Which intervention would the nurse include in the plan of care for a client with COPD and respiratory acidosis?

Assess level of consciousness

Monitor serum sodium

Check skin turgor

Administer diuretics

Answer and Explanation

The Correct Answer is A

a. Assess level of consciousness: Respiratory acidosis in COPD patients can lead to hypercapnia (elevated carbon dioxide levels), which may result in altered mental status, confusion, or decreased level of consciousness due to respiratory depression. Assessing the level of consciousness is important to monitor for signs of worsening respiratory distress or impending respiratory failure.

b. Monitor serum sodium: COPD patients with respiratory acidosis may retain carbon dioxide, leading to respiratory compensation by the kidneys through increased retention of bicarbonate ions. This retention of bicarbonate can result in metabolic alkalosis and potentially affect electrolyte balance, including sodium levels. Monitoring serum sodium levels is essential to detect any electrolyte imbalances that may occur as a result of respiratory acidosis and its compensatory mechanisms.

c. Check skin turgor: While checking skin turgor is a valuable assessment for hydration status, it may not be directly related to respiratory acidosis in COPD. However, it's still important to assess hydration status in COPD patients, especially those with exacerbations, as dehydration can exacerbate respiratory symptoms.

d. Administer diuretics: Diuretics are not typically indicated in the management of respiratory acidosis in COPD. In fact, diuretics can worsen respiratory acidosis by potentially causing volume depletion and further reducing effective gas exchange in already compromised lungs. Diuretics may be used cautiously in COPD patients with concomitant heart failure or volume overload, but their use should be carefully monitored and individualized.

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Correct Answer is D

Explanation

a. Warfarin: Warfarin is an anticoagulant medication used to prevent blood clot formation. While it is commonly prescribed for certain cardiac conditions such as atrial fibrillation or mechanical heart valves to prevent thromboembolic events, it does not directly improve the force of cardiac contraction. Therefore, warfarin is not the appropriate medication for improving cardiac contraction in a client with pulmonary edema.

b. Enalapril: Enalapril is an angiotensin-converting enzyme (ACE) inhibitor used to manage hypertension and heart failure. While ACE inhibitors can help reduce preload and afterload on the heart, leading to improved cardiac function over time, they do not directly improve the force of cardiac contraction acutely. Therefore, enalapril is not the appropriate medication for improving cardiac contraction in a client with pulmonary edema.

c. Bumetanide: Bumetanide is a loop diuretic medication used to promote diuresis and reduce fluid overload in conditions such as heart failure and pulmonary edema. While reducing fluid overload can indirectly improve cardiac function by reducing preload on the heart, loop diuretics do not directly improve the force of cardiac contraction.

d. Dobutamine: Dobutamine is a positive inotropic medication that directly stimulates beta-1 adrenergic receptors in the heart, leading to increased myocardial contractility (force of cardiac contraction) and improved cardiac output. It is commonly used in the treatment of acute heart failure, including pulmonary edema, to enhance cardiac function and reduce symptoms of congestion.

A. pH 7.49 Pa, CO2 36mmHg, HCO3 31mEq/L B. pH 7.47 Pa, CO2 25mmHg, HCO3 26mEq/L C. pH 7.32 Pa, CO2 41mmHg, HCO3 22mEq/L D. pH 7.30 Pa, CO2 48mmHg, HCO3 26mEq/L

Correct Answer is B

Explanation

Based on the expected changes in hyperventilation related to anxiety, option b (pH 7.47, PaCO2 25 mmHg, HCO3 26 mEq/L) is the most consistent with respiratory alkalosis, which occurs due to hyperventilation:

a. pH 7.49, PaCO2 36 mmHg, HCO3 31 mEq/L:

The pH is higher than the normal range, indicating alkalosis.
The PaCO2 is within the normal range (slightly elevated), which is unexpected in hyperventilation where PaCO2 is typically decreased.
The HCO3 is elevated, indicating metabolic alkalosis, which is not typically associated with hyperventilation related to anxiety.

b. pH 7.47, PaCO2 25 mmHg, HCO3 26 mEq/L:

The pH is higher than the normal range, indicating alkalosis.
The PaCO2 is below the normal range, indicating respiratory alkalosis, which is consistent with hyperventilation.
The HCO3 is within the normal range, which can occur as a compensatory mechanism for respiratory alkalosis.

c. pH 7.32, PaCO2 41 mmHg, HCO3 22 mEq/L:

The pH is lower than the normal range, indicating acidosis.
The PaCO2 is within the normal range, which is unexpected in hyperventilation where PaCO2 is typically decreased.
The HCO3 is within the normal range, indicating compensated metabolic acidosis, which is not typically associated with hyperventilation related to anxiety.

d. pH 7.30, PaCO2 48 mmHg, HCO3 26 mEq/L:

The pH is lower than the normal range, indicating acidosis.
The PaCO2 is elevated, indicating respiratory acidosis, which is not typically associated with hyperventilation.
The HCO3 is within the normal range, which can occur as a compensatory mechanism for respiratory acidosis.

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Which intervention would the nurse include in the plan of care for a client with COPD and respiratory acidosis?

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Naxlex Comprehensive Predictor Exams

A client is admitted for treatment of pulmonary edema. Which medication will the nurse administer to improve the force of cardiac contraction for this client?

Correct Answer is D

Explanation

A client in the emergency department is being treated for hyperventilation related to anxiety. Which arterial blood gas result would the nurse anticipate for this client? Normal arterial blood gas values pH: 7.35-7.45, PaCO2: 35-45mmHg, HCO3: 22-26mEq/L.

Correct Answer is B

Explanation

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