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. One of the primary reasons for administering IV fluids is to correct imbalances in fluid volume or electrolyte concentrations. Examples include correcting dehydration, restoring electrolyte levels (such as sodium, potassium), and addressing fluid losses due to vomiting, diarrhea, or excessive sweating.
B. IV fluids are typically used to increase intravascular volume rather than decrease it. In conditions such as hypovolemia (low blood volume), IV fluids are administered to restore blood volume and improve circulation.
C. Third spacing refers to the abnormal accumulation of fluid in interstitial spaces, which can occur in conditions like sepsis, burns, or trauma. IV fluids are not typically administered to increase third spacing; rather, treatment aims to redistribute fluids and improve fluid balance.
D. Enteral fluids are fluids administered directly into the gastrointestinal tract (via oral or tube feeding). IV fluids are administered directly into the bloodstream and are used when enteral administration is not feasible or sufficient.
Correct Answer is A
Explanation
A. The psychomotor domain involves the development of physical skills and the ability to manipulate objects. When the client performs a return demonstration of using the incentive spirometer, they are demonstrating their ability to coordinate their muscles and movements to correctly operate the device. This includes actions such as inhaling deeply, maintaining proper technique, and achieving the desired lung volume.
B The cognitive domain pertains to the acquisition and application of knowledge and intellectual skills. Understanding how the incentive spirometer works, its purpose in improving lung function post-surgery, and the correct technique for using it all fall under cognitive learning. The client must grasp the
Rationale behind using the spirometer to promote effective breathing and prevent complications like atelectasis.
C. Imitation involves observing and copying someone else's actions. In the context of using an incentive spirometer, the initial demonstration by the nurse serves as a model for the client to imitate. After receiving instructions and observing the nurse's demonstration, the client imitates the correct technique during the return demonstration. However, imitation alone does not fully capture the learning domain demonstrated by the client.
D. The affective domain focuses on attitudes, values, beliefs, and emotions. While using the incentive spirometer involves physical and cognitive skills, it also involves motivation and willingness to engage in the activity as prescribed by the healthcare provider. This domain encompasses the client's commitment to following through with spirometer use as part of their recovery and adherence to the healthcare plan.
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