The nurse receives an order to administer drug R 300 mg IVPB over one hour. Drug R is available as 300 mg in 100 mL NSS. The drip factor of the piggyback tubing is 15 gtts/mL. At what rate should the nurse regulate the IV flow?

Choice A reason: Metabolic alkalosis is characterized by an elevated pH and an increased bicarbonate (HCO3) level. In this case, the pH is elevated (7.51), but the bicarbonate level is within the normal range (24 mEq/L), indicating that the alkalosis is not metabolic in origin.

Choice B reason: Metabolic acidosis is characterized by a decreased pH and a decreased bicarbonate (HCO3) level. In this scenario, the pH is elevated, not decreased, and the bicarbonate level is normal, ruling out metabolic acidosis.

Choice C reason: Respiratory alkalosis is characterized by an elevated pH and a decreased partial pressure of carbon dioxide (PaCO2). The given values show a pH of 7.51 (elevated) and a PaCO2 of 28 mmHg (decreased), which are indicative of respiratory alkalosis. This condition often occurs in the early stages of an asthma attack due to hyperventilation, which causes excessive exhalation of CO2.

Choice D reason: Respiratory acidosis is characterized by a decreased pH and an increased PaCO2. In this case, the pH is elevated, and the PaCO2 is decreased, which is the opposite of what is seen in respiratory acidosis.

Choice A reason: A decreased anteroposterior diameter of the chest is not typically associated with COPD and emphysema. In fact, patients with COPD often have an increased anteroposterior diameter, known as a “barrel chest,” due to hyperinflation of the lungs. This change in chest shape is a compensatory mechanism to accommodate the increased lung volume and is a common physical finding in advanced COPD.

Choice B reason: Oxygen saturation level below 95% is a common finding in patients with COPD and emphysema. These conditions impair the lungs’ ability to oxygenate the blood effectively, leading to lower oxygen levels. Chronic hypoxemia is a hallmark of COPD, and monitoring oxygen saturation is crucial in managing these patients. Normal oxygen saturation levels typically range from 95% to 100%, so levels below 95% indicate a need for supplemental oxygen or other interventions.

Choice C reason: Petechiae on the chest are not a typical finding in COPD or emphysema. Petechiae are small, red or purple spots caused by bleeding into the skin and are usually associated with conditions affecting blood clotting or platelet function. They are not related to the respiratory pathology seen in COPD and emphysema.

Choice D reason: Respiratory alkalosis is not commonly associated with COPD and emphysema. These conditions are more likely to cause respiratory acidosis due to chronic retention of carbon dioxide (CO2). In COPD, the damaged alveoli and airways lead to impaired gas exchange, resulting in elevated CO2 levels and a decrease in blood pH. Respiratory alkalosis, characterized by low CO2 levels and increased pH, is more often seen in conditions causing hyperventilation, such as anxiety or acute asthma attacks.