NUR 425 complex care exam 2 UPDATED
ACTUAL Exam Questions and CORRECT
Answers
PaO2 - CORRECT ANSWER - 80-100 mmHg
partial pressure of oxygen in the blood this can be >100
SaO2 - CORRECT ANSWER - 95-100%
a % of oxygen that is attached to hemoglobin in the blood - this is your oxygen saturations
PaCO2 - CORRECT ANSWER - 35-45 mmHg
the partial pressure of CO2 in the blood (indicates lung function - respiratory issues or
compensation)
HCO3 - CORRECT ANSWER - 22-26 mEq/L
bicarb in the blood (kidneys, metabolic issues or compensation)
how are the kidneys working?
Buffer system compensatory mechanism - CORRECT ANSWER - -fastest acting system,
but not sustainable
-primary regulator
-bind acids to neutralize their effect
-responsible mainly for buffering blood and interstitial fluid
-Buffers cannot maintain pH without the adequate functioning of the respiratory and renal
systems
Renal system compensation - CORRECT ANSWER - -kidneys relate to HCO3 (bicarb)
levels
-usually begins within 24 hours (slower than the lungs but more sustainable)
,-if blood has too much acid or not enough base, pH drops and kidneys reabsorb bicarb
-also excrete hydrogen in ammonia and phosphate
-children and older adult kidneys can't handle excess acid as well
Respiratory system compensation - CORRECT ANSWER - -second line of defense
against imbalance
-twice as effective as chemical buffer system bc it can handle twice the amount of acids/bases
-responds within minutes to pH changes
-only temporary
-regulates CO2 (normal 35-45)
-carbon dioxide is the main stimulus
Metabolic disturbance - CORRECT ANSWER - respiratory system compensates by:
-decreased HCO3 (met. acid/ decreased pH): lungs increase ventilation to blow off CO2, which
decrease CO2 and increases pH
-increased HCO3 (met alk/ increased pH): lungs decrease ventilation to retain CO2, which
increases CO2 and decreases pH
Respiratory disturbance - CORRECT ANSWER - renal system compensates by:
-increased PaCO2 (resp. acid, decreased pH): kidneys retain HCO3, excrete H+, which increases
HCO3 and pH
-decreased PaCO2 (resp. alk/increased pH): kidneys excrete HCO3 and retain H+, which
decreases HCO3 and pH
Causes of respiratory acidosis - CORRECT ANSWER - -depressant drug overdose
(depresses the resp. drive)
-COPD (CO2 retention)
-ETOH intoxication (depressed respiration)
-not fully awake post-surgical procedure
-rib fracture: inability to take effective deep breaths
, -airway obstruction: decreased depth of RR
-neuromuscular disease: impaired ability of muscles to take deep breaths
-chest trauma
-pulmonary edema: decreased CO2 and O2
Treatment of respiratory acidosis - CORRECT ANSWER - -incentive spirometer
-NG tube with charcoal if OD
-bronchodilators or corticosteroids if COPD
-reversal agent such as Narcan or Romazicon
-TCDB (turn, cough, deep breathe)
-increase O2, PEEP, Vt and ventilation rate if on mechanical vent
Metabolic acidosis causes - CORRECT ANSWER - -DKA: ketoacid accumulation
-ASA OD: lactic acid and pyruvic acid
-shock states, sepsis: lactic acid buildup from anaerobic metabolism
-diarrhea: loss of bicarb
-renal failure: lose ability to reabsorb bicarb and excrete H+
Treatments for met. acidosis - CORRECT ANSWER - treat the cause first!
-IV sodium bicarb
-hemodialysis
-manage blood sugars
-OD protocols
-antibiotics
-anti-diarrhea agents
Causes of respiratory alkalosis - CORRECT ANSWER - HYPOXEMIA
-hyperventilation: blow off too much CO2
ACTUAL Exam Questions and CORRECT
Answers
PaO2 - CORRECT ANSWER - 80-100 mmHg
partial pressure of oxygen in the blood this can be >100
SaO2 - CORRECT ANSWER - 95-100%
a % of oxygen that is attached to hemoglobin in the blood - this is your oxygen saturations
PaCO2 - CORRECT ANSWER - 35-45 mmHg
the partial pressure of CO2 in the blood (indicates lung function - respiratory issues or
compensation)
HCO3 - CORRECT ANSWER - 22-26 mEq/L
bicarb in the blood (kidneys, metabolic issues or compensation)
how are the kidneys working?
Buffer system compensatory mechanism - CORRECT ANSWER - -fastest acting system,
but not sustainable
-primary regulator
-bind acids to neutralize their effect
-responsible mainly for buffering blood and interstitial fluid
-Buffers cannot maintain pH without the adequate functioning of the respiratory and renal
systems
Renal system compensation - CORRECT ANSWER - -kidneys relate to HCO3 (bicarb)
levels
-usually begins within 24 hours (slower than the lungs but more sustainable)
,-if blood has too much acid or not enough base, pH drops and kidneys reabsorb bicarb
-also excrete hydrogen in ammonia and phosphate
-children and older adult kidneys can't handle excess acid as well
Respiratory system compensation - CORRECT ANSWER - -second line of defense
against imbalance
-twice as effective as chemical buffer system bc it can handle twice the amount of acids/bases
-responds within minutes to pH changes
-only temporary
-regulates CO2 (normal 35-45)
-carbon dioxide is the main stimulus
Metabolic disturbance - CORRECT ANSWER - respiratory system compensates by:
-decreased HCO3 (met. acid/ decreased pH): lungs increase ventilation to blow off CO2, which
decrease CO2 and increases pH
-increased HCO3 (met alk/ increased pH): lungs decrease ventilation to retain CO2, which
increases CO2 and decreases pH
Respiratory disturbance - CORRECT ANSWER - renal system compensates by:
-increased PaCO2 (resp. acid, decreased pH): kidneys retain HCO3, excrete H+, which increases
HCO3 and pH
-decreased PaCO2 (resp. alk/increased pH): kidneys excrete HCO3 and retain H+, which
decreases HCO3 and pH
Causes of respiratory acidosis - CORRECT ANSWER - -depressant drug overdose
(depresses the resp. drive)
-COPD (CO2 retention)
-ETOH intoxication (depressed respiration)
-not fully awake post-surgical procedure
-rib fracture: inability to take effective deep breaths
, -airway obstruction: decreased depth of RR
-neuromuscular disease: impaired ability of muscles to take deep breaths
-chest trauma
-pulmonary edema: decreased CO2 and O2
Treatment of respiratory acidosis - CORRECT ANSWER - -incentive spirometer
-NG tube with charcoal if OD
-bronchodilators or corticosteroids if COPD
-reversal agent such as Narcan or Romazicon
-TCDB (turn, cough, deep breathe)
-increase O2, PEEP, Vt and ventilation rate if on mechanical vent
Metabolic acidosis causes - CORRECT ANSWER - -DKA: ketoacid accumulation
-ASA OD: lactic acid and pyruvic acid
-shock states, sepsis: lactic acid buildup from anaerobic metabolism
-diarrhea: loss of bicarb
-renal failure: lose ability to reabsorb bicarb and excrete H+
Treatments for met. acidosis - CORRECT ANSWER - treat the cause first!
-IV sodium bicarb
-hemodialysis
-manage blood sugars
-OD protocols
-antibiotics
-anti-diarrhea agents
Causes of respiratory alkalosis - CORRECT ANSWER - HYPOXEMIA
-hyperventilation: blow off too much CO2
