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

Choice A reason:

Administering oxygen per the prescriber’s order to keep SpO2 greater than 96% is not typically recommended for clients with chronic bronchitis. High levels of oxygen can suppress the respiratory drive in clients with chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis. The target SpO2 for these clients is usually between 88% and 92%.

Choice B reason:

Placing the patient in the Sims position is not the most effective position for airway clearance. The Fowler’s or semi-Fowler’s position is generally preferred as it promotes better lung expansion and facilitates easier breathing.

Choice C reason:

Assessing the client’s use of a peak expiratory flow rate meter is important for monitoring the severity of bronchospasm and airflow obstruction. However, it is not a direct intervention for improving gas exchange.

Choice D reason:

Assisting with coughing and deep breathing at least every 2 hours while awake is an effective intervention for clients with chronic bronchitis. This helps to mobilize secretions, improve ventilation, and enhance gas exchange. Regular coughing and deep breathing exercises can prevent atelectasis and reduce the risk of respiratory infections.

A. Exhale quickly and forcefully through the mouth. B. Inhale sharply with a “huff” sound. C. Inhale deeply through pursed lips. D. Exhale slowly through pursed lips.

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.

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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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