Mr. Casper, a 55-year-old patient with Gastroesophageal Reflux Disease (GERD), consumes about 16 Tums antacid tablets daily. An Arterial Blood Gas (ABG) test is conducted to evaluate his acid/base balance. The results are as follows: pH 7.46, CO2 46, PO2 86, HCO3 29, SaO2 97%. What is the interpretation of these results?

Uncompensated Respiratory Acidosis

Compensated Metabolic Acidosis

Partially Compensated Metabolic Alkalosis

Partially Compensated Respiratory Acidosis

Answer and Explanation

The Correct Answer is C

Choice A rationale:
Uncompensated Respiratory Acidosis is characterized by a low pH (less than 7.35) and a high pCO2 (greater than 45 mmHg). In this case, the pH is slightly elevated (7.46), making this option less likely.
While the pCO2 is elevated (46 mmHg), the body has begun to compensate, as evidenced by the elevated HCO3 (29 mEq/L). This partial compensation does not align with an uncompensated respiratory acidosis.
Choice B rationale:
Compensated Metabolic Acidosis would present with a normal pH (7.35-7.45) due to full compensation by the respiratory system. In this case, the pH is slightly elevated (7.46), which is not consistent with full compensation.
Additionally, the HCO3 is elevated (29 mEq/L), which is characteristic of metabolic alkalosis, not acidosis.
Choice C rationale:
Partially Compensated Metabolic Alkalosis is the most likely interpretation based on the ABG results. The pH is elevated (7.46), indicating alkalosis.
The HCO3 is also elevated (29 mEq/L), which is the primary cause of metabolic alkalosis.
The pCO2 is elevated (46 mmHg), which is a compensatory mechanism to try to normalize the pH. However, the compensation is not complete, as the pH is still slightly elevated.
This partial compensation is consistent with partially compensated metabolic alkalosis.
Choice D rationale:
Partially Compensated Respiratory Acidosis would present with a low pH (less than 7.35) and an elevated pCO2 (greater than 45 mmHg).
The HCO3 would also be elevated, but to a lesser degree than in metabolic alkalosis, as it's a secondary compensatory mechanism.
In this case, the pH is slightly elevated (7.46), making respiratory acidosis less likely.

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Correct Answer is C

Explanation

Step 1: Divide the prescribed dose (40 mg) by the concentration on hand (30 mg/mL).

Step 2: Perform the calculation: 40 mg ÷ 30 mg/mL = 1.3333 mL.

Step 3: Round the answer to the nearest tenth: 1.3333 mL rounds to 1.3 mL.

A. Assess the patient’s adherence to the drug regimen. B. Inquire about the patient’s recent travel to foreign countries. C. Determine if the patient has any new sexual partners. D. Request information about changes in the patient’s living conditions or pets.

Correct Answer is A

Explanation

Choice A rationale:

Assessing the patient's adherence to the drug regimen is the most crucial first step in this situation. Here's a comprehensive explanation:

1. Significance of Adherence in HIV Treatment:

Viral Suppression and Disease Progression: Adherence to antiretroviral therapy (ART) is paramount in HIV management. It directly impacts viral suppression, preventing disease progression, and reducing the risk of opportunistic infections and complications. Non-adherence can lead to viral rebound, increased viral load, and potential disease advancement.

Primary Cause of Treatment Failure: Suboptimal adherence is the leading cause of treatment failure in HIV patients. It can result in:

Reduced effectiveness of ART Development of drug resistance Increased healthcare costs Increased risk of transmission

2. Rationale for Prioritizing Adherence Assessment:

Direct Link to Viral Load and Health Status: A sudden decline in health status and a significant increase in viral load strongly suggest potential non-adherence. Assessing adherence early on can:

Identify the root cause of the clinical deterioration

Inform timely interventions to address adherence barriers Prevent further complications

3. Assessing Adherence Thoroughly:

Non-Judgmental Approach: Creating a supportive and non-judgmental environment is essential for honest and accurate assessment.

Open-Ended Questions: Utilize open-ended questions to explore potential challenges and barriers to adherence, such as: Difficulties with medication schedules

Side effects Financial constraints Forgetfulness

Mental health concerns Substance abuse

Lack of social support

Objective Measures: Complement patient reports with objective measures like:

Pill counts

Pharmacy refill records

Medication Event Monitoring Systems (MEMS)

4. Addressing Adherence Barriers:

Tailored Interventions: Based on the assessment findings, develop individualized strategies to enhance adherence, such as: Simplifying medication regimens

Addressing side effects

Providing medication reminders

Offering counseling and support services

Connecting patients with resources

5. Reassessing and Monitoring:

Continuous Evaluation: Regularly reassess adherence and viral load to ensure treatment effectiveness and make adjustments as needed.

Conclusion:

While other options (B, C, D) may provide valuable information, prioritizing adherence assessment is critical to promptly identify and address potential adherence issues, optimize treatment outcomes, and prevent further health decline in HIV patients experiencing viral rebound.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

You are instructed to administer 40 mg of methadone (Dolophine) subcutaneously for opioid detoxification. Given that you have a concentration of 30 mg/mL on hand, how much should you draw into the syringe?

Correct Answer is C

Explanation

A patient with HIV-1 has experienced a sudden decline in health status accompanied by a significant increase in viral load. What is the first action the nurse should take?

Correct Answer is A

Explanation

A client has urinary incontinence. Which assessment finding indicates that outcomes for a priority nursing diagnosis have been met?

The nurse caring for patients admitted for infectious diseases understands what information about emerging global diseases and bioterrorism?

A nurse is providing care for four patients. Which patient should the nurse evaluate first for cognitive impairment?

A nurse is caring for several clients in the morning prior to surgery. Which medications taken by the clients necessitate a consultation with the primary health care provider regarding their administration? (Select all that apply.)

A nurse is educating a client who is prescribed a central vascular access device and is transferring to a skilled facility for long-term treatment. Which statement should the nurse include in this client’s teaching?

A postoperative client vomited. After cleaning and comforting the client, which action by the nurse is most important?

A nurse studying infection control learns that which factor is the most effective and crucial barrier to infection?

A patient diagnosed with HIV-II is admitted to the hospital presenting symptoms of fever, night sweats, and a severe cough. The laboratory results show a CD4+ cell count of 180/mm and a negative tuberculosis (TB) skin test conducted 4 days prior. What is the first action the nurse should take?