A nurse is caring for a client who has acute kidney injury (AKI). Which of the following arterial blood gas values would the nurse expect this client to have?
pH 7.49, HCO3 24, PaCO2 30
pH 7.26, HCO3 24, PaCO2 46
pH 7.26, HCO3 14, PaCO2 30
pH 7.49, HCO3 30, PaCO2 40
The Correct Answer is C
Choice A Reason: This choice is incorrect because it indicates respiratory alkalosis, not AKI. Respiratory alkalosis is a condition in which the lungs eliminate too much carbon dioxide (CO2) from the blood, resulting in a low level of CO2 (PaCO2) and a high level of pH. A normal PaCO2 range is 35 to 45 mm Hg, and a normal pH range is 7.35 to 7.45, so a value of 30 mm Hg and 7.49 indicate respiratory alkalosis.
Choice B Reason: This choice is incorrect because it indicates respiratory acidosis, not AKI. Respiratory acidosis is a condition in which the lungs cannot eliminate enough CO2 from the blood, resulting in a high level of CO2 (PaCO2) and a low level of pH. A value of 46 mm Hg and 7.26 indicate respiratory acidosis.
Choice C Reason: This choice is correct because it indicates metabolic acidosis, which is a common complication of AKI. Metabolic acidosis is a condition in which the body produces too much acid or loses too much base, resulting in a low level of bicarbonate (HCO3) and a low level of pH. A normal HCO3 range is 22 to 26 mEq/L, so a value of 14 mEq/L indicates metabolic acidosis. The low PaCO2 value (30 mm Hg) is due to the respiratory compensation mechanism that tries to restore the acid-base balance by increasing the ventilation and eliminating more CO2.
Choice D Reason: This choice is incorrect because it indicates metabolic alkalosis, not AKI. Metabolic alkalosis is a condition in which the body loses too much acid or gains too much base, resulting in a high level of bicarbonate (HCO3) and a high level of pH. A value of 30 mEq/L and 7.49 indicate metabolic alkalosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A Reason: This is incorrect because dextrose 5% in 0.9% sodium chloride is a hypertonic solution that can cause fluid overload and pulmonary edema in a client who has burns.
Choice B Reason: This is incorrect because dextrose 5% in water is a hypotonic solution that can cause fluid shifts from the intravascular space to the interstitial space, resulting in hypovolemia and hypotension in a client who has burns.
Choice C Reason: This is incorrect because 0.9% sodium chloride is an isotonic solution that can cause hypernatremia and hyperchloremia in a client who has burns, as the fluid loss from burns is greater than the sodium loss.
Choice D Reason: This is correct because lactated Ringer's is an isotonic solution that contains electrolytes similar to plasma, such as sodium, potassium, calcium, and chloride. It also contains lactate, which is converted to bicarbonate in the liver and helps correct the metabolic acidosis that occurs in a client who has burns.
Correct Answer is C
Explanation
Choice A Reason: This choice is incorrect because inserting a central line is not a priority action for a client who has a sucking chest wound. A central line is a catheter that is inserted into a large vein in the neck, chest, or groin to administer fluids, medications, or blood products. It may be indicated for clients who have hypovolemia, sepsis, or shock, but it does not address the underlying cause of the client's respiratory distress.
Choice B Reason: This choice is incorrect because removing the dressing to inspect the wound may worsen the client's condition. A sucking chest wound is an open wound in the chest wall that allows air to enter and exit the pleural cavity with each breath. This creates a positive pressure in the pleural space that collapses the lung on the affected side and shifts the mediastinum to the opposite side, impairing the ventilation and circulation of both lungs. Therefore, the nurse should apply an occlusive dressing that covers three sides of the wound and allows air to escape but not enter the pleural cavity. Removing the dressing may allow more air to enter and increase the risk of tension pneumothorax, which is a life-threatening complication.
Choice C Reason: This choice is correct because administering oxygen via nasal cannula may help to improve the client's oxygenation and ventilation. A nasal cannula is a device that delivers oxygen through two prongs that fit into the nostrils. It can provide oxygen at low flow rates (1 to 6 L/min) and low concentrations (24 to 44 percent). The nurse should monitor the client's respiratory rate, pulse oximetry, and arterial blood gases to assess the effectiveness of oxygen therapy.
Choice D Reason: This choice is incorrect because raising the foot of the bed to a 90° angle may worsen the client's respiratory distress. This position may increase the pressure on the diaphragm and reduce the lung expansion. It may also decrease the venous return and cardiac output, leading to hypotension and shock. Therefore, the nurse should position the client in a semi-Fowler's position (30 to 45° angle) or high-Fowler's position (60 to 90° angle) to facilitate breathing and prevent further complications.
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