The nurse is evaluating the arterial blood gas (ABG) of a client who was admitted in status asthmaticus. Which ABG result would indicate the client has an improved acid-base status?

pH 7.37, PaO2 90 mmHg, PaCO2 44 mmHg, HCO3 22 mEq/L

pH 7.36, PaO2 60 mmHg, PaCO2 45 mmHg, HCO3 22 mEq/L

pH 7.48, PaO2 80 mmHg, PaCO2 32 mmHg, HCO3 18 mEq/L

pH 7.27, PaO2 70 mmHg, PaCO2 38 mmHg, HCO3 14 mEq/L

Answer and Explanation

The Correct Answer is A

Choice A reason:

A pH of 7.37, PaO2 of 90 mmHg, PaCO2 of 44 mmHg, and HCO3 of 22 mEq/L indicate a near-normal acid-base balance and adequate oxygenation. The pH is within the normal range (7.35-7.45), suggesting that the client’s acid-base status has improved. The PaO2 is also within the normal range (80-100 mmHg), indicating good oxygenation.

Choice B reason:

A pH of 7.36, PaO2 of 60 mmHg, PaCO2 of 45 mmHg, and HCO3 of 22 mEq/L indicate a slightly acidic pH and hypoxemia (low PaO2). While the pH is close to normal, the low PaO2 suggests that the client is still experiencing significant respiratory distress.

Choice C reason:

A pH of 7.48, PaO2 of 80 mmHg, PaCO2 of 32 mmHg, and HCO3 of 18 mEq/L indicate alkalosis (high pH) and a low PaCO2, which may suggest hyperventilation. This is not an improved acid-base status as it indicates an imbalance.

Choice D reason:

A pH of 7.27, PaO2 of 70 mmHg, PaCO2 of 38 mmHg, and HCO3 of 14 mEq/L indicate acidosis (low pH) and hypoxemia. This result suggests that the client is still in significant respiratory distress and has not achieved an improved acid-base status.

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Correct Answer is D

Explanation

Pursed-lip breathing is a technique used to help manage shortness of breath and improve ventilation. It involves breathing in through the nose and exhaling slowly through pursed lips, as if blowing out a candle. This method helps to keep the airways open longer, allowing more air to escape and reducing the work of breathing.

Choice A reason:

Exhale quickly and forcefully through the mouth is not the correct intervention for pursed-lip breathing. Exhaling quickly and forcefully can cause the airways to collapse, making it harder to breathe out all the air. This can lead to air trapping and increased shortness of breath, which is counterproductive for clients with respiratory issues.

Choice B reason:

Inhale sharply with a “huff” sound is also not correct for pursed-lip breathing. Huff coughing is a technique used to clear mucus from the airways, not to manage breathing patterns. Inhaling sharply can cause irritation and may not provide the controlled breathing needed for effective gas exchange.

Choice C reason:

Inhale deeply through pursed lips is incorrect. The correct technique for pursed-lip breathing involves inhaling through the nose, not through pursed lips. Inhaling through the nose helps to filter and humidify the air, making it easier on the lungs and airways.

Choice D reason:

Exhale slowly through pursed lips is the correct intervention. This technique helps to prolong exhalation, which reduces the respiratory rate and improves ventilation. By keeping the airways open longer, it helps to release trapped air and improve oxygenation. This method is particularly beneficial for clients with chronic obstructive pulmonary disease (COPD) and asthma, as it helps to reduce the work of breathing and improve overall respiratory function.

A. Covers the mouth and nose when coughing. B. Reports daily to the public health department. C. Demonstrates correct use of the N95 mask. D. Washes dishes and personal items after use.

Correct Answer is A

Explanation

Choice A reason: Covering the mouth and nose when coughing is a critical measure to prevent the spread of tuberculosis (TB). TB is primarily transmitted through airborne particles when an infected person coughs, sneezes, or talks. By covering the mouth and nose, the client reduces the risk of spreading the bacteria to others, which is a fundamental goal of TB transmission education.

Choice B reason: Reporting daily to the public health department is important for monitoring and managing TB treatment, but it does not directly relate to preventing the transmission of TB. This action is more about ensuring adherence to treatment protocols and monitoring the client’s health status.

Choice C reason: Demonstrating correct use of the N95 mask is also crucial in preventing the spread of TB, especially in healthcare settings or when the client is in close contact with others. The N95 mask filters out airborne particles, including TB bacteria, thereby reducing the risk of transmission. However, this measure is typically emphasized in specific situations rather than as a general practice for all clients with TB.

Choice D reason: Washing dishes and personal items after use is good hygiene practice but is not specifically related to the transmission of TB. TB is not spread through contact with dishes or personal items but through airborne particles.

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The nurse is evaluating the arterial blood gas (ABG) of a client who was admitted in status asthmaticus. Which ABG result would indicate the client has an improved acid-base status?

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