A nurse is caring for a client who has the following arterial ...

[CQXA]

A nurse is caring for a client who has the following arterial blood values: pH 7.12, PaO2 56 mm Hg, PaCO2 65 mm Hg, and HCO3- 22 mEq/L. Which clinical situation should the nurse correlate with these values?
 
  a. Diabetic ketoacidosis in a person with emphysema
  b. Bronchial obstruction related to aspiration of a hot dog
  c. Anxiety-induced hyperventilation in an adolescent
  d. Diarrhea for 36 hours in an older, frail woman

Question 2

A nurse is caring for a client who has just experienced a 90-second tonic-clonic seizure. The client's arterial blood gas values are pH 6.88, PaO2 50 mm Hg, PaCO2 60 mm Hg, and HCO3- 22 mEq/L. Which action should the nurse take first?
 
  a. Apply oxygen by mask or nasal cannula.
  b. Apply a paper bag over the client's nose and mouth.
  c. Administer 50 mL of sodium bicarbonate intravenously.
  d. Administer 50 mL of 20 glucose and 20 units of regular insulin.

[mk6555]

Answer to Question 1

ANS: B
Arterial blood gas values indicate that the client has acidosis with normal levels of bicarbonate, suggesting that the problem is not metabolic. Arterial concentrations of oxygen and carbon dioxide are abnormal, with low oxygen and high carbon dioxide levels. Thus, this client has respiratory acidosis from inadequate gas exchange. The fact that the bicarbonate level is normal indicates that this is an acute respiratory problem rather than a chronic problem, because no renal compensation has occurred.

Answer to Question 2

ANS: A
The client has experienced a combination of metabolic and acute respiratory acidosis through heavy skeletal muscle contractions and no gas exchange. When the seizures have stopped and the client can breathe again, the fastest way to return acid-base balance is to administer oxygen. Applying a paper bag over the client's nose and mouth would worsen the acidosis. Sodium bicarbonate should not be administered because the client's arterial bicarbonate level is normal. Glucose and insulin are administered together to decrease serum potassium levels. This action is not appropriate based on the information provided.