarbonate level remains within the normal range of 22-26 mmol/L. The provided PaCO2 is within normal limits, and bicarbonate is elevated, which contradicts the criteria for respiratory alkalosis.
Choice D rationale
Metabolic alkalosis is characterized by a primary increase in serum bicarbonate (HCO3), typically above the normal range of 26 mmol/L, which results in an elevated blood pH above 7.45. Uncompensated metabolic alkalosis indicates that the PaCO2 remains within its normal range (35-45 mm Hg) as the respiratory system has not yet initiated or completed compensatory hypoventilation. The provided pH of 7.5, PaCO2 of 40 mm Hg, and HCO3 of 34 mmol/L precisely fit this definition.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Pancuronium is a non-depolarizing neuromuscular blocker, but it is not directly linked to malignant hyperthermia. Neostigmine is an acetylcholinesterase inhibitor used to reverse the effects of non-depolarizing neuromuscular blockers by increasing acetylcholine at the neuromuscular junction, not a treatment for malignant hyperthermia.
Choice B rationale
Rocuronium is a non-depolarizing neuromuscular blocker and, while generally safe, is not the primary paralytic associated with malignant hyperthermia. Dantrolene is the specific pharmacological treatment for malignant hyperthermia, acting by inhibiting calcium release from the sarcoplasmic reticulum in muscle cells, reducing muscle rigidity and hypermetabolism.
Choice C rationale
Vecuronium is a non-depolarizing neuromuscular blocker and does not directly trigger malignant hyperthermia. Neostigmine, as previously stated, is a reversal agent for non-depolarizing muscle relaxants and has no role in the treatment of malignant hyperthermia, which requires specific intervention to address altered calcium homeostasis.
Choice D rationale
Succinylcholine, a depolarizing neuromuscular blocker, is the only commonly used paralytic drug that can reliably trigger malignant hyperthermia in susceptible individuals due to its direct interaction with the ryanodine receptor. Dantrolene is the definitive treatment, acting to restore intracellular calcium homeostasis by blocking calcium release from the sarcoplasmic reticulum.
Correct Answer is ["A","B","D","E"]
Explanation
Choice A rationale
Daily sedation and weaning protocols, often termed "sedation vacations," reduce the duration of mechanical ventilation by allowing for spontaneous breathing trials. Decreased ventilation duration minimizes the risk of VAP by reducing exposure to invasive tubes and promoting earlier extubation and mobility.
Choice B rationale
Oral care with Chlorhexidine (CHG) significantly reduces the bacterial load in the oropharynx. This decreases the aspiration of pathogenic microorganisms into the lungs, which is a primary pathway for the development of ventilator-associated pneumonia (VAP), thereby disrupting biofilm formation.
Choice C rationale
Suctioning on a frequent schedule can actually increase the risk of VAP by introducing bacteria into the lower respiratory tract. Suctioning should only be performed as needed based on patient assessment, such as visible secretions or adventitious breath sounds, to minimize contamination.
Choice D rationale
Elevating the head of the bed (HOB) to 30 degrees or more helps prevent aspiration of oropharyngeal secretions and gastric contents into the lungs. This reduces the risk of VAP by minimizing the entry of bacteria from the upper airway and gastrointestinal tract into the sterile lower respiratory tract.
Choice E rationale
Hand hygiene is paramount in preventing healthcare-associated infections, including VAP. Proper handwashing or alcohol-based hand rub use before and after patient contact, and especially before manipulating the ventilator circuit, reduces the transmission of pathogens to the patient.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.