The nurse is analyzing a client's arterial blood gas (ABG) values with the following results: pH 7.44, PaCO2 30 mmHg, Pa02 90 mmHg, and HCO3 18mEg/L. Which acid base Imbalance should the nurse associate with these results?

Table 9.9 Normal Arterial Blood Gas Values

ABG Value.                                                             Normal Value

pH                                                                             7.35-7.45

PaCO2                                                                                                            35-45 mmHg

HCO3-                                                                         22-26mEq/L

Base excess                                                               -2 to +2

PaO2                                                                            80-95 mmHg

SaO2                                                                            >95%

Partially compensated metabolic alkalosis

Partially compensated metabolic acidosis

Fully compensated respiratory acidosis

Fully compensated respiratory alkalosis

Answer and Explanation

The Correct Answer is B

A) Partially compensated metabolic alkalosis:
Metabolic alkalosis is typically characterized by an elevated pH and a high bicarbonate level (HCO3 >26 mEq/L). In this scenario, the pH is normal (7.44), and the bicarbonate level (HCO3 18 mEq/L) is low, which does not support a diagnosis of metabolic alkalosis. Furthermore, there is no evidence of compensation by respiratory mechanisms (i.e., low PaCO2). Therefore, this is not a likely diagnosis.

B) Partially compensated metabolic acidosis:
The ABG values indicate metabolic acidosis with a low bicarbonate level (HCO3 18 mEq/L) and a pH of 7.44, which is on the higher end of the normal range. A lower-than-normal bicarbonate level suggests an acidotic state, but the pH is compensating toward normal. The PaCO2 of 30 mmHg indicates a compensatory respiratory alkalosis, which would lower the PaCO2 to try to offset the acidosis. This represents a partially compensated metabolic acidosis, where the body is attempting to compensate for the acidosis but has not fully done so.

C) Fully compensated respiratory acidosis:
Respiratory acidosis is associated with elevated levels of carbon dioxide (PaCO2 >45 mmHg), which leads to a drop in pH. However, in this scenario, the PaCO2 is only 30 mmHg, which is lower than the normal range (35-45 mmHg), indicating that the problem is not respiratory acidosis. Additionally, fully compensated respiratory acidosis would show a normal pH with an elevated PaCO2 and compensatory elevation in bicarbonate levels. Thus, this option does not fit the ABG values.

D) Fully compensated respiratory alkalosis:
Respiratory alkalosis occurs when excessive CO2 is exhaled, leading to an elevated pH and a low PaCO2. Although the PaCO2 is low (30 mmHg), which could suggest respiratory alkalosis, the bicarbonate (HCO3) is low at 18 mEq/L, not high as would be expected in a fully compensated respiratory alkalosis. In a fully compensated state, the pH would be normal (around 7.4), and there would be compensatory changes in both the bicarbonate and PaCO2. Since the bicarbonate is low and the pH is not at normal levels, this diagnosis is not appropriate.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is ["3.9"]

Explanation

Step-by-Step Solution:

Convert the toddler's weight from pounds to kilograms.

1 pound is =0.453592 kilograms.

So, 26 pounds = 26 x 0.453592 = 11.793592 kilograms.

Calculate the total daily dose of prednisolone.

The prescribed dose is 2 mg/kg/day.

The toddler weighs 11.793592 kg.

The total daily dose = 2 mg/kg/day x 11.793592 kg = 23.587184 mg/day.

Determine the dose per administration.

The total daily dose is divided into two equal doses (every 12 hours).

The dose per administration = 23.587184 mg/day / 2 = 11.793592 mg per dose.

Calculate the volume of prednisolone syrup to administer.

The available prednisolone syrup is 15 mg/5 ml.

We need to administer 11.793592 mg per dose.

To find the volume, we can set up a proportion:

15 mg / 5 ml = 11.793592 mg / x ml

Cross-multiplying:

15x = 5 x 11.793592

Solving for x:

x = (5 x 11.793592) / 15 = 3.931197 ml

Round the answer to the nearest tenth.

3.9 ml.

A. there is continuous bubbling in the water-seal chamber. B. the water levels in the water-seal chamber and suction chambers are decreased. C. fluid in the water-seal chamber fluctuates with the client's breathing. D. there is constant bubbling in the suction-control chamber.

Correct Answer is A

Explanation

A. There is continuous bubbling in the water-seal chamber: Continuous bubbling in the water-seal chamber suggests a potential air leak in the system, which needs to be investigated. The water-seal chamber is designed to prevent backflow of air into the pleural space, and persistent bubbling typically indicates that air is escaping from the pleural cavity or there is a problem with the tubing or chest tube placement. This is the first sign that the system may not be sealed properly and should be checked for leaks.

B. The water levels in the water-seal chamber and suction chambers are decreased: Decreased water levels in both the water-seal and suction chambers may be indicative of fluid loss or evaporation, but it does not necessarily point to a leak. In the case of a chest tube, water levels may also drop due to suction pressure or gradual evaporation, which would need to be adjusted or monitored. While this should be addressed, it is not an immediate cause for suspicion of an air leak in the system.

C. Fluid in the water-seal chamber fluctuates with the client's breathing: The fluctuation (also known as "tidaling") in the water-seal chamber is a normal finding that occurs when the client breathes in and out. It reflects the pressure changes in the pleural cavity during respiration. The absence of tidaling might indicate that the lung has re-expanded or that there is a blockage in the tubing. While tidaling is a normal occurrence, the absence or abnormality of this fluctuation would require further assessment but not for an air leak.

D. There is constant bubbling in the suction-control chamber: Constant bubbling in the suction-control chamber generally indicates that suction is appropriately applied to the system. However, if there is continuous bubbling in this chamber, it is typically related to the level of suction being applied, not an air leak. This is a normal occurrence and does not require checking for leaks in the system unless suction pressure is too high or low for optimal functioning.

View Question and Answer

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

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is receiving a continuous infusion of IV insulin at 8 mL/hour. Pharmacy makes an infusion of 75 units of regular insulin in 150 mL of Normal Saline for this institution. How many units per hour is the client receiving? (Round to the nearest whole number)

Correct Answer is ["3.9"]

Explanation

The nurse would check for leaks in the chest tube and water seal system when:

Correct Answer is A

Explanation

The nurse is caring for a client who is being discharged following coronary artery bypass graft surgery. Discharge instructions would include:

A client with an acute stroke must receive Alteplase 0.9 mg/kg (maximum dose 90 mg) over 60 minutes. The client weighs 220 pounds. How many mg should the client receive? (Round to the nearest tenth, do not use trailing zeros)

The nurse prepares discharge instructions for the client diagnosed with a myocardial infarction. Which client statement indicates a need for further education? "I will take:

The nurse is providing care to a client admitted with a diagnosis of bacterial pneumonia. On assessment, the client has dry mucous membranes and coarse rhonchi. What nursing interventions would the nurse include in the plan of care?

The nurse is caring for a client in acute respiratory distress syndrome (ARDS). The chest x-ray displays evidence of pulmonary edema. The nurse assesses the client for which clinical manifestation?

A client with a medical diagnosis of acute respiratory distress syndrome (ARDS) is being placed in the prone position. The nurse explains to family members that, "This will help improve ventilation by: