ABG ANALYSIS NCLEX EXAM 1

S - The Marketplace to Buy and Sell your Study Material ABG ANALYSIS NCLEX EXAM 1 1. George Kent is a 54 year old widower with a history of chronic obstructive pulmonary disease and was rushed to the emergency department with increasing shortness of breath, pyrexia, and a productive cough with yellow-green sputum. He has difficulty in communicating because of his inability to complete a sentence. One of his sons, Jacob, says he has been unwell for three days. Upon examination, crackles and wheezes can be heard in the lower lobes; he has a tachycardia and a bounding pulse. Measurement of arterial blood gas shows pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L, and PaO2 60 mm Hg. How would you interpret this? A. Respiratory Acidosis, Uncompensated B. Respiratory Acidosis, Partially Compensated C. Metabolic Alkalosis, Uncompensated D. Metabolic Acidosis, Partially Compensated 2. Carl, an elementary student, was rushed to the hospital due to vomiting and a decreased level of consciousness. The patient displays slow and deep (Kussmaul breathing), and he is lethargic and irritable in response to stimulation. He appears to be dehydrated—his eyes are sunken and mucous membranes are dry—and he has a two week history of polydipsia, polyuria, and weight loss. Measurement of arterial blood gas shows pH 7.0, PaO2 90 mm Hg, PaCO2 23 mm Hg, and HCO3 12 mmol/L; other results are Na+ 126 mmol/L, K+ 5 mmol/L, and Cl- 95 mmol/L. What is your assessment? A. Respiratory Acidosis, Uncompensated B. Respiratory Acidosis, Partially Compensated C. Metabolic Alkalosis, Uncompensated D. Metabolic Acidosis, Partially, Compensated 3. A cigarette vendor was brought to the emergency department of a hospital after she fell into the ground and hurt her left leg. She is noted to be tachycardic and tachypneic. Painkillers were carried out to lessen her pain. Suddenly, she started complaining that she is still in pain and now experiencing muscle cramps, tingling, and paraesthesia. Measurement of arterial blood gas reveals pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm Hg, and HCO3 25 mmol/L. What does this mean? A. Respiratory Alkalosis, Uncompensated B. Respiratory Acidosis, Partially Compensated C. Metabolic Alkalosis, Uncompensated D. Metabolic Alkalosis, Partially Compensated 4. Ricky’s grandmother is suffering from persistent vomiting for two days now. She appears to be lethargic and weak and has myalgia. She is noted to have dry mucus membranes and her capillary refill takes >4 seconds. She is diagnosed as having gastroenteritis and dehydration. Measurement of arterial blood gas shows pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L. What acid-base disorder is shown? A. Respiratory Alkalosis, Uncompensated B. Respiratory Acidosis, Partially Compensated C. Metabolic Alkalosis, Uncompensated D. Metabolic Alkalosis, Partially Compensated 5. Mrs. Johansson, who had undergone surgery in the post-anesthesia care unit (PACU), is difficult to arouse two hours following surgery. Nurse Florence 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! Measurement of arterial blood gas shows pH 7.10, PaCO2 70 mm Hg and HCO3 24 mEq/L. What does this mean? A. Respiratory Alkalosis, Partially Compensated B. Respiratory Acidosis, Uncompensated C. Metabolic Alkalosis, Partially Compensated D. Metabolic Acidosis, Uncompensated 6. Baby Angela was rushed to the Emergency Room following her mother’s complaint that the infant has been irritable, difficult to breastfeed and has had Downloaded by: Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material This study source was downloaded by from CourseH on 10-30-2d0i2a1r1r3h:5e4a:22foGrMtThe-05p:0a0st 3 days. The Downloaded by: Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material rate is elevated and the fontanels are sunken. The Emergency Room physician orders ABGs after assessing the ABCs. The results from the ABG results show pH 7.39, PaCO2 27 mmHg and HCO3 19 mEq/L. What does this mean? A. Respiratory Alkalosis, Fully Compensated B. Metabolic Acidosis, Uncompensated C. Metabolic Acidosis, Fully Compensated D. Respiratory Acidosis, Uncompensated 7. Mr. Wales, who underwent