A nurse is caring for a patient who has acute kidney injury.
The patient’s ABGs are: pH: 7.26, PaCO2: 30 mm Hg, HCO3: 14 mEq/L. Which of the following acid-base imbalances should the nurse identify the patient is experiencing?
Metabolic alkalosis.
Metabolic acidosis.
Respiratory alkalosis.
Respiratory acidosis.
The Correct Answer is B
Choice A rationale:
Metabolic alkalosis is characterized by a high pH (above 7.45), high bicarbonate (HCO3-) levels, and normal or low PaCO2. The patient's ABGs show a low pH (7.26), low bicarbonate (14 mEq/L), and low PaCO2 (30 mm Hg), which are not consistent with metabolic alkalosis.
Choice C rationale:
Respiratory alkalosis is characterized by a high pH (above 7.45), low PaCO2, and normal or slightly elevated bicarbonate levels. The patient's ABGs do show a low PaCO2, but the pH is low (acidic) and the bicarbonate is low, which are not consistent with respiratory alkalosis.
Choice D rationale:
Respiratory acidosis is characterized by a low pH (below 7.35), high PaCO2, and normal or slightly elevated bicarbonate levels. The patient's ABGs do show a low pH, but the PaCO2 is also low, which is not consistent with respiratory acidosis.
Rationale for the correct answer, B:
Metabolic acidosis is characterized by a low pH (below 7.35), low bicarbonate levels, and normal or low PaCO2. The patient's ABGs are consistent with metabolic acidosis because they show a low pH (7.26), low bicarbonate (14 mEq/L), and low PaCO2 (30 mm Hg).
Acute kidney injury is a common cause of metabolic acidosis. The kidneys play a vital role in regulating acid-base balance by excreting acids and reabsorbing bicarbonate. When the kidneys are damaged, they are unable to excrete acids effectively, leading to an accumulation of acids in the blood and a decrease in bicarbonate levels.
Additional Information:
It's important to note that the patient's low PaCO2 is likely a compensatory mechanism for the metabolic acidosis. In response to acidosis, the respiratory system tries to increase ventilation to blow off more carbon dioxide, which helps to raise the pH. However, this compensatory mechanism is often not enough to fully correct the acidosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice B rationale:
Phlebitis is the inflammation of a vein, often caused by an IV catheter. It's characterized by redness, swelling, warmth, and pain along the vein.
Promptly discontinuing the IV infusion is crucial to prevent further irritation and potential complications such as: Thrombophlebitis (inflammation with clot formation)
Infection
Infiltration (leakage of fluids into surrounding tissues) Extravasation (leakage of vesicant or damaging medications)
Continuing the infusion could exacerbate the inflammation and increase the risk of these complications.
Choice A rationale:
Elevation of the extremity can help reduce swelling, but it does not address the underlying inflammation. It's often used as an adjunct measure after discontinuing the IV.
Choice C rationale:
Warm, moist compresses can provide some comfort and potentially promote blood flow, but they are not recommended as a first-line treatment for phlebitis. They may even worsen inflammation in some cases.
Choice D rationale:
Inserting an IV catheter in the opposite extremity is necessary if the patient still requires IV therapy, but it should not be done before addressing the phlebitis in the current site. This could lead to multiple sites of inflammation and increased risk of complications.
Correct Answer is C
Explanation
Choice A rationale:
Bilateral flank pain is not a typical sign of an allergic blood transfusion reaction. It can be associated with other conditions, such as kidney problems, musculoskeletal issues, or abdominal aortic aneurysm. While it's important to assess flank pain, it doesn't directly suggest an allergic reaction to the transfusion.
Choice B Rationale:
Distended jugular veins can indicate fluid overload, which could potentially occur during a transfusion. However, it's not a specific sign of an allergic reaction. Fluid overload can result from various causes, including heart failure, kidney problems, or excessive fluid intake. It's crucial to monitor for fluid overload during transfusions, but it doesn't definitively point to an allergic reaction.
Choice C Rationale:
Generalized urticaria, or hives, is a hallmark sign of an allergic reaction. It's characterized by raised, red, itchy welts that can appear on various parts of the body. Hives can develop rapidly and spread extensively. During a blood transfusion, generalized urticaria strongly suggests that the patient's immune system is reacting to a component of the transfused blood, such as proteins or antibodies.
Choice D Rationale:
Blood pressure 184/92 mm Hg is elevated and could be concerning, but it's not specific to allergic reactions. High blood pressure can have various causes, including stress, pain, anxiety, or underlying hypertension. While monitoring blood pressure during transfusions is essential, it doesn't directly indicate an allergic reaction.
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