Your patient is admitted to the hospital and is to undergo brain surgery.

The patient is very anxious and scared of the upcoming surgery.

She begins to hyperventilate and becomes very dizzy.

The client loses consciousness and the STAT ABGs reveal pH 7.61, PaCO2 22 mmHg, and HCO3 25 mEq/L. What is the ABG interpretation based on the findings?

Respiratory Acidosis, with Partial Compensation.

Respiratory Alkalosis, Uncompensated.

Metabolic Alkalosis, Uncompensated.

Metabolic Acidosis, with Partial Compensation.

Answer and Explanation

The Correct Answer is B

Choice A rationale

Respiratory acidosis is characterized by a low pH and an elevated PaCO2. The patient's pH is elevated (7.61), indicating alkalosis, and the PaCO2 is low (22 mmHg). These findings are the opposite of what would be seen in respiratory acidosis.

Choice B rationale

The pH of 7.61 is significantly elevated, indicating alkalosis. The PaCO2 of 22 mmHg is markedly decreased below the normal range (35-45 mmHg). This decrease in carbon dioxide, a potent acid, directly causes the alkalosis. The bicarbonate (HCO3) level of 25 mEq/L is within the normal range (22-26 mEq/L), indicating that the renal system has not yet initiated any compensatory response. Therefore, this pattern is consistent with uncompensated respiratory alkalosis, primarily driven by hyperventilation.

Choice C rationale

Metabolic alkalosis would present with an elevated pH and an elevated bicarbonate level. While the pH is elevated, the bicarbonate (25 mEq/L) is within the normal range, and the PaCO2 is low, which is inconsistent with metabolic alkalosis as the primary imbalance.

Choice D rationale

Metabolic acidosis is characterized by a low pH and a low bicarbonate level. The patient's pH is high (alkalotic) and the bicarbonate is normal. This contradicts the diagnostic criteria for metabolic acidosis.

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Correct Answer is D

Explanation

Choice A rationale

Uncompensated respiratory acidosis would display a low pH (normal 7.35-7.45) and an elevated PaCO2 (normal 35-45 mmHg), with the bicarbonate (normal 22-26 mEq/L) remaining within the normal range. This patient's PaCO2 is low, and the primary issue is metabolic, not respiratory.

Choice B rationale

Partially compensated respiratory acidosis would show a low pH (normal 7.35-7.45), an elevated PaCO2 (normal 35-45 mmHg), and an elevated bicarbonate (normal 22-26 mEq/L). This patient's PaCO2 is low, and the bicarbonate is significantly low, indicating a metabolic origin.

Choice C rationale

Metabolic alkalosis is characterized by an elevated pH (normal 7.35-7.45) and an elevated bicarbonate level (normal 22-26 mEq/L). This patient has a significantly low pH and bicarbonate, directly contradicting the parameters of metabolic alkalosis.

Choice D rationale

The patient's pH of 7.0 is highly acidic (normal 7.35-7.45). The bicarbonate level of 12 mmol/L is significantly low (normal 22-26 mEq/L), indicating a primary metabolic acidosis. The PaCO2 of 23 mm Hg is low (normal 35-45 mmHg), demonstrating respiratory compensation through Kussmaul breathing. The pH is still acidic, showing partial compensation.

A. Absence of bacteria. B. Decreased glucose. C. Absence of leukocytes. D. Absence of protein.

Correct Answer is B

Explanation

Choice A rationale

The presence of bacteria in the cerebrospinal fluid is a hallmark indicator of bacterial meningitis. Therefore, an absence of bacteria would typically rule out a bacterial infection, suggesting either a different etiology or a sterile CSF culture due to prior antibiotic administration.

Choice B rationale

In bacterial meningitis, bacteria consume glucose from the CSF for their metabolic needs. This leads to a characteristic decrease in CSF glucose levels (normal range 40-70 mg/dL or approximately 2/3 of blood glucose). This metabolic activity of the bacteria is a key diagnostic marker.

Choice C rationale

Bacterial meningitis is characterized by a significant inflammatory response within the central nervous system. This response includes a robust influx of leukocytes, predominantly neutrophils, into the cerebrospinal fluid. Therefore, an absence of leukocytes would contradict a diagnosis of bacterial meningitis.

Choice D rationale

The inflammation and increased permeability of the blood-brain barrier associated with bacterial meningitis often lead to an elevated protein concentration in the cerebrospinal fluid (normal range 15-45 mg/dL). Therefore, an absence of protein would be inconsistent with the expected findings.

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Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

You are caring for a patient with suspected bacterial meningitis. The physician performs a lumbar puncture to extract some cerebral spinal fluid (CSF) for testing. Which of the following lab results would you expect if the patient does indeed have bacterial meningitis?

Correct Answer is B

Explanation

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