post-abdominal surgery, has a nasogastric tube. The nurse on duty notes that the nasogastric tube (NGT) is draining a large amount (900 cc in 2 hours) of coffee ground secretions. The client is not oriented to person, place, or time. The nurse contacts the attending physician and STAT ABGs are ordered. The results from the ABGs show pH 7.57, PaCO2 37 mmHg and HCO3 30 mEq/L. What is your assessment? A. Metabolic Acidosis, Uncompensated B. Metabolic Alkalosis, Uncompensated C. Respiratory Alkalosis, Uncompensated D. Metabolic Alkalosis, Partially Compensated 8. Client Z is admitted to the hospital and is to undergo brain surgery. The client is very anxious and scared of the upcoming surgery. He begins to hyperventilate and becomes very dizzy. The client loses consciousness and the STAT ABGs reveal pH 7.61, PaCO2 22 mmHg and HCO3 25 mEq/L. What is the ABG interpretation based on the findings? A. Metabolic Acidosis, Uncompensated B. Respiratory Alkalosis, Partially Compensated C. Respiratory Alkalosis, Uncompensated D. Metabolic Alkalosis, Partially Compensated 9. Three-year-old Adrian is admitted to the hospital with a diagnosis of asthma and respiratory distress syndrome. The mother of the child reports to the nurse on duty that she has witnessed slight tremors and behavioral changes in her child over the past four are pH 7.35, PaCO2 72 mmHg and HCO3 38 mEq/L. What acid-base disorder is shown? A. Respiratory Acidosis, Uncompensated B. Respiratory Acidosis, Fully Compensated C. Respiratory Alkalosis, Fully Compensated D. Metabolic Alkalosis, Partially Compensated 10. Anne, who is drinking beer at a party, falls and hits her head on the ground. Her friend Liza dials “911” because Anne is unconscious, depressed ventilation (shallow and slow respirations), rapid heart rate, and is profusely bleeding from both ears. Which primary acid-base imbalance is Anne at risk for if medical attention is not provided? A. Metabolic Acidosis B. Metabolic Alkalosis C. Respiratory Acidosis D. Respiratory Alkalosis Answers and Rationale: 1. Answer: B. Respiratory Acidosis, Partially Compensated The patient has respiratory acidosis (raised carbon dioxide) resulting from an acute exacerbation of chronic obstructive pulmonary disease, with partial compensation. 2. Answer: D. Metabolic Acidosis, Partially, Compensated The student was diagnosed having diabetes mellitus. The results show that he has metabolic acidosis (low HCO3 -) with respiratory compensation (low CO2). 3. Answer: A. Respiratory Alkalosis, Uncompensated The primary disorder is acute respiratory alkalosis (low CO2) due to the pain and anxiety causing her to hyperventilate. There has not been time for metabolic compensation. 4. Answer: C. Metabolic Alkalosis, Uncompensated days. The attending physician orders routine ABGs Thfoislslotuwdyinsoguracenwaassdsoewsnslomadeendtbyo1f0t0h00e08A1B79C3s6.68T7hferomABCGourrseeH on :54:22 GMT -05:00 Downloaded by: Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material The primary disorder is uncompensated metabolic alkalosis (high HCO3 -). As CO2 is the strongest driver of respiration, it generally will not allow hypoventilation as compensation for metabolic alkalosis. 5. Answer: B. Respiratory Acidosis, Uncompensated The results show that Mrs. Johansson has respiratory acidosis because of decreased pH and increased PaCO2 which mean acidic in nature. Meanwhile, it is uncompensated because HCO3 is within the normal range. 6. Answer: C. Metabolic Acidosis, Fully Compensated Baby Angela has metabolic acidosis due to decreased HCO3 and slightly acidic pH. Her pH value is within the normal range which made the result fully compensated. 7. Answer: B. Metabolic Alkalosis, Uncompensated The postoperative client’s ABG results show that he has metabolic alkalosis because of an increased pH and HCO3. It is uncompensated due to the normal PaCO2 which is within 35 to 45 mmHg. 8. Answer: C. Respiratory Alkalosis, Uncompensated The results show that client Z has respiratory alkalosis since there is an increase in the pH value and a decrease in PaCO2 which are both basic. It is uncompensated due to the normal HCO3 which is within 22-26 mEq/L. 9. Answer: B. Respiratory Acidosis, Fully Compensated The patient has respiratory acidosis (raised carbon dioxide) resulting from asthma and respiratory distress syndrome, with compensation having normal pH value within 7.35to 7.45, increased PaCO2 which is acidic and increased HCO3 which is basic. 