The nurse is reading the arterial blood gas results of a patient admitted for sepsis. Which of the following would the nurse expect for a patient in metabolic acidosis?

pH 7.25. CO2 40. HCO3-16

pH 7.5, CO2 35, HCO3-30

pH 7.5, CO2 30 HCO3- 22

pH 7.25, CO2 55. HCO3. 25

Answer and Explanation

The Correct Answer is A

A) pH 7.25, CO2 40, HCO3- 16:
In metabolic acidosis, the pH is decreased indicating acidemia. The bicarbonate level is low which is a hallmark of metabolic acidosis. The CO2 level of 40 is within the normal range suggesting that the body is not compensating for the acidosis through respiratory compensation yet. In metabolic acidosis, the body will often try to compensate by increasing respiratory rate to blow off CO2, but this takes time.

B) pH 7.5, CO2 35, HCO3- 30:
In metabolic alkalosis, the pH is increased above 7.45, and the bicarbonate level (HCO3-) is elevated both of which are seen here. The CO2 level of 35 is within normal limits, and while respiratory compensation could increase CO2 in response to metabolic alkalosis,

C) pH 7.5, CO2 30, HCO3- 22:
The pH is increased above 7.45, and the bicarbonate level is within the normal range. The CO2 level of 30 is low, which is typical in respiratory alkalosis, where the body compensates for the increased pH by blowing off CO2.

D) pH 7.25, CO2 55, HCO3- 25:
The pH is low, but the bicarbonate level is normal. The CO2 level is elevated, which is indicative of hypoventilation or inadequate respiratory compensation, commonly seen in respiratory acidosis, where the lungs cannot excrete CO2 effectively

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Correct Answer is D

Explanation

A. "You probably have a gastrointestinal infection":
This statement is incorrect. A positive result on the enzyme-linked immunosorbent assay (ELISA) indicates the presence of antibodies to HIV, which suggests exposure to the virus. It does not point to a gastrointestinal infection. HIV is a viral infection that primarily affects the immune system, not the gastrointestinal system. Misleading the client in this way would delay proper care and understanding of their health status.

B. "You are confirmed to be infected with the HIV virus.":
A positive ELISA test result does not automatically confirm an HIV diagnosis. ELISA is a screening test that detects HIV antibodies, but it can sometimes produce false-positive results. A positive ELISA result must be confirmed with a more specific confirmatory test, such as the Western blot test. Therefore, it would be premature to tell the client that they are "confirmed" to be infected with HIV without further confirmatory testing.

C. "This is a good result, which means you do not have HIV.":
This statement is also incorrect. A positive ELISA test result does not mean that the client does not have HIV. In fact, it indicates potential exposure to the virus. However, because the result is a screening test, it must be followed up with confirmatory testing. Telling the client that this is a "good result" would be misleading and could cause confusion or delay in appropriate care.

D. "Your result will need to be confirmed with a Western blot test.":
This is the correct response. The Western blot test is the confirmatory test used to verify a positive result from the ELISA. If the ELISA result is positive, the client should be informed that further testing, such as the Western blot, is needed to confirm the diagnosis of HIV infection. It is important to explain that the ELISA is a screening tool, and a positive result does not mean a definitive diagnosis without confirmation. This helps to set realistic expectations and ensures the client receives the appropriate follow-up care.

A. The patient has the virus but the infection is well controlled and not currently transmissible B. The syndrome has gone from Stage 3 back to stage 2 C. The patient can discontinue with antiretroviral therapy until the viral load rises again D. The patient will be prescribed lower doses of antiretroviral medications for 2 months

Correct Answer is A

Explanation

A) "The patient has the virus but the infection is well controlled and not currently transmissible."
An undetectable viral load means that the amount of HIV in the blood is so low that it cannot be detected by standard laboratory tests, typically due to effective antiretroviral therapy. However, the patient still has the HIV virus in their body, and it is essential to continue treatment. An undetectable viral load reduces the risk of transmission, particularly to partners, but it does not eliminate the virus entirely. Hence, the infection is well controlled, but ongoing medication is still necessary to maintain viral suppression.

B) "The syndrome has gone from Stage 3 back to stage 2."
An undetectable viral load does not change the HIV stage. HIV is classified into three stages, with Stage 3 representing AIDS. While effective antiretroviral therapy can prevent the progression to AIDS and help control the viral load, it does not "reverse" the stage of HIV infection. Once a person progresses to Stage 3 (AIDS), they remain in this category even if their viral load becomes undetectable.

C) "The patient can discontinue with antiretroviral therapy until the viral load rises again."
An undetectable viral load indicates successful treatment, but it is crucial for the patient to continue taking antiretroviral medications to maintain viral suppression. Discontinuing therapy increases the risk of viral rebound and drug resistance. Long-term adherence to antiretroviral therapy is essential for keeping the virus under control.

D) "The patient will be prescribed lower doses of antiretroviral medications for 2 months.". The goal of antiretroviral therapy is to maintain viral suppression indefinitely, not to reduce the dose or discontinue it temporarily. Lowering the dose of antiretroviral medications could result in viral rebound and loss of viral suppression. Therefore, consistent, full-dose therapy is required for optimal HIV management.

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The nurse is reading the arterial blood gas results of a patient admitted for sepsis. Which of the following would the nurse expect for a patient in metabolic acidosis?

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Correct Answer is D

Explanation

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