Nutrition ABGs and Fluid Balance

Front

A 68-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents with shortness of breath and lethargy. Arterial blood gas (ABG) results show pH 7.28, PaCO₂ 58 mmHg, and HCO₃⁻ 24 mEq/L. Which condition is the most likely cause of these findings? Options: Hyperventilation due to anxiety, Hypoventilation due to chronic lung disease, Metabolic acidosis from kidney failure, Respiratory alkalosis from fever

Back

Hypoventilation due to chronic lung disease

Answer explanation

The ABG results show respiratory acidosis (low pH, high PaCO₂) with normal HCO₃⁻, indicating hypoventilation. This is consistent with the patient's COPD, which impairs gas exchange and leads to CO₂ retention.

Front

The nurse is caring for a patient with acute respiratory acidosis. Which symptoms would the nurse most likely observe?

Back

Confusion, lethargy, and rapid, shallow breathing

Answer explanation

In acute respiratory acidosis, confusion, lethargy, and rapid, shallow breathing are common due to increased carbon dioxide levels affecting the central nervous system. This choice best reflects the expected symptoms.

Front

A patient with a history of asthma is admitted with an exacerbation. Arterial blood gas results indicate respiratory acidosis. What is the priority intervention?

Back

Administer a bronchodilator as prescribed.

Answer explanation

Administering a bronchodilator is the priority intervention for a patient with asthma exacerbation and respiratory acidosis, as it helps to open the airways, improve ventilation, and correct the acidosis. Pursed-lip breathing is helpful but not as immediate as medication. Sodium bicarbonate is not a primary treatment for respiratory acidosis.

Front

A patient’s ABG results are pH 7.33, PaCO₂ 55 mmHg, and HCO₃⁻ 30 mEq/L. The nurse recognizes that these values indicate:

Back

Partially compensated respiratory acidosis

Answer explanation

The pH of 7.33 indicates acidosis. The elevated PaCO₂ of 55 mmHg confirms respiratory acidosis. The HCO₃⁻ of 30 mEq/L shows partial compensation. The elevated HCO₃⁻ suggests renal compensation is occurring but not complete since the pH is not yet normalized, making the correct choice 'Partially compensated respiratory acidosis'.

Front

The nurse is teaching a patient with obstructive sleep apnea about preventing respiratory acidosis. Which statement by the patient indicates the need for further teaching?
“I can skip using my CPAP machine if I feel fine.”

Back

The patient needs further teaching if they believe they can skip using their CPAP machine.

Answer explanation

The statement "I can skip using my CPAP machine if I feel fine" indicates a lack of understanding. CPAP is essential to prevent hypoventilation and CO₂ retention in patients with obstructive sleep apnea. Skipping CPAP increases the risk of respiratory acidosis. The CPAP is necessary for managing obstructive sleep apnea and preventing respiratory acidosis, regardless of how the patient feels.

Front

A patient is admitted with suspected metabolic acidosis. Which arterial blood gas (ABG) values would the nurse expect to see? Options: pH 7.50, PaCO₂ 30 mmHg, HCO₃⁻ 20 mEq/L; pH 7.30, PaCO₂ 40 mmHg, HCO₃⁻ 18 mEq/L; pH 7.45, PaCO₂ 38 mmHg, HCO₃⁻ 24 mEq/L; pH 7.20, PaCO₂ 60 mmHg, HCO₃⁻ 35 mEq/L

Back

pH 7.30, PaCO₂ 40 mmHg, HCO₃⁻ 18 mEq/L

Answer explanation

Metabolic acidosis is characterized by a low pH (<7.35) and low bicarbonate levels (<22 mEq/L). Option 2 shows these findings.

Front

A patient with diabetic ketoacidosis (DKA) is at risk for metabolic acidosis. Which symptom is most consistent with this condition? Slow, shallow respirations; Hypertension; Bradypnea with pauses; Kussmaul respirations

Back

Kussmaul respirations

Answer explanation

Kussmaul respirations are deep, labored breaths that occur in response to metabolic acidosis, such as in diabetic ketoacidosis (DKA). This compensatory mechanism helps to blow off excess carbon dioxide, correcting the acidosis.

Front

The nurse is caring for a patient with chronic kidney disease (CKD) who develops metabolic acidosis. Which intervention is the priority?

Back

Administering sodium bicarbonate as prescribed

Answer explanation

Administering sodium bicarbonate is the priority intervention for metabolic acidosis in CKD, as it helps to neutralize excess acid and restore pH balance, which is critical for the patient's stability.

Front

A patient with sepsis is diagnosed with metabolic acidosis. What is the underlying mechanism causing this condition?

Back

Increased lactic acid production

Answer explanation

In sepsis, increased lactic acid production occurs due to tissue hypoperfusion and hypoxia, leading to metabolic acidosis. This is the primary mechanism, unlike the other options which do not directly cause this condition.

Front

Avery, a medical student, is reviewing a patient's laboratory results. Which laboratory finding is most indicative of metabolic acidosis? Options: pH of 7.48, Serum potassium level of 5.8 mEq/L, Decreased anion gap, Elevated serum bicarbonate

Back

Serum potassium level of 5.8 mEq/L

Answer explanation

A serum potassium level of 5.8 mEq/L indicates hyperkalemia, which can occur in metabolic acidosis due to shifts in potassium. The other options suggest alkalosis or normal findings, not acidosis.