NUR 425 CC Exam 2 Prediction Questions – COMPLETE SOLUTION

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NUR 425 CC Exam 2 Prediction Questions – COMPLETE SOLUTION Which of the following is the body's first line of defense against an acid-base imbalance? A) Respiratory buffers B) Chemical and prote... in buffers C) Renal buffers D) Ventricular buffers - ✔✔B In regards to acid-base imbalance, what does "compensation" mean? - ✔✔It is the body's attempt to correct the acid-base imbalance Which of the following places a patient at risk for a state of acidosis? (SELECT ALL THAT APPLY) a. A patient with severe anxiety b. A patient rescued from a drowning c. A patient who consumed an entire bottle of Tums d. A patient with severe diarrhea e. A patient with kidney failure - ✔✔B,D,E In general, respiratory alkalosis is due to what? - ✔✔Breathing too quickly and/ or deeply Which of the following values is associated with "alkalosis"? (SELECT ALL THAT APPLY) a. ph: 7.5 b. CO2: 30 c. HCO3: 20 d. CO2: 45 e. HCO3: 45 - ✔✔A,B,EHow will the kidneys compensate if for a patient in respiratory acidosis - ✔✔the kidneys will retain HCO3 and/or excrete H+ to inc the pH How will the kidneys compensate if for a patient in respiratory alkalosis - ✔✔the kidneys will excrete HCO3 and/or excrete H+ to dec the pH How will the lungs compensate if for a patient in metabolic alkalosis - ✔✔the lungs will dec breathing rate/ depth to retain CO2 to dec the pH How will the lungs compensate if for a patient in metabolic acidosis - ✔✔the lungs will inc breathing rate/ depth to blow off more CO2 to inc the pH potential causes for: respiratory acidosis - ✔✔opioid OD, pulmonary embolism, brainstem injury inhibiting respiratory drive, oversedation potential causes for: respiratory alkalosis - ✔✔extreme anxiety, initial response to hypoxia, severe pain, high altitude potential causes for: metabolic acidosis - ✔✔shock (lactic acid), DKA, untreated chronic kidney disease, diarrhea potential causes for: metabolic alkalosis - ✔✔vomiting, thiazide or loop diuretics, antacid OD, constant NGT suctioning Interpret this ABG: pH 7.24 PaCO2 50 HCO3 25 - ✔✔uncompensated respiratory acidosisWhen we see that a PaCO2 is high >45, what is happening in the body to cause this? - ✔✔The patient is breathing slow and/or shallow --A high PaCO2 level means that the patient is breathing slow and/or shallow. They are hypoventilating. Something is wrong with the patient's ability to breath effectively to blow off adequate amounts of CO2 that it should. Interpret this ABG: pH 7.49 PaCO2 30 HCO3 24 - ✔✔uncompensated respirator alkalosis When we see that a PaCO2 is low <35, what is happening in the body to cause this? - ✔✔The patient is breathing fast and/or deep. --When the patient has a low CO2 level <35, the patient is breathing faster and/or deeper to blow off extra CO2. This is hyperventilation. Although we can see this with extreme fear and anxiety, we can also see it in earlier compensatory states where a patient is trying to breath deeper and faster because they feel like they are not getting enough oxygen - such as in early stages of hypoxia. Interpret this ABG: pH 7.52 PaCO2 