Mrs. Jamerson, who had undergone surgery in the post-anesthesia care unit (PACU), is difficult to arouse two hours following surgery. Nurse Williams in the PACU has been administering Morphine Sulfate intravenously to the client for complaints of post-surgical pain. The client's respiratory rate is 7 per minute and demonstrates shallow breathing. The patient does not respond to any stimuli. The nurse assesses the ABCs (remember Airway, Breathing, Circulation!) and obtains ABGS STAT! Arterial blood gas measurement shows pH 7.10. PaCO2 70 mm Hg, and HCO3 24 mEq/L

What does this mean?

Metabolic Acidosis, Uncompensated

Respiratory Alkalosis. Partially Compensated

Respiratory Acidosis. Uncompensated

Metabolic Alkalosis. Partially Compensated

Answer and Explanation

The Correct Answer is C

A.   Metabolic Acidosis, Uncompensated, is ruled out because the elevated PaCO2 and low pH indicate a respiratory problem rather than a metabolic one.
B.   Respiratory Alkalosis. Partially Compensated is ruled out because the pH and PaCO2 levels are both abnormal and indicate acidosis rather than alkalosis.
C.   The low pH (acidosis) along with the high PaCO2 indicate respiratory acidosis, and there is no evidence of compensation by the kidneys (normal HCO3).
D.   Metabolic Alkalosis. Partially Compensated, is ruled out because the pH is low (acidosis) rather than high (alkalosis), and the PaCO2 is elevated, suggesting a respiratory problem rather than a metabolic one.

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Correct Answer is B

Explanation

A. Respiratory Acidosis, both compensated and uncompensated, is characterized by an elevated PaCO2, which is not present in this case.
B. The elevated pH (7.5) and HCO3 (34 mmol/L) indicate metabolic alkalosis. The elevated pH and the slightly elevated PaCO2 (40 mm Hg) suggest the partially compensated state, which is the respiratory compensation attempting to correct the alkalosis.
C. The fact that the PaCO2 is not low rules out respiratory alkalosis.
D. The arterial blood gas values indicate a high pH (7.5), a normal PaCO2 (40 mm Hg), and an elevated HCO3 (34 mmol/L), which are indicative of metabolic alkalosis. However, the elevated pH and the slightly elevated PaCO2 (40 mm Hg) suggest a partially compensated state.

A. Maintain an IV of 0.45% sodium chloride. B. Administer desmopressin acetate 0.2 mg orally. C. Provide a diet containing 2 g of sodium per day. D. Restrict fluid intake to 1,000 mL per day.

Correct Answer is D

Explanation

A. Infusing hypotonic fluids such as 0.45% sodium chloride can exacerbate hyponatremia in a client with SIADH by further diluting serum sodium levels.
B. Desmopressin acetate is a synthetic form of ADH and would exacerbate the symptoms of SIADH by increasing water reabsorption and further diluting serum sodium levels.
C. Increasing dietary sodium intake would not be appropriate for a client with SIADH, as it would contribute to further fluid retention and exacerbate hyponatremia.
D. Fluid restriction is a key component of managing SIADH to prevent further water retention and dilutional hyponatremia. Restricting fluid intake helps to normalize serum sodium levels by allowing excess water to be excreted.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is B

Explanation

A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) and a sodium level of 123 mEq/L. Which of the following prescriptions should the nurse anticipate?

Correct Answer is D

Explanation

A nurse is assessing a client who had a craniotomy and has developed syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following manifestations should the nurse anticipate?

A nurse is assisting with the care of a client who has metabolic alkalosis. Which of the following actions should the nurse take?

A nurse is planning care for a client who has hypernatremia. Which of the following IV solutions should the nurse plan to initiate?

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A nurse is reviewing the medical records of four clients who have an acid-base imbalance. The nurse should recognize that which of the following clients is at risk for metabolic acidosis?

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