The nurse is reviewing the client's following arterial blood gases: pH 7.33, PaCo2 47, HCO3 24. Which manifestation would the nurse expect the client to be experiencing with this imbalance?

Confusion

Kussmaul's Respirations

Seizures

Paresthesia in the extremities

Answer and Explanation

The Correct Answer is A

A. Confusion: Respiratory acidosis (low pH + high PaCO2) leads to decreased oxygenation of brain tissues, causing confusion, drowsiness, and lethargy.

B. Kussmaul's Respirations: Seen in metabolic acidosis, not respiratory acidosis.

C. Seizures: Seizures are more common with alkalosis (high pH) due to neuronal excitability.

D. Paresthesia in the Extremities: More common in respiratory alkalosis due to calcium shifts.

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Correct Answer is B

Explanation

A. Fluid will be pushed into the interstitial spaces. Hypertonic solutions draw water into the bloodstream, not into tissues.

B. Fluid will be pulled out of the cells and into the bloodstream: Hypertonic solutions (e.g., 3% NaCl, D10W) have a higher osmolarity than blood plasma. This pulls fluid from cells into the intravascular space, causing cell shrinkage and increasing blood volume.

C. Fluid will be pushed out of the bloodstream into extravascular spaces. This describes a hypotonic solution’s effect.

D. Fluid will be pulled out of the bloodstream into the cells. This describes an isotonic or hypotonic effect.

A. Respiratory Acidosis B. Metabolic Alkalosis C. Respiratory Alkalosis D. Metabolic acidosis

Correct Answer is D

Explanation

A. Respiratory Acidosis: Respiratory acidosis results from inadequate ventilation leading to CO₂ retention, which is unrelated to kidney failure.

B. Metabolic Alkalosis: Metabolic alkalosis occurs due to excessive loss of acids (e.g., vomiting) or excess bicarbonate intake. Acute renal failure causes acid retention, not loss.

C. Respiratory Alkalosis: Respiratory alkalosis is caused by hyperventilation and excessive CO₂ loss, not renal dysfunction.

D. Metabolic acidosis: The kidneys play a vital role in acid-base balance by excreting hydrogen ions and reabsorbing bicarbonate. Acute renal failure impairs these functions, leading to acid retention and metabolic acidosis.

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