The nurse is caring for a client whose arterial blood gas reveals partially compensated respiratory alkalosis. Which results are consistent with this finding?

Table 9.9 Normal Arterial Blood Gas Values

ABG Value.                                                             Normal Value

pH                                                                             7.35-7.45

PaCO2                                                                                                            35-45 mmHg

HCO3-                                                                         22-26mEq/L

Base excess                                                               -2 to +2

PaO2                                                                            80-95 mmHg

SaO2                                                                            >95%

pH 7.32, Pa02 88 mmHg, PaCO2 50 mmHg, HCO3 29 mEq/L, 02 sat 94%

pH 7.35, Pa02 98 mmHg, PaCO2 55 mmHg, HCO3 28 mEq/L, 02 sat 99%

pH 7.64, PaO2 94 mmHg, PaCO2 23 mmHg, HCO3 14 mEq/L, 02 sat 88%

PH 7.50, Pa02 91 mmHg, PaCO2 52 mmHg, HCO3 30 mEq/L, 02 sat 96%

Answer and Explanation

The Correct Answer is C

A) pH 7.32, PaO2 88 mmHg, PaCO2 50 mmHg, HCO3 29 mEq/L, O2 sat 94%
This result suggests respiratory acidosis rather than respiratory alkalosis. In respiratory acidosis, the pH would be low (acidotic), PaCO2 would be elevated (since it reflects CO2 retention), and HCO3 would typically be elevated as a compensatory mechanism. This set of ABG values does not align with respiratory alkalosis, so it is not consistent with partially compensated respiratory alkalosis.

B) pH 7.35, PaO2 98 mmHg, PaCO2 55 mmHg, HCO3 28 mEq/L, O2 sat 99%
This set of values suggests respiratory acidosis, as indicated by a low pH (acidosis) and high PaCO2 (carbon dioxide retention). The HCO3 value is slightly elevated in compensation for respiratory acidosis, but this is not an example of partially compensated respiratory alkalosis, so it doesn't match the question's requirement.

C) pH 7.64, PaO2 94 mmHg, PaCO2 23 mmHg, HCO3 14 mEq/L, O2 sat 88%
This result is consistent with partially compensated respiratory alkalosis. In respiratory alkalosis, the pH would be elevated (alkalotic), PaCO2 would be low (indicating hyperventilation), and the kidneys would attempt to compensate by lowering bicarbonate (HCO3). In this case, the low PaCO2 (23 mmHg) and the low HCO3 (14 mEq/L) demonstrate partial compensation. The pH is also elevated at 7.64, which aligns with alkalosis. This is the correct answer for partially compensated respiratory alkalosis.

D) pH 7.50, PaO2 91 mmHg, PaCO2 52 mmHg, HCO3 30 mEq/L, O2 sat 96%
This result suggests respiratory acidosis with compensation. The elevated PaCO2 (52 mmHg) indicates CO2 retention, leading to acidosis, while the slightly elevated HCO3 (30 mEq/L) shows that the kidneys are compensating for the respiratory acidosis. The pH of 7.50 is slightly alkalotic, but it is more consistent with compensation for respiratory acidosis rather than respiratory alkalosis. Thus, this set of ABG values does not match the description of partially compensated respiratory alkalosis.

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Correct Answer is D

Explanation

A. Encourage the daily use of the incentive spirometer: While the use of an incentive spirometer is important for improving lung expansion and preventing atelectasis, it may not be effective unless the client’s pain is well-managed. If pain is not addressed first, the client may be unable or unwilling to use the incentive spirometer properly, thus delaying recovery and increasing the risk of respiratory complications.

B. Assisting the client with ambulation in the hallway: Ambulation is an important post-operative activity for improving circulation and preventing complications such as deep vein thrombosis (DVT) or pneumonia. However, the priority at this time should be addressing the client's pain and ensuring adequate breathing before attempting more strenuous activities like ambulation. If the client is in pain and not breathing effectively, ambulation could exacerbate respiratory difficulties..

C. Increasing the chest tube suction to 44 mmHg: Increasing chest tube suction is not indicated unless there is evidence of inadequate drainage or a specific complication, such as a pneumothorax or pleural effusion. In this case, the priority is to address the client’s respiratory function, which is more likely to improve with pain relief, deep breathing, and appropriate positioning. Suctioning should only be adjusted if there is a clinical reason such as signs of a pneumothorax or inadequate drainage, which is not indicated by the information provided.

D. Assessing for adequate pain relief: The most urgent intervention in this scenario is ensuring that the client has adequate pain relief. The client’s shallow respirations and guarding of the operative site suggest that pain is inhibiting effective breathing and deep inspiration, which is crucial for preventing atelectasis and improving ventilation. Pain control is essential in promoting optimal respiratory function, as uncontrolled pain can lead to shallow breathing, reduced lung expansion, and compromised gas exchange, all of which can increase the risk of acute respiratory failure. Once pain is managed, the client will be better able to engage in other respiratory interventions

A. Fluid bolus and IV heparin B. A medical prescription for a stat chest x-ray C. Coronary artery bypass (CABG) surgery if there is no improvement in 12 hours D. Repeat PCI with thrombectomy or angioplasty

Correct Answer is D

Explanation

A) Fluid bolus and IV heparin:
A fluid bolus and IV heparin may be used in certain cardiovascular conditions, such as hypotension or in the setting of acute coronary syndrome (ACS) to prevent clot formation. However, in this case, the client is experiencing chest pain with ST segment elevations, a sign of ongoing ischemia, which suggests that the problem may be related to inadequate blood flow to the heart. Fluid boluses could exacerbate the condition if the heart's function is compromised, and IV heparin alone would not address the root cause of the ischemia. Hence, this is not the most appropriate intervention at this time.

B) A medical prescription for a stat chest x-ray:
A chest x-ray would not be immediately indicated in this scenario. The client's symptoms of chest pain, diaphoresis, and ST segment elevations on the ECG are indicative of myocardial ischemia or infarction, not a respiratory or structural lung issue that would be visualized on an x-ray. The priority here is to address the myocardial ischemia, which could be due to a clot or reocclusion in the coronary artery. A stat chest x-ray would not address the underlying cardiac issue, so this is not the best choice.

C) Coronary artery bypass (CABG) surgery if there is no improvement in 12 hours:
While CABG is an option for clients with severe coronary artery disease, it is generally considered when PCI is not successful or when there are multiple blockages that cannot be stented. In this situation, since the client has just undergone PCI and is now experiencing signs of reocclusion (e.g., chest pain, ST segment elevations), a repeat PCI with thrombectomy or angioplasty is more appropriate and urgent. Waiting 12 hours would delay treatment and risk further myocardial damage. CABG would not be the first intervention after a failed PCI within hours of the procedure.

D) Repeat PCI with thrombectomy or angioplasty:
This is the most appropriate intervention. The client's symptoms (chest pain, diaphoresis, and ST segment elevations) are suggestive of reocclusion of the stented artery, a complication that can occur after PCI. Reocclusion can cause further myocardial ischemia and infarction. A repeat PCI with thrombectomy or angioplasty would aim to reopen the blocked artery and restore blood flow to the myocardium, which is the immediate priority in this situation. This intervention can help resolve the ischemia and prevent further damage to the heart muscle.

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Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

Correct Answer is D

Explanation

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