38 HCO3 30 - ✔✔uncompensated metabolic alkalosis When we see that a HCO3 is low <22, what is happening in the body to cause this? - ✔✔The kidney's are excreting too much HCO3 --When you see on an ABG that the HCO3 is < 22, that means that the kidney's are excreting more HCO3 than usual or retaining extra H+. This can occur with disturbances such as shock, renal failure, DKA, or even severe diarrhea. The body will also hold onto extra H+ and/or excrete more HCO3 to compensate when it senses that there is not enough acid in the body (too alkalotic). Interpret this ABG: pH 7.31PaCO2 38 HCO3 20 - ✔✔uncompensated metabolic acidosis interpret the ABG: pH 7.13 PaCO2 57 HCO3 18 - ✔✔mixed acidosis interpret the ABG: pH 7.60 PaCO2 30 HCO3 32 - ✔✔mixed alkalosis interpret the ABG: pH 7.54 PaCO2 22 HCO3 12 - ✔✔partially comp. resp alkalosis interpret the ABG: pH 7.18 PaCO2 28 HCO3 16 - ✔✔partially comp met acidosis interpret the ABG: pH 7.28 PaCO2 53 HCO3 31 - ✔✔partially comp resp acidosis interpret the ABG: pH 7.65 PaCO2 88 HCO3 41 - ✔✔partially comp met alkalosis interpret the ABG: pH 7.35 PaCO2 48 HCO3 30 - ✔✔fully comp resp acidosis interpret the ABG: pH 7.44 PaCO2 33 HCO3 18 - ✔✔fully comp resp alkalosis interpret the ABG:pH 7.36 PaCO2 30 HCO3 14 - ✔✔fully comp met acidosis interpret the ABG: pH 7.43 PaCO2 50 HCO3 31 - ✔✔fully comp met alkalosis ABG reads: pH: 7.28 PaCO2: 52 HCO3: 25 - ✔✔uncompensated respiratory acidosis -7.28 is out of normal range -> not "fully compensated" by kidneys because... HCO3 is normal -> didn't try to compensate ABG reads: pH: 7.50 PaCO2: 38 HCO3: 28 - ✔✔uncompensated metabolic alkalosis -7.50 is out of normal range -> not "fully compensated" by lungs because... CO2 is normal -> didn't try to compensate PH 7.14 PaCO2 51 HCO3 24 - ✔✔uncompensated respiratory acidosis PH 7.21 PaCO2 40 HCO3 16 - ✔✔uncompensated metabolic acidosis PH 7.50PaCO2 30 HCO3 25 - ✔✔uncompensated respiratory alkalosis PH 7.61 PaCO2 40 HCO3 42 - ✔✔uncompensated metabolic alkalosis PH 7.68 PaCO2 24 HCO3 36 - ✔✔mixed alkalosis PH 7.11 PaCO2 58 HCO3 18 - ✔✔mixed acidosis PH 7.62 PaCO2 30 HCO3 30 - ✔✔mixed alkalosis PH 7.51 PaCO2 26 HCO3 32 - ✔✔mixed alkalosis PH 7.28 PaCO2 53 HCO3 31 - ✔✔partially compensated respiratory acidosis PH 7.55PaCO2 21 HCO3 10 - ✔✔partially compensated respiratory alkalosis PH 7.14 PaCO2 27 HCO3 14 - ✔✔partially compensated metabolic acidosis PH 7.65 PaCO2 88 HCO3 41 - ✔✔partially compensated metabolic alkalosis pH = 7.35 PaCO2 = 48 HCO3 =30 - ✔✔fully comp respiratory acidosis pH = 7.44 PaCO2 = 33 HCO3 = 18 - ✔✔fully comp respiratory alkalosis pH = 7.36 PaCO2 = 30 HCO3 = 14 - ✔✔fully comp metabolic acidosis pH = 7.43 PaCO2 = 50 HCO3 = 31 - ✔✔fully comp metabolic alkalosis pH: 7.25PaCO2: 60 PaHCO3: 24 -----> pH: 7.25 PaCO2: 60 PaHCO3: 30 -----> pH: 7.36 PaCO2: 60 PaHCO3: 30 - ✔✔uncompensated respiratory acidosis-> partially comp respiratory acidosis-> fully comp respiratory acidosis pH = 7.31 PaCO2 = 55 HCO3 =30 - ✔✔partially compensated resp acidosis pH = 7.52 PaCO2 = 33 HCO3 = 30 - ✔✔mixed alkalosis pH = 7.22 PaCO2 = 25 HCO3 = 12 - ✔✔partially comp metabolic acidosis pH = 7.12 PaCO2 = 50 HCO3 = 31 - ✔✔partially