The nurse is caring for a client whose arterial blood gas reveals partially compensated respiratory alkalosis. 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 7.32, Pa02 88 mmHg, PaCO2 50 mmHg, HCO3 29 mEq/L, 02 sat 94%

pH 7.35, Pa02 98 mmHg, PaCO2 55 mmHg, HCO3 28 mEq/L, 02 sat 99%

pH 7.64, PaO2 94 mmHg, PaCO2 23 mmHg, HCO3 14 mEq/L, 02 sat 88%

PH 7.50, Pa02 91 mmHg, PaCO2 52 mmHg, HCO3 30 mEq/L, 02 sat 96%

Answer and Explanation

The Correct Answer is C

A) pH 7.32, PaO2 88 mmHg, PaCO2 50 mmHg, HCO3 29 mEq/L, O2 sat 94%
This result suggests respiratory acidosis rather than respiratory alkalosis. In respiratory acidosis, the pH would be low (acidotic), PaCO2 would be elevated (since it reflects CO2 retention), and HCO3 would typically be elevated as a compensatory mechanism. This set of ABG values does not align with respiratory alkalosis, so it is not consistent with partially compensated respiratory alkalosis.

B) pH 7.35, PaO2 98 mmHg, PaCO2 55 mmHg, HCO3 28 mEq/L, O2 sat 99%
This set of values suggests respiratory acidosis, as indicated by a low pH (acidosis) and high PaCO2 (carbon dioxide retention). The HCO3 value is slightly elevated in compensation for respiratory acidosis, but this is not an example of partially compensated respiratory alkalosis, so it doesn't match the question's requirement.

C) pH 7.64, PaO2 94 mmHg, PaCO2 23 mmHg, HCO3 14 mEq/L, O2 sat 88%
This result is consistent with partially compensated respiratory alkalosis. In respiratory alkalosis, the pH would be elevated (alkalotic), PaCO2 would be low (indicating hyperventilation), and the kidneys would attempt to compensate by lowering bicarbonate (HCO3). In this case, the low PaCO2 (23 mmHg) and the low HCO3 (14 mEq/L) demonstrate partial compensation. The pH is also elevated at 7.64, which aligns with alkalosis. This is the correct answer for partially compensated respiratory alkalosis.

D) pH 7.50, PaO2 91 mmHg, PaCO2 52 mmHg, HCO3 30 mEq/L, O2 sat 96%
This result suggests respiratory acidosis with compensation. The elevated PaCO2 (52 mmHg) indicates CO2 retention, leading to acidosis, while the slightly elevated HCO3 (30 mEq/L) shows that the kidneys are compensating for the respiratory acidosis. The pH of 7.50 is slightly alkalotic, but it is more consistent with compensation for respiratory acidosis rather than respiratory alkalosis. Thus, this set of ABG values does not match the description of partially compensated respiratory alkalosis.

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Correct Answer is D

Explanation

A. Similar to the angina attacks you had in the past:
This response is not entirely accurate. Angina refers to chest pain that occurs when the heart's demand for oxygen exceeds its supply, usually due to partial blockage of the coronary arteries. NSTEMI (non-ST elevation myocardial infarction) is different from angina in that it involves actual heart muscle injury or damage due to partial or intermittent blockage of a coronary artery, whereas angina does not cause permanent heart muscle damage. Therefore, describing NSTEMI as similar to past angina attacks would be misleading.

B. A condition characterized by coronary arteries vasodilating:
This is incorrect. NSTEMI occurs due to a partial blockage or narrowing of the coronary arteries, usually caused by a blood clot that forms around a ruptured atherosclerotic plaque. The blockage restricts blood flow to the heart muscle, causing injury or infarction. Vasodilation (the widening of blood vessels) is not a characteristic of NSTEMI; in fact, it is the constriction or blockage of the coronary arteries that leads to this type of heart attack.

C. A term used to describe an irregular heartbeat:
This is incorrect. NSTEMI is not related to an irregular heartbeat or arrhythmia directly. While arrhythmias (irregular heartbeats) can occur as a result of a heart attack, NSTEMI specifically refers to a type of heart attack that is not accompanied by the characteristic ST-segment elevation seen on an electrocardiogram (ECG) in a STEMI (ST-elevation myocardial infarction). It indicates a partial blockage of a coronary artery and is generally less severe than STEMI.

D. Is a less severe type of heart attack compared to STEMI:
This is the most accurate response. NSTEMI is a type of heart attack that is often considered less severe than STEMI, but still involves heart muscle injury. The difference between NSTEMI and STEMI lies in the ECG findings: STEMI involves a full-thickness myocardial infarction with a significant blockage of the artery, as indicated by ST-segment elevation on an ECG. In NSTEMI, there is a partial blockage or temporary decrease in blood flow, and the ST-segment does not elevate on the ECG, but biomarkers (like troponin) are elevated, indicating heart muscle damage. NSTEMI is often less severe in terms of the extent of damage compared to STEMI, but it still requires urgent treatment to prevent further complications.

A. Speak slow and loud so that the client can understand speech B. Encourage the client to write questions on a white erase board C. Use pre-arranged eye signais because eye muscles remain intact D. Have the client squeeze the nurse's hand when intubated and on the ventilator

Correct Answer is C

Explanation

A. Speak slow and loud so that the client can understand speech:

While speaking slowly and clearly may help with communication in some patients with ALS, this approach is less effective as the disease progresses. As ALS advances, speech muscles become affected, and the client may be unable to speak at all, making this method inappropriate for end-stage ALS. Simply speaking louder does not address the communication needs of a client who can no longer use their voice.

B. Encourage the client to write questions on a white erase board:

While writing on a whiteboard may be an effective communication strategy in the early stages of ALS when the client still has adequate hand function, this becomes increasingly difficult as muscle weakness progresses. By the end-stage, clients may lose the ability to hold a pen or write legibly, making this method less viable as the disease advances. It is not the best option for clients with significant motor impairment.

C. Use pre-arranged eye signals because eye muscles remain intact: In clients with end-stage amyotrophic lateral sclerosis (ALS), muscle weakness and loss of voluntary control progressively affect motor functions, including the ability to speak, write, and move. However, the eye muscles are typically preserved until the later stages of the disease, allowing patients to communicate through eye movements. Pre-arranged eye signals, such as blinking for "yes" or "no" or using a system of eye movements to select letters or words, are effective ways to facilitate communication with clients who can no longer speak or write. This method respects the client's remaining abilities and allows for more effective communication, especially as the disease progresses to its final stages.

D. Have the client squeeze the nurse's hand when intubated and on the ventilator:

When a client is intubated and on a ventilator, their ability to squeeze the nurse's hand may be limited due to the sedation and ventilator settings, and they may not have sufficient motor control to respond consistently. Additionally, when intubated, respiratory effort is controlled by the ventilator, so relying on hand squeezing would not be an effective or reliable method of communication. Furthermore, ALS patients in the later stages may not have enough muscle control for this method to be practical.

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Naxlex Comprehensive Predictor Exams

The client tells the nurse, "My physician told me that I had a non-ST elevation myocardial infarction (NSTEMI). " I thought all heart attacks were the same. Can you explain this to me?" The nurse's best response to the client's question would be: "NSTEMI is

Correct Answer is D

Explanation

Which method would the nurse utilize to best facilitate communication when caring for a client with end stage amyotrophic lateral sclerosis (ALS)?

Correct Answer is C

Explanation

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