10. Answer: C. Respiratory Acidosis One of the risk factors of having respiratory acidosis is hypoventilation which may be due to brain trauma, coma, and hypothyroidism or myxedema. Other risk factors include pneumonia and status asthmaticus. Drugs such as Morphine and MgSO4 toxicity are also risk factors of respiratory acidosis. ABG ANALYSIS NCLEX EXAM 2 In acid-base balance the normal plasma PCO2 and bicarbonate levels are disturbed. Match the changes in these parameters given below with the disorders in the drop down list. 1. Low plasma PaCO2 A. Metabolic Acidosis B. Respiratory Alkalosis C. Metabolic Alkalosis D. Respiratory Acidosis 2. High plasma PaCO2 A. Metabolic Acidosis B. Respiratory Alkalosis C. Metabolic Alkalosis D. Respiratory Acidosis 3. Decreased plasma bicarbonate (HCO3-) A. Metabolic Acidosis B. Respiratory Alkalosis C. Metabolic Alkalosis D. Respiratory Acidosis 4. Increased plasma bicarbonate (HCO3-) A. Metabolic Acidosis B. Respiratory Alkalosis C. Metabolic Alkalosis D. Respiratory Acidosis 5. What two organs in the body serve as a compensatory function to maintain acid base balance? A. Kidneys and Lungs B. Lungs and Spleen C. Heart and Liver D. Gallbladder and Appendix 6. Arterial blood gas (ABG) measurement will give the information needed to determine if the primary disturbance of acid-base balance is respiratory or metabolic in nature. ThCiOs sPtuDd,yRseousrpcierawtaosrdyowconnlodaditeidonbys 1s0u0c0h00a8s17p9n3e66u8m7 ofrtohmorCaoxu,rseH on :54:22 GMT Downloaded by: Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material -05:00 Downloaded by: Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material A. True B. False C. Both Carbonic Acid Excess and Deficit Only D. Both Bicarbonate Excess and Deficit Only 7. The major effect of acidosis is overexcitement of the central nervous system. A. True B. False C. Maybe D. Both Acidosis and Alkalosis result in overexcitement of the central nervous system. 8. Alkalosis is characterized by overexcitement of the nervous system. A. True B. False C. The major effect of Alkalosis is a depression of the central nervous system. D. Both Acidosis and Alkalosis result in overexcitement of the central nervous system. 9. The human body functions optimally in a state of homeostasis. A. True B. False C. Maybe D. Homeostasis has nothing to do with metabolic balance. 10. Acids have no hydrogen ions and are able to bind in a solution. A. True B. False C. Acid is a substance that is not capable of donating hydrogen ions. D. Acids and bases have nothing to do with hydrogen ions. Match the acid-base status of the following blood samples to the disorders in the drop down list. (PaCO2 values are in mm Hg and bicarbonate values in mmol/l). 11. pH 7.57, PaCO2 22, HCO3- 17 A. Respiratory Acidosis, Partially Compensated B. Respiratory Alkalosis, Uncompensated C. Metabolic Acidosis, Partially Compensated D. Respiratory Alkalosis, Partially Compensated 12. pH 7.39, PaCO2 44, HCO3- 26 A. Respiratory Acidosis B. Metabolic Acidosis C. Respiratory Alkalosis D. Normal 13. pH 7.55, PaCO2 25, HCO3- 22 A. Respiratory Acidosis, Partially Compensated B. Respiratory Alkalosis, Uncompensated C. Metabolic Alkalosis, Partially Compensated D. Metabolic Acidosis, Uncompensated 14. pH 7.17, PaCO2 48, HCO3- 36 A. Respiratory Acidosis, Uncompensated B. Metabolic Acidosis, Partially Compensated C. Respiratory Alkalosis, Partially Compensated D. Respiratory Acidosis, Partially Compensated 15. pH 7.34, PaCO2 24, HCO3- 20 A. Respiratory Acidosis, Partially Compensated B. Metabolic Acidosis, Partially Compensated C. Metabolic Acidosis, Uncompensated D. Metabolic Alkalosis, Partially Compensated 16. pH 7.64, PaCO2 25, HCO3- 19 A. Respiratory Acidosis, Uncompensated B. Respiratory Alkalosis, Partially Compensated C. Respiratory Alkalosis, Uncompensated D. Metabolic Alkalosis, Partially Compensated 17. pH 7.45, PaCO2 50, HCO3- 30 A. Metabolic Alkalosis, Fully