compensated respiratory acidosis pH: 7.44PaCO2: 24 HCO3: 16 - ✔✔fully compensated respiratory alkalosis pH: 7.38 PaCO2: 76 HCO3: 42 - ✔✔fully compensated respiratory acidosis pH: 7.56 PaCO2: 44 HCO3: 38 - ✔✔uncompensated metabolic alkalosis pH: 7.26 PaCO2: 56 HCO3: 25 - ✔✔uncompensated respiratory acidosis pH: 7.56 PaCO2: 40 HCO3: 34 - ✔✔Uncompensated Metabolic Alkalosis 80 yo with heart disease. RX: diuretic ABGs: pH: 7.58, PaCO2: 48mmHg HCO3-: 44 mEq/L BE: + 19 mEq/L Serum CL- 95 mE - ✔✔partially compensated metabolic alkalosis Mild cyanosis and labored breathing. ABGs: pH: 7.44, PaCO2: 26 mmHg, HCO3-: 17 mEq/L, PaO2: 53 mmHg - ✔✔fully compensated respiratory alkalosisHx/Dx: 77yo, anxiety, psychosomatic origin. Rapid breathing and slurred speech. ABGs: pH: 7.57, PaCO2: 23 mmHg, HCO3-: 21 mEq/L - ✔✔partially compensated respiratory alkalosis Hx/Dx: 73yo, emphysema, labored breathing at rest. ABGs: pH: 7.36, PaCO2: 64 mmHg, HCO3-: 35 mEq/L - ✔✔fully compensated respiratory acidosis Dx - heroin overdose.Breathing - shallow, slow. ABGs: pH: 7.30, PaCO2: 55 mm/Hg, HCO3-: 27 mEq/L - ✔✔partially compensated respiratory acidosis Your patient in the ICU has a diagnosis of pneumonia and presents with the following ABG. She is currently receiving 4L O2 via nasal cannula and laying down in bed. pH=7.33 CO2=47 HCO3=25 PaO2=82 Which collaborative action is most appropriate? 1.Increase the oxygen flow rate 2.Sit her up in bed 3.Administer midazolam IV 4.Assist her in ambulating around the unit - ✔✔2 Your patient has just arrived to the ED on RA after being "found down." The team suspects sepsis. ABG: pH=7.29 CO2=50 HCO3=18 PaO2=78 Vital signs: RR=8, HR=50, BP=80/45, T=36C, SaO2=90% Which collaborative actions are indicated (select all that apply)? 1.Administer sodium bicarbonate2.Administer midazolam IV 3.Administer metoprolol 4.Assist her in ambulating around the unit 5.Place the patient on CPAP mask 6.Administer norepinephrine - ✔✔1,5,6 mixed acidosis Your patient in the med-surg unit is awaiting a bilateral above the knee amputation and presents with the following. ABG: pH=7.49 CO2=30 HCO3=24 PaO2=98 Vital signs: RR=28, HR=115, BP=140/95, T=37C, SaO2=99% What problem does the nurse suspect? 1.The patient is anxious about the upcoming surgery 2.The patient no longer needs surgery 3.The patient has been given too much oxygen prior to surgery 4.The patient is not stable enough to have surgery - ✔✔1 uncompensated resp alkalosis Which condition could have caused this ABG disturbance and what should be done? ABG: pH=7.50, CO2=30, HCO3=28, PaO2=95 1.Code blue, the patient needs vasopressors and mechanical ventilation 2.Anxiety and vomiting, antiemetic and talk with the patient about what is bothering her 3.Opioid overdose and shock, the patient needs narcan and vasopressors 4.Myocardial infarction at high altitude: the patient needs oxygen and a cardiac catheterization - ✔✔2 mixed alkalosiswhat is ventilation? - ✔✔movement of air into the alveoli what is oxygenation? - ✔✔movement of oxygen from alveoli to blood what is perfusion? - ✔✔transportation of blood to alveoli [Show More]

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