A client is brought into the emergency department for an overdose of morphine. The client has a respiratory rate of 5 to 8 breaths per minute. Which of the following ABG results would the nurse expect to see?
pH 7.45, PaCO2 35, HCO3 22
pH 7.25. PaCO2 61, HCO3 26
pH 7.23. PaCO2 27, HCO3 25
pH 7.54, PaCO2 59. HCO3 26
The Correct Answer is B
B. pH 7.25, PaCO2 61, HCO3 26
pH is decreased (acidosis).
PaCO2 is elevated (61 mmHg), indicating respiratory acidosis (increased CO2 retention). HCO3 is slightly elevated (26 mEq/L), compensating for the respiratory acidosis.
A. pH 7.45, PaCO2 35, HCO3 22
pH is within normal range (7.35-7.45).
PaCO2 is slightly lower than normal (35 mmHg), indicating mild respiratory alkalosis. HCO3 (bicarbonate) is within normal range (22 mEq/L).
C. pH 7.23, PaCO2 27, HCO3 25
pH is decreased (acidosis).
PaCO2 is lower than normal (27 mmHg), indicating respiratory alkalosis (which is unlikely in the context of morphine overdose with hypoventilation).
HCO3 is within normal range (25 mEq/L).
D. pH 7.54, PaCO2 59, HCO3 26
pH is increased (alkalosis).
PaCO2 is elevated (59 mmHg), indicating respiratory acidosis (consistent with hypoventilation). HCO3 is slightly elevated (26 mEq/L), compensating for the respiratory acidosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Gender can influence health beliefs and practices due to societal norms, roles, and expectations associated with masculinity and femininity. For example, certain health issues may be more prevalent or
stigmatized based on gender. Understanding a client's gender-related health beliefs can help nurses tailor care that respects and addresses these factors.
B. Socioeconomic status (SES) impacts access to healthcare resources, health literacy, and health behaviors. Clients with higher SES may have greater access to healthcare facilities, medications, and preventive services. However, this is an external variable.
C. Family health practices often shape an individual's beliefs about health and illness. Clients may adopt health behaviors based on familial traditions, cultural practices, or experiences with illness within the family. However, this is an external variable.
D. Education level influences health literacy, understanding of medical information, and decision-making regarding healthcare. Higher education levels are often associated with better health outcomes due to increased knowledge of health-related issues, ability to navigate healthcare systems, and adherence to medical advice. However, this is an external variable.
Correct Answer is C
Explanation
C. Chvostek's sign is assessed by tapping or lightly percussing the facial nerve (facial muscles) at the angle of the jaw, just in front of the earlobe. A positive Chvostek's sign is indicated by facial twitching, especially around the mouth, nose, and eye, in response to this percussion. It indicates neuromuscular irritability due to low calcium levels.
A. Straining urine is typically done to collect urine for analysis or to detect urinary stones. It does not relate to the assessment of neuromuscular irritability, which is what Chvostek's sign evaluates.
B. This option does not pertain to assessing Chvostek's sign either. Inflating a blood pressure cuff above systolic measurement is a technique used to assess for Trousseau's sign, which is another clinical indicator of hypocalcemia but involves different physiological mechanisms than Chvostek's sign.
D. This option is unrelated to assessing Chvostek's sign or hypocalcemia. Baseline height and weight are typically obtained for nutritional assessment, growth monitoring, or as part of a general health assessment. They do not help in evaluating neuromuscular irritability associated with calcium levels.
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