The nurse is caring for a client whose arterial blood gas reveals fully compensated metabolic acidosis. Which results are consistent with this finding?

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%

pH 7.36, Pa02 98 mmHg, PaCO2 27 mmHg, HCO3 16 mEq/L, 02 sat 99%

pH 7.47, Pa02 91 mmHg, PaCO2 52 mmHg. HCO3 30 mEg/L, 02 sat 96%

pH 7.45, P302 86 mmHg, PaCO2 56 mmHg, HCO3 28 mEg/L, 02 sat 94%

PH 7.32, PaO2 88 mmHg. PaCO2 54 mmHg. HCO3 29 mEq/L. 02 sat 94%

Answer and Explanation

The Correct Answer is A

A. pH 7.36, PaO2 98 mmHg, PaCO2 27 mmHg, HCO3 16 mEq/L, O2 sat 99%: This set of ABG results is consistent with fully compensated metabolic acidosis. pH 7.36: This is within the normal range (7.35-7.45), indicating that compensation has occurred, as the pH has returned to normal levels. PaCO2 27 mmHg: The PaCO2 is low, suggesting that the respiratory system has compensated for the metabolic acidosis by increasing ventilation to excrete CO2, thus reducing the acid load. HCO3 16 mEq/L: The bicarbonate level is low, which is consistent with metabolic acidosis as the primary disturbance. The PaO2 and O2 saturation are normal, indicating adequate oxygenation. Since the pH is within the normal range and the PaCO2 and HCO3 levels reflect the compensatory changes needed to correct the metabolic acidosis, this is a case of fully compensated metabolic acidosis.

B. pH 7.47, PaO2 91 mmHg, PaCO2 52 mmHg, HCO3 30 mEq/L, O2 sat 96%:

This result indicates alkalosis rather than acidosis. The pH is alkalotic (7.47), and PaCO2 is elevated (52 mmHg), which suggests respiratory acidosis as the primary disturbance. The HCO3 is also high (30 mEq/L), which is consistent with metabolic compensation for respiratory acidosis, not for metabolic acidosis. Therefore, this is not consistent with fully compensated metabolic acidosis.

C. pH 7.45, PaO2 86 mmHg, PaCO2 56 mmHg, HCO3 28 mEq/L, O2 sat 94%:

The pH is normal, but PaCO2 is elevated (56 mmHg), indicating respiratory acidosis rather than metabolic acidosis. The HCO3 is also elevated (28 mEq/L), which is consistent with compensation for respiratory acidosis, not metabolic acidosis. This result suggests respiratory acidosis with compensated metabolic alkalosis rather than metabolic acidosis.

D. pH 7.32, PaO2 88 mmHg, PaCO2 54 mmHg, HCO3 29 mEq/L, O2 sat 94%:

The pH of 7.32 indicates acidosis, but it is not within the normal range, so this is not fully compensated. The PaCO2 is elevated (54 mmHg), indicating respiratory acidosis, and the HCO3 is elevated (29 mEq/L), showing metabolic compensation. However, since the pH has not yet returned to normal (it remains acidotic), this is an example of partially compensated respiratory acidosis, not fully compensated metabolic acidosis.

respiratory acidosis, not fully compensated metabolic acidosis.

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Correct Answer is B

Explanation

A. Tizanidine is a sleep aid and used to promote sleep along with melatonin:

This is incorrect. Tizanidine is not classified as a sleep aid. While muscle relaxants like tizanidine may cause drowsiness as a side effect, its primary purpose is to reduce muscle spasms rather than to promote sleep. Using it in combination with melatonin for sleep would not be appropriate unless specifically prescribed by a healthcare provider.

B. Tizanidine is a muscle relaxant medication used to reduce muscle spasms:

Tizanidine is a centrally acting muscle relaxant that is commonly used to treat muscle spasms and spasticity. In clients with amyotrophic lateral sclerosis (ALS), spasticity can be a significant symptom, leading to muscle stiffness and discomfort. Tizanidine helps by relaxing the muscles and alleviating the muscle tightness associated with ALS. It works by inhibiting nerve impulses that cause muscles to contract, thus reducing spasticity and improving mobility. This medication is not intended for sleep promotion or pain relief directly, but rather to manage muscle spasms.

C. Tizanidine is an antibiotic medication used to treat bacterial infections:

This is incorrect. Tizanidine is not an antibiotic and has no role in treating bacterial infections. It is a muscle relaxant used for managing spasticity, not an antimicrobial drug.

D. Tizanidine is an opiate and is used to relieve severe pain:

This is incorrect. Tizanidine is not an opiate and does not belong to the class of opioids. It does not have the pain-relieving effects of opioid analgesics. While it may provide some relief from muscle discomfort, it is not used to treat severe pain in the way opiates like morphine or oxycodone are. Tizanidine’s primary purpose is to address muscle spasticity, not pain management.

A. Encourage the daily use of the incentive spirometer B. Assisting the client with ambulation in the hallway C. Increasing the chest tube suction to 44 mmHg D. Assessing for adequate pain relief

Correct Answer is D

Explanation

A. Encourage the daily use of the incentive spirometer: While the use of an incentive spirometer is important for improving lung expansion and preventing atelectasis, it may not be effective unless the client’s pain is well-managed. If pain is not addressed first, the client may be unable or unwilling to use the incentive spirometer properly, thus delaying recovery and increasing the risk of respiratory complications.

B. Assisting the client with ambulation in the hallway: Ambulation is an important post-operative activity for improving circulation and preventing complications such as deep vein thrombosis (DVT) or pneumonia. However, the priority at this time should be addressing the client's pain and ensuring adequate breathing before attempting more strenuous activities like ambulation. If the client is in pain and not breathing effectively, ambulation could exacerbate respiratory difficulties..

C. Increasing the chest tube suction to 44 mmHg: Increasing chest tube suction is not indicated unless there is evidence of inadequate drainage or a specific complication, such as a pneumothorax or pleural effusion. In this case, the priority is to address the client’s respiratory function, which is more likely to improve with pain relief, deep breathing, and appropriate positioning. Suctioning should only be adjusted if there is a clinical reason such as signs of a pneumothorax or inadequate drainage, which is not indicated by the information provided.

D. Assessing for adequate pain relief: The most urgent intervention in this scenario is ensuring that the client has adequate pain relief. The client’s shallow respirations and guarding of the operative site suggest that pain is inhibiting effective breathing and deep inspiration, which is crucial for preventing atelectasis and improving ventilation. Pain control is essential in promoting optimal respiratory function, as uncontrolled pain can lead to shallow breathing, reduced lung expansion, and compromised gas exchange, all of which can increase the risk of acute respiratory failure. Once pain is managed, the client will be better able to engage in other respiratory interventions

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a client diagnosed with amyotrophic lateral sclerosis (ALS). The client was given a medical prescription for tizanidine. What information would the nurse provide regarding this medication? Tizanidine is

Correct Answer is B

Explanation

Correct Answer is D

Explanation

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