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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Correct Answer is C

Explanation

A. Hyperglycemia:
Although hyperglycemia can occur as a result of stress or corticosteroid use during the treatment of GBS (such as in the case of plasma exchange or IV immunoglobulin (IVIG) therapy), it is not the primary complication associated with GBS. While hyperglycemia requires monitoring and management, respiratory failure is a more immediate and critical concern.

B. Urinary retention:
Urinary retention can occur in some clients with neurologic disorders like GBS, but it is not as life-threatening as respiratory failure. The autonomic nervous system, which controls bladder function, may be affected, but urinary retention is usually manageable with intermittent catheterization or other interventions. It does not carry the same immediate risks to life or organ function as respiratory failure.

C. Respiratory failure:
In Guillain-Barré syndrome (GBS), the immune system attacks the peripheral nervous system, which can lead to progressive muscle weakness and paralysis. The most significant and potentially life-threatening complication of GBS is respiratory failure. This occurs because the paralysis can affect the muscles involved in breathing, including the diaphragm and intercostal muscles, leading to impaired ventilation. As the weakness progresses, the client may become unable to maintain effective breathing, requiring mechanical ventilation. Monitoring for signs of respiratory distress (e.g., increasing work of breathing, tachypnea, decreased breath sounds, or a drop in oxygen saturation) is critical in GBS, especially during the acute phase of the disease.

D. Hypertension:
Hypertension may be seen in some cases of GBS, particularly during the early stages of the disease, due to the autonomic dysfunction that can result from nerve involvement. However, hypotension (low blood pressure) is more commonly associated with the autonomic dysfunction in GBS rather than hypertension. Regardless, respiratory failure remains the most urgent complication to monitor for in clients with GBS.

Correct Answer is ["56"]

Explanation

Calculate the infusion rate in mL/min.

The total volume to be infused is 500 mL.

The infusion time is 90 minutes.

The infusion rate = 500 mL / 90 minutes = 5.5556 mL/min.

Calculate the drip rate in gtt/min.

The drop factor is 10 gtt/mL.

We need to deliver 5.5556 mL/min.

To find the drip rate, we can set up a proportion:

10 gtt / 1 mL = x gtt / 5.5556 mL

Cross-multiplying:

x = 10 gtt/mL x 5.5556 mL = 55.5556 gtt

Round the answer to the nearest whole number.

56 gtt/min.

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Naxlex Comprehensive Predictor Exams

The nurse is caring for the client experiencing Guillain-Barre syndrome (GBS). It is most important for the nurse to monitor the client for which complication?

Correct Answer is C

Explanation

A patient is prescribed 500 ml of Normal Saline to be infused over 90 minutes. The drop factor on the tubing is 10 gtt/mL. At what rate should the nurse regulate the IV (gtt/min)? (Round to the nearest whole number)

Correct Answer is ["56"]

Explanation

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