A patient who was involved in a motor vehicle crash has had a ...

[charchew]

A patient who was involved in a motor vehicle crash has had a tracheostomy placed to allow for continued mechanical ventilation.
 
  How should the nurse interpret the following arterial blood gas results: pH 7.48, PaO2 85 mm Hg, PaCO2 32 mm Hg, and HCO3 25 mEq/L?
  a. Metabolic acidosis
  b. Metabolic alkalosis
  c. Respiratory acidosis
  d. Respiratory alkalosis

Question 2

A postoperative patient who had surgery for a perforated gastric ulcer has been receiving nasogastric suction for 3 days. The patient now has a serum sodium level of 127 mEq/L (127 mmol/L). Which prescribed therapy should the nurse question?
 
  a. Infuse 5 dextrose in water at 125 mL/hr.
  b. Administer IV morphine sulfate 4 mg every 2 hours PRN.
  c. Give IV metoclopramide (Reglan) 10 mg every 6 hours PRN for nausea.
  d. Administer 3 saline if serum sodium decreases to less than 128 mEq/L.

[Ahnyah]

Answer to Question 1

ANS: D
The pH indicates that the patient has alkalosis and the low PaCO2 indicates a respiratory cause. The other responses are incorrect based on the pH and the normal HCO3.

Answer to Question 2

ANS: A
Because the patient's gastric suction has been depleting electrolytes, the IV solution should include electrolyte replacement. Solutions such as lactated Ringer's solution would usually be ordered for this patient. The other orders are appropriate for a postoperative patient with gastric suction.