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Acid–Base/ABG Interpretation - NCLEX Rn

  1. A 68-year-old client with a history of chronic obstructive pulmonary disease (COPD) arrives to the emergency department with increased dyspnea and wheezing; vital signs are temperature 37.1°C (98.8°F), heart rate 112/min, respiratory rate 30/min with accessory muscle use, blood pressure 148/86 mm Hg, oxygen saturation 86% on room air, and the client is drowsy. Arterial blood gas results are pH 7.28, PaCO2 62 mm Hg, HCO3 28 mEq/L, PaO2 52 mm Hg. What is the nurse's PRIORITY action based on these ABG results?
    Answer: Initiate bilevel positive airway pressure (BiPAP) and apply supplemental oxygen per protocol This question tests ABG interpretation and clinical response in a COPD patient with acute respiratory acidosis. The ABG shows pH 7.28 (acidotic), PaCO2 62 mm Hg (elevated), HCO3 28 mEq/L (slightly elevated), and PaO2 52 mm Hg (hypoxemic), indicating acute-on-chronic respiratory acidosis with severe hypoxemia. BiPAP with supplemental oxygen (B) is the priority intervention because it provides ventilatory support to reduce CO2 retention while improving oxygenation, addressing both the acidosis and hypoxemia. Pursed-lip breathing (A) is insufficient for this severe presentation with drowsiness indicating CO2 narcosis; delegating ABG collection to UAP (C) is outside their scope and delays treatment; supine positioning (D) would worsen respiratory mechanics in COPD. The decision-making principle prioritizes immediate ventilatory support when respiratory acidosis causes altered mental status. When analyzing ABGs in COPD, recognize that drowsiness with elevated PaCO2 indicates impending respiratory failure requiring immediate non-invasive or invasive ventilation.
  2. A 79-year-old client with chronic kidney disease has been taking prescribed diuretics and has persistent vomiting; vital signs: temperature 36.7°C (98.1°F), heart rate 90/min, respiratory rate 14/min, blood pressure 94/58 mm Hg, oxygen saturation 97% on room air. ABG results: pH 7.51, PaCO2 44 mm Hg, HCO3 34 mEq/L, PaO2 89 mm Hg. The nurse should anticipate which intervention for this ABG finding?
    Answer: Anticipate orders for intravenous fluids and electrolyte replacement and hold contributing medications per provider direction This question tests ABG interpretation and the nurse's clinical response to metabolic alkalosis in chronic kidney disease. The ABG shows pH 7.51 (alkalosis), PaCO2 44 mm Hg (normal), HCO3 34 mEq/L (metabolic alkalosis), and PaO2 89 mm Hg (normal). Anticipating orders for IV fluids, electrolytes, and holding diuretics addresses losses and restores balance. Sodium bicarbonate (B) worsens alkalosis; hyperventilation (C) is inappropriate; high-protein meal (D) doesn't correct acute issues. The principle prioritizes fluid and electrolyte replacement while stopping causative agents. This targets dehydration and ion imbalances. A transferable strategy is to link ABG to medication effects and adjust therapies accordingly.
  3. A 72-year-old client with chronic kidney disease is confused and weak after several days of vomiting; vital signs: temperature 36.6°C (97.9°F), heart rate 100/min, respiratory rate 12/min, blood pressure 88/54 mm Hg, oxygen saturation 96% on room air. ABG results: pH 7.54, PaCO2 49 mm Hg, HCO3 40 mEq/L, PaO2 86 mm Hg. Which ABG result requires IMMEDIATE intervention?
    Answer: pH 7.54 This question tests ABG interpretation and identification of the most critical abnormality in metabolic alkalosis with chronic kidney disease. The ABG parameters are pH 7.54 (severe alkalosis), PaCO2 49 mm Hg (respiratory compensation), HCO3 40 mEq/L (metabolic alkalosis), and PaO2 86 mm Hg (normal). The pH 7.54 requires immediate intervention as it poses risks like arrhythmias from electrolyte shifts. PaO2 86 mm Hg (A) and PaCO2 49 mm Hg (B) are near normal; HCO3 40 mEq/L (D) causes the imbalance but pH reflects urgency. The principle prioritizes extreme pH correction in metabolic disorders. This addresses potential complications. A transferable strategy is to target pH normalization first in compensated imbalances.
  4. A 64-year-old client with severe COPD presents with increasing somnolence and shallow respirations; vital signs are heart rate 110/min, respiratory rate 8/min, blood pressure 158/84 mm Hg, oxygen saturation 88% on 2 L/min nasal cannula. Arterial blood gas results are pH 7.18, PaCO2 78 mm Hg, HCO3 30 mEq/L, PaO2 54 mm Hg. Which ABG result requires IMMEDIATE intervention?
