A nurse is analyzing the arterial blood gas (ABG) results of a patient.


The patient’s ABGs are: pH:7.6, PaCO2:40 mm Hg, HCO3:32 mEq/L. Which of the following acid-base conditions should the nurse identify the patient is experiencing?

Choice A rationale:

Distended neck veins are not a reliable indicator of dehydration in adults. They can be caused by other factors, such as heart failure or fluid overload.

In cases of dehydration, the veins in the neck may actually be less visible due to decreased blood volume.

It's important to assess for other signs and symptoms of dehydration, such as urine output, skin turgor, and vital signs, to make an accurate diagnosis.

Choice B rationale:

A bounding pulse can be a sign of dehydration, but it can also be caused by other factors, such as anxiety, exercise, or fever. It's important to assess the pulse rate and rhythm in conjunction with other signs and symptoms to determine the cause.

A normal pulse rate is 60-100 beats per minute in adults. A bounding pulse is typically a strong, forceful pulse that can be easily felt.

Choice C rationale:

A blood pressure of 146/94 mm Hg is considered elevated, but it is not necessarily a sign of dehydration. Blood pressure can be elevated due to other factors, such as stress, pain, or underlying medical conditions. It's important to assess blood pressure in conjunction with other signs and symptoms to determine the cause. Choice D rationale:

Urine specific gravity is a measure of the concentration of solutes in the urine. A higher urine specific gravity indicates more concentrated urine, which is a sign of dehydration.

A normal urine specific gravity is 1.005-1.030. A urine specific gravity of 1.034 is considered high and is a strong indicator of dehydration.

Choice A rationale:

While explaining the importance and rationale of the new policy can be helpful, it may not address the underlying reasons for the nurse's resistance.

If the nurse does not understand or agree with the rationale, they may still be resistant to change.

Additionally, simply providing information may not create an open and trusting environment where the nurse feels comfortable expressing their concerns.

Choice B rationale:

Encouraging the nurse to verbalize their concerns allows the nurse manager to understand the specific reasons for the resistance.

This can help to identify any misconceptions or concerns that can be addressed directly.

It also gives the nurse an opportunity to feel heard and understood, which can help to build trust and rapport. When nurses feel that their concerns are being taken seriously, they are more likely to be open to change.

Choice C rationale:

Threatening disciplinary action is likely to create resentment and further resistance. It may also damage the relationship between the nurse manager and the nurse.

This approach should only be used as a last resort, after other attempts to address the resistance have failed.

Choice D rationale:

Ignoring the resistance is not an effective strategy.

It is likely to lead to continued noncompliance with the new policy,

It may also send the message that the nurse manager does not care about the nurse's concerns.

Peer pressure can sometimes be helpful in facilitating change, but it should not be relied upon as the sole strategy.