The nurse has just received arterial blood gas (ABG) results on four patients. Which result is most important to report rapidly to the health care provider?
pH 7.31, PaO2 91 mm Hg, PaCO2 50 mm Hg, and O2 sat 96%
pH 7.34, PaO2 85 mm Hg, PaCO2 40 mm Hg, and O2 sat 97%
pH 7.46, PaO2 89 mm Hg, PaCO2 32 mm Hg, and O2 sat 98%
pH 7.35, PaO2 85 mm Hg, PaCO2 45 mm Hg, and O2 sat 95%
The Correct Answer is A
Rationale:
A. This ABG indicates respiratory acidosis (low pH, elevated PaCO2). A pH of 7.31 is below the normal range (7.35–7.45), and a PaCO2 of 50 mm Hg is elevated (normal 35–45 mm Hg), showing hypoventilation. Respiratory acidosis can progress rapidly to respiratory failure if not addressed, making it the highest priority to report. Early recognition and intervention, such as assessing airway patency, ventilatory support, or adjusting ventilator settings, are crucial.
B. This ABG is within mildly low-normal limits for pH, PaO2, and PaCO2. While it should be monitored, it is not immediately life-threatening.
C. This result shows mild respiratory alkalosis (slightly elevated pH, low PaCO2). The patient is stable, and the values do not require rapid intervention.
D. This ABG is at the lower end of normal pH, with slightly reduced PaO2. The patient is stable, and immediate reporting is not necessary.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Rationale:
A. The patient is experiencing bradypnea is incorrect because ARDS is typically associated with tachypnea, not bradypnea. Patients initially respond to hypoxemia by increasing their respiratory rate to improve oxygenation.
B. The patient is tired and confused is incorrect because while altered mental status can occur due to hypoxemia, it is a secondary symptom, not the hallmark diagnostic feature of ARDS.
C. The patient's PaO2 remains at 45 mmHg is correct. A hallmark of ARDS is severe hypoxemia that persists despite 100% oxygen delivery. In ARDS, inflammation and alveolar damage lead to non-cardiogenic pulmonary edema, reducing gas exchange. This refractory hypoxemia is a key diagnostic criterion for ARDS and distinguishes it from other causes of respiratory distress.
D. The patient's blood pressure is 180/96 is incorrect because ARDS is primarily a pulmonary disorder, not a hypertensive emergency. Blood pressure changes may occur secondary to stress or sepsis, but they are not hallmark signs of ARDS.
Correct Answer is D
Explanation
Rationale:
A. Neuromuscular blocking agents (NMBAs) do not relieve anxiety. They only paralyze skeletal muscles and do not affect the central nervous system’s perception of fear or distress.
B. NMBAs do not provide pain relief. A patient under the effects of an NMBA may still experience pain but cannot move or communicate discomfort. Analgesics must be administered separately.
C. NMBAs do not induce sedation. The patient remains fully conscious and aware unless sedatives or anesthetics are given concurrently.
D. Neuromuscular blocking agents only cause skeletal muscle paralysis. They do not affect pain perception, consciousness, or anxiety. Because patients cannot move or communicate while paralyzed, it is essential to provide concurrent sedation and analgesia to prevent severe distress.
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