    Answer: pH 7.18 This question tests ABG interpretation and prioritizing the most critical value requiring immediate intervention. The ABG shows severe respiratory acidosis with pH 7.18 (life-threatening acidosis), PaCO2 78 mm Hg (severe hypercapnia), HCO3 30 mEq/L (chronic compensation), and PaO2 54 mm Hg (hypoxemia). The pH of 7.18 (D) requires immediate intervention because severe acidemia (pH <7.20) causes cardiovascular instability, decreased cardiac contractility, and increased risk of arrhythmias and death. While the PaO2 of 54 (A) indicates hypoxemia and PaCO2 of 78 (C) shows severe CO2 retention, both contributing to the acidosis, the pH itself represents the immediate life threat; HCO3 of 30 (B) shows appropriate chronic compensation. The principle is recognizing that pH <7.20 or >7.60 represents immediate life threat regardless of cause. When analyzing critical ABGs, prioritize intervention based on pH extremes that directly threaten cardiovascular stability and survival.
  5. A 19-year-old client with type 1 diabetes is lethargic and has fruity breath; vital signs: temperature 37.9°C (100.2°F), heart rate 132/min, respiratory rate 30/min and deep, blood pressure 88/50 mm Hg, oxygen saturation 99% on room air. ABG results: pH 7.08, PaCO2 20 mm Hg, HCO3 6 mEq/L, PaO2 98 mm Hg. What is the nurse's PRIORITY action based on these ABG results?
    Answer: Establish two large-bore intravenous lines and begin isotonic fluid resuscitation per protocol This question tests ABG interpretation and the nurse's clinical response to severe diabetic ketoacidosis. The ABG shows pH 7.08 (severe acidosis), PaCO2 20 mm Hg (respiratory compensation), HCO3 6 mEq/L (metabolic acidosis), and PaO2 98 mm Hg (normal). Establishing two large-bore IV lines and beginning isotonic fluid resuscitation is the priority to correct hypovolemia and support perfusion. Starting insulin without fluids (A) risks hypotension; oral bicarbonate (D) is inappropriate for severe cases; delegating weight/urine (C) delays action. The principle prioritizes volume replacement before insulin to prevent shifts exacerbating dehydration. This addresses the underlying osmotic diuresis. A transferable strategy is to classify the ABG, correlate with symptoms, and sequence interventions from stabilization to correction.
  6. A 58-year-old client is post-operative and suddenly becomes anxious and complains of lightheadedness; vital signs: temperature 36.8°C (98.2°F), heart rate 102/min, respiratory rate 38/min, blood pressure 132/80 mm Hg, oxygen saturation 100% on room air. ABG results: pH 7.53, PaCO2 27 mm Hg, HCO3 22 mEq/L, PaO2 108 mm Hg. Which ABG result requires IMMEDIATE intervention?
    Answer: pH 7.53 This question tests ABG interpretation and identification of the most critical abnormality in post-operative respiratory alkalosis. The ABG parameters are pH 7.53 (severe alkalosis), PaCO2 27 mm Hg (hypocapnia), HCO3 22 mEq/L (normal), and PaO2 108 mm Hg (slightly above normal, as expected with rapid breathing). The pH 7.53 requires immediate intervention as it signals acute alkalemia risking seizures or arrhythmias. PaO2 108 mm Hg (A) poses no danger and HCO3 22 mEq/L (B) is normal; PaCO2 27 mm Hg (C) causes the imbalance but pH indicates overall severity. The principle prioritizes correcting extreme pH deviations. This mitigates neurological risks. A transferable strategy is to prioritize pH in ABG analysis when oxygenation is adequate.
  7. A 26-year-old client with type 1 diabetes is being treated for diabetic ketoacidosis; vital signs: heart rate 112/min, respiratory rate 22/min, blood pressure 102/64 mm Hg, oxygen saturation 99% on room air. ABG results: pH 7.16, PaCO2 25 mm Hg, HCO3 9 mEq/L, PaO2 98 mm Hg. The nurse should anticipate which intervention for this ABG finding?
    Answer: Continue isotonic fluids and insulin therapy per protocol and monitor potassium closely This question tests ABG interpretation and the nurse's clinical response during diabetic ketoacidosis treatment. The ABG shows pH 7.16 (acidosis), PaCO2 25 mm Hg (respiratory compensation), HCO3 9 mEq/L (metabolic acidosis), and PaO2 98 mm Hg (normal). Continuing isotonic fluids and insulin with potassium monitoring is anticipated to progressively correct the imbalance. Stopping insulin (B) halts treatment; opioids (C) suppress compensation; delegating oral intake (D) is inadequate. The principle prioritizes sustained therapy while watching for shifts. This ensures safe acidosis resolution. A transferable strategy is to monitor ABG during treatment and adjust based on response.