Compensated B. Respiratory Alkalosis, Fully Compensated C. Metabolic Alkalosis, Partially Compensated D. Respiratory Acidosis, Partially Compensated 18. pH 7.6, PaCO2 53, HCO3- 38 A. Metabolic Alkalosis, Partially Compensated B. Metabolic Alkalosis, Fully Compensated C. Respiratory Acidosis, Partially Compensated D. Respiratory Alkalosis, Fully Compensated 19. pH 7.5, PaCO2 19, HCO3- 22 A. Respiratory Alkalosis, Partially Compensated This study source was downloaded by from CourseH on 10-30-2B0.21M1e3t:a5b4:o2l2icGAMlkTa-l0o5s:0is0, Partially Downloaded by: Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material Compensated Downloaded by: Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material C. Respiratory Acidosis, Uncompensated D. Respiratory Alkalosis, Uncompensated 20. pH 7.4, PaCO2 59, HCO3- 35 A. Respiratory Acidosis, Uncompensated B. Metabolic Alkalosis, Uncompensated C. Respiratory Acidosis, Fully Compensated D. Metabolic Alkalosis, Partially Compensated Answers and Rationale: 1. Answer: B. Respiratory Alkalosis Excessive pulmonary ventilation decreases hydrogen ion concentration and thus causes respiratory alkalosis. It can become dangerous when it leads to cardiac dysrhythmias caused partly by a decrease in serum potassium levels. 2. Answer: D. Respiratory Acidosis An excess of carbon dioxide (hypercapnia) can cause carbon dioxide narcosis. In this condition, carbon dioxide levels are so high that they no longer stimulate respirations but depress them. 3. Answer: A. Metabolic Acidosis The body compensates by using body fat for energy, producing abnormal amounts of ketone bodies. In an effort to neutralize the ketones and maintain the acid-base balance of the body, plasma bicarbonate is exhausted. This condition can develop in anyone who does not eat an adequate diet and whose body fat must be burned for energy. Symptoms include headache and mental dullness. 4. Answer: C. Metabolic Alkalosis In metabolic alkalosis, breathing becomes depressed in an effort to conserve carbon dioxide for combination with water in the blood to raise the blood level of carbonic acid. Symptoms include confusion, dizziness, numbness or tingling of fingers or toes. 5. Answer: A. Kidneys and Lungs The carbonic acid concentration is controlled by the amount of carbon dioxide excreted by the lungs. The bicarbonate concentration is controlled by the kidneys, which selectively retain or excrete bicarbonate in response to the body’s needs. 6. Answer: A. True ABG’s are blood tests that are useful in identifying the cause and extent of the acid-base disturbance and in guiding and monitoring treatment. 7. Answer: B. False The major effect is a depression of the central nervous system, as evidenced by disorientation followed by coma. 8. Answer: A. True The muscles may go into a state of tetany and convulsions. 9. Answer: A. True The maintenance of acid-base balance, which in one part of homeostasis, is evidenced by an arterial plasma pH value of 7.35-7.45. Many mechanisms in the body work together to achieve and maintain this delicate narrow range of pH that is essential for normal cell function. 10. Answer: B. False Acids are substances having one or more hydrogen ions that can be liberated into a solution. Bases are substances that can bind hydrogen ions in a solution. 11. Answer: D. Respiratory Alkalosis, Partially Compensated 12. Answer: D. Normal 13. Answer: B. Respiratory Alkalosis, Uncompensated 14. Answer: D. Respiratory Acidosis, Partially Compensated 15. Answer: B. Metabolic Acidosis, Partially Compensated 16. Answer: B. Respiratory Alkalosis, Partially Compensated This study source was downloaded by from CourseH on 10-30-. 1A3n:5s4w:22erG:MAT. -M05e:0t0abolic Alkalosis, Fully Compensated Downloaded by: Distribution of this document is illegal Want to earn $103 per month? S - The Marketplace to Buy and Sell your Study Material 18. Answer: A. Metabolic Alkalosis, Partially Compensated 19. Answer: D. Respiratory Alkalosis, Uncompensated 20. Answer: C. Respiratory Acidosis, Fully Compensated This study source was downloaded by from CourseH on :54:22 GMT -05:00 Downloaded by Distribution of this document is illegal Want to earn $103 per month?