A nurse is reviewing the laboratory results of a client who has DKA. The client's ABG results are pH 7.30, PaCO2 34 mm Hg and HCO3 21 mEq/L. The nurse should identify that these values indicate which of the following acid-base imbalances?

Respiratory alkalosis

Metabolic alkalosis

Metabolic acidosis

Respiratory acidosis

Answer and Explanation

The Correct Answer is C

A.   Respiratory alkalosis: This condition is characterized by low levels of carbon dioxide
(PaCO2) in the blood and an elevated pH. The ABG results in DKA show a low pH, ruling out respiratory alkalosis.
B.   Metabolic alkalosis: Metabolic alkalosis is characterized by high bicarbonate (HCO3) levels and an elevated pH. The ABG results in DKA show low bicarbonate levels, ruling out metabolic alkalosis.
C.   Metabolic acidosis: Metabolic acidosis is characterized by low pH and low bicarbonate (HCO3) levels. The ABG results in DKA demonstrate both low pH and low bicarbonate levels, consistent with metabolic acidosis.
D.   Respiratory acidosis: Respiratory acidosis is characterized by high carbon dioxide (PaCO2) levels and low pH. The ABG results in DKA show a normal or slightly decreased PaCO2, ruling out respiratory acidosis.

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Correct Answer is A

Explanation

A. Documenting the client's respiratory rate in 1 hour is within the scope of practice for an assistive personnel (AP) and does not require nursing judgment or assessment.
B. Monitoring the client for an allergic reaction for 30 minutes requires nursing judgment and assessment skills to recognize signs and symptoms of allergic reactions.
C. Checking the client's response to the medication in 1 hour requires nursing judgment and assessment skills to evaluate pain relief and any adverse effects.
D. Evaluating the client for therapeutic effects in 30 minutes requires nursing judgment and assessment skills to determine the effectiveness of the pain medication.

A. The client's foot feels cooler than in the previous assessment. B. The client's pedal pulse in the right foot is not palpable. C. The client's capillary refill time is 5 seconds in the toes. D. The client reports a pain level of 8 on a scale from 0 to 10.

Correct Answer is B

Explanation

A. While a cooler foot than in the previous assessment may indicate decreased perfusion, the absence of a palpable pedal pulse is a more significant finding as it suggests compromised arterial blood flow to the foot.
B. The absence of a palpable pedal pulse indicates diminished arterial blood flow to the foot, which is a critical finding following a femoropopliteal bypass graft. It suggests potential complications such as graft occlusion or inadequate blood flow distal to the graft site.
C. Capillary refill time of 5 seconds in the toes may indicate delayed capillary refill, which could be a concern but is not as immediately critical as the absence of a palpable pedal pulse.

D. While pain is an important assessment finding, a pain level of 8 on a scale from 0 to 10 is subjective and does not provide specific information about the client's vascular status. Pain assessment should be considered along with other objective findings.

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A nurse is reviewing the laboratory results of a client who has DKA. The client's ABG results are pH 7.30, PaCO2 34 mm Hg and HCO3 21 mEq/L. The nurse should identify that these values indicate which of the following acid-base imbalances?

Nursing Test Bank

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