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.

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Free Nursing Study Resources

Correct Answer is C

Explanation

A. "I will report any unusual movements or behaviors to my healthcare provider."
This statement is correct and indicates that the client understands the potential side effects of levodopa/carbidopa. The medication can cause dyskinesia (uncontrolled movements) and other behavioral changes, so the client should report these symptoms to their healthcare provider for possible adjustment of the treatment plan.

B. "I may experience nausea while taking this medication."
This is also correct. Nausea is a common side effect of levodopa/carbidopa, especially when starting the medication. Taking it with food may help reduce this side effect, but some clients may still experience nausea.

C. "I will take this medication with a high-protein meal."
This statement is incorrect. Levodopa is absorbed best on an empty stomach or with a low-protein meal. Protein can interfere with the absorption of levodopa because amino acids (found in proteins) compete with levodopa for absorption across the blood-brain barrier. Therefore, it's recommended that levodopa/carbidopa be taken either 30 minutes before or 1 hour after meals, especially those high in protein.

D. "I will avoid sudden changes in position to prevent dizziness or falls."
This statement is correct. Levodopa/carbidopa can cause orthostatic hypotension (a sudden drop in blood pressure when standing up), which increases the risk of dizziness and falls. The client should be advised to change positions slowly and use support when rising from a sitting or lying position to avoid injury.

A. Serum potassium of 5.2 mEq/L (normal 3.5 mEq/L-5.3 mEq/L.) B. T wave depression on electrocardiogram C. Heart rate of 90 beats per minute D. Blood pressure of 90/50

Correct Answer is D

Explanation

A. Serum potassium of 5.2 mEq/L: A potassium level of 5.2 mEq/L is slightly elevated but is still within a potentially acceptable range (normal is 3.5-5.3 mEq/L). While elevated potassium can be a concern, particularly in the context of an MI or with certain medications (like potassium-sparing diuretics), this level is not critically high. The nurse should monitor the potassium levels, but this is not an urgent finding requiring immediate reporting unless it increases further or is accompanied by significant symptoms (such as arrhythmias).

B. T wave depression on electrocardiogram (ECG): T wave depression can be a sign of ischemia or injury, which is common in the setting of an acute myocardial infarction. However, T wave changes are expected in this context and do not indicate an immediate emergency. The nurse should continue to monitor the ECG for any progression or worsening of ischemic changes but should prioritize concerns such as hypotension or worsening clinical status over this finding.

C. Heart rate of 90 beats per minute: A heart rate of 90 beats per minute is within normal limits (60-100 beats per minute), especially in the early stages of an MI. Nitroglycerin may cause a reflex tachycardia as a compensatory response to the decreased blood pressure, but a heart rate of 90 bpm is not an alarming finding. The nurse should continue to monitor the heart rate, but it is not the most pressing concern compared to hypotension. 4o mini

D. Blood pressure of 90/50: A blood pressure of 90/50 mmHg is significantly low and could indicate that the client is experiencing hypotension, which is a known side effect of nitroglycerin infusion. Nitroglycerin causes vasodilation, which can reduce blood pressure, especially in clients who are already at risk due to an acute myocardial infarction (MI). Low blood pressure can compromise perfusion to vital organs, including the heart, brain, and kidneys, and may lead to shock if not corrected promptly. This finding should be reported immediately to the healthcare provider, as it may require adjustment of the nitroglycerin dosage or discontinuation of the infusion.

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A nurse is providing discharge teaching to a client who will be taking levodopa/carbidopa for Parkinson's disease. Which of the following statements by the client indicates a need for further teaching?

Correct Answer is C

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The nurse is to begin a nitroglycerin infusion for a client diagnosed with an anterior wall myocardial infarction. Which assessment finding should the nurse report to the provider immediately?

Correct Answer is D

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