  8. A 66-year-old client with COPD is receiving 4 L/min oxygen by nasal cannula for increased dyspnea; vital signs are heart rate 104/min, respiratory rate 10/min, blood pressure 142/78 mm Hg, oxygen saturation 91%, and the client is difficult to arouse. Arterial blood gas results are pH 7.22, PaCO2 70 mm Hg, HCO3 30 mEq/L, PaO2 68 mm Hg. What is the nurse's PRIORITY action based on these ABG results?
    Answer: Notify the provider/rapid response team and prepare to support ventilation (for example, BiPAP) per protocol This question tests ABG interpretation and clinical response in COPD with acute respiratory acidosis and CO2 narcosis. The ABG shows pH 7.22 (severe acidosis), PaCO2 70 mm Hg (markedly elevated), HCO3 30 mEq/L (chronic compensation), and PaO2 68 mm Hg (adequate on oxygen), indicating acute-on-chronic respiratory acidosis with CO2 narcosis (decreased respiratory rate and altered mental status). Notifying the provider/rapid response team and preparing ventilatory support (B) is the priority because the patient has oxygen-induced hypoventilation with CO2 narcosis requiring immediate intervention to prevent respiratory arrest. Continuing current therapy (A) ignores the critical situation; oral fluids (C) are inappropriate with altered consciousness; ambulation (D) is unsafe with severe acidosis and altered mental status. The principle is recognizing that excessive oxygen in COPD can suppress respiratory drive, causing CO2 retention and requiring ventilatory support. When analyzing ABGs in COPD patients on oxygen, watch for rising CO2 with decreased respiratory rate indicating oxygen-induced hypoventilation requiring immediate intervention.
  9. A 63-year-old client with COPD is brought in for worsening shortness of breath and confusion; vital signs: temperature 37.2°C (99.0°F), heart rate 118/min, respiratory rate 8/min, blood pressure 148/90 mm Hg, oxygen saturation 80% on 3 L/min nasal cannula. ABG results: pH 7.22, PaCO2 70 mm Hg, HCO3 30 mEq/L, PaO2 48 mm Hg. What is the nurse's PRIORITY action?
    Answer: Notify the provider or rapid response team and prepare for ventilatory support (noninvasive or mechanical ventilation) The ABG shows acute-on-chronic respiratory acidosis with hypoxemia: pH 7.22, PaCO2 70 mm Hg, HCO3 30 mEq/L (partial compensation), and PaO2 48 mm Hg. A respiratory rate of 8/min and new confusion mean the client is not ventilating adequately, so the problem is ventilation, not just oxygenation. The priority is to notify the provider or rapid response team and prepare for ventilatory support, such as noninvasive positive pressure ventilation or intubation (A). Oxygen should be titrated to a target of 88–92%, but increasing nasal cannula flow and waiting an hour for a repeat ABG (B) does not correct hypoventilation and delays needed ventilatory support. Sodium bicarbonate (C) does not treat a respiratory acidosis; the fix is better ventilation. Pursed-lip breathing (D) helps a client who is breathing adequately, not one with a respiratory rate of 8/min and confusion.
  10. A 45-year-old post-operative client reports severe incisional pain and is breathing rapidly; vital signs: temperature 36.9°C (98.4°F), heart rate 110/min, respiratory rate 32/min, blood pressure 158/90 mm Hg, oxygen saturation 100% on room air. ABG results: pH 7.51, PaCO2 29 mm Hg, HCO3 23 mEq/L, PaO2 105 mm Hg. The nurse should anticipate which intervention for this ABG finding?
    Answer: Administer prescribed analgesic and use relaxation coaching to slow respirations This question tests ABG interpretation and the nurse's clinical response to respiratory alkalosis from post-operative pain. The ABG indicates pH 7.51 (alkalosis), PaCO2 29 mm Hg (hypocapnia), HCO3 23 mEq/L (normal), and PaO2 105 mm Hg (normal). Administering prescribed analgesic and relaxation coaching is anticipated to slow respirations and correct hypocapnia. Sodium bicarbonate (B) worsens alkalosis; increasing oxygen (C) is unneeded; delegating repeat ABG (D) delays symptom management. The principle prioritizes pain control to normalize breathing patterns. This addresses the trigger for hyperventilation. A transferable strategy is to connect ABG changes to pain or anxiety and use multimodal interventions.
  11. A 67-year-old client with COPD has worsening dyspnea and cyanosis; vital signs: temperature 37.0°C (98.6°F), heart rate 120/min, respiratory rate 9/min, blood pressure 158/94 mm Hg, oxygen saturation 82% on 2 L/min nasal cannula. ABG results: pH 7.29, PaCO2 64 mm Hg, HCO3 30 mEq/L, PaO2 46 mm Hg. What is the nurse's PRIORITY action based on these ABG results?
    Answer: Apply noninvasive positive pressure ventilation (if ordered/available) and notify the provider of acute respiratory failure findings This question tests ABG interpretation and the nurse's clinical response to acute respiratory acidosis in COPD. The ABG reveals pH 7.29 (acidosis), PaCO2 64 mm Hg (hypercapnia), HCO3 30 mEq/L (partial compensation), and PaO2 46 mm Hg (severe hypoxemia). Applying noninvasive positive pressure ventilation and notifying the provider is the priority for acute failure support. Encouraging oral fluids (A) is secondary; delegating sputum (C) delays; teaching breathing (D) is for stable clients. The principle prioritizes immediate ventilatory assistance in decompensation. This improves gas exchange rapidly. A transferable strategy is to assess ABG trends and initiate protocol-driven respiratory support.
  12. A 68-year-old client with severe chronic obstructive pulmonary disease (COPD) arrives to the emergency department with increased dyspnea, drowsiness, and use of accessory muscles; vital signs: temperature 37.1°C (98.8°F), heart rate 112/min, respiratory rate 10/min and shallow, blood pressure 154/88 mm Hg, oxygen saturation 84% on 2 L/min nasal cannula. Arterial blood gas (ABG) results: pH 7.28, PaCO2 62 mm Hg, HCO3 29 mEq/L, PaO2 52 mm Hg. What is the nurse's PRIORITY action based on these ABG results?
    Answer: Initiate bilevel positive airway pressure (BiPAP) and keep the client in high-Fowler position This question tests arterial blood gas (ABG) interpretation and the nurse's clinical response to acute respiratory failure in a client with COPD. The ABG shows pH 7.28 (acidosis), PaCO2 62 mm Hg (hypercapnia indicating respiratory acidosis), HCO3 29 mEq/L (partial renal compensation), and PaO2 52 mm Hg (hypoxemia). Initiating bilevel positive airway pressure (BiPAP) and placing the client in high-Fowler position is the priority as it supports ventilation, reduces work of breathing, and improves gas exchange without risking intubation. Increasing oxygen to 15 L/min (A) risks suppressing hypoxic drive in COPD; delegating for repeat saturation (C) delays intervention; encouraging pursed-lip breathing and rechecking in 1 hour (D) is insufficient for acute decompensation. The decision-making principle prioritizes immediate correction of life-threatening hypoxemia and hypercapnia while avoiding oxygen toxicity. This addresses the underlying ventilatory failure in COPD exacerbations. A transferable strategy is to first classify the ABG imbalance, assess oxygenation status, and select interventions that enhance ventilation and perfusion while monitoring for compensation.
  13. A 71-year-old client with chronic kidney disease has had several days of nasogastric suction and is weak; vital signs: temperature 36.6°C (97.9°F), heart rate 92/min, respiratory rate 16/min, blood pressure 96/58 mm Hg, oxygen saturation 98% on room air. ABG results: pH 7.48, PaCO2 48 mm Hg, HCO3 34 mEq/L, PaO2 92 mm Hg. Based on the ABG, which treatment should the nurse QUESTION?
    Answer: Continue nasogastric suction at high continuous settings without reassessment This question tests ABG interpretation and the nurse's ability to question inappropriate treatments for metabolic alkalosis in chronic kidney disease. The ABG shows pH 7.48 (alkalosis), PaCO2 48 mm Hg (respiratory compensation), HCO3 34 mEq/L (metabolic alkalosis from gastric losses), and PaO2 92 mm Hg (normal). Continuing nasogastric suction without reassessment should be questioned as it perpetuates HCl loss and worsens alkalosis. IV fluids (B), monitoring electrolytes (C), and antiemetics (D) are appropriate to correct and prevent further imbalance. The principle involves challenging interventions that exacerbate the underlying cause. This promotes resolution of the metabolic issue. A transferable strategy is to evaluate ABG in context of ongoing therapies and advocate for adjustments based on trends.
  14. A 47-year-old client is 1 hour post-operative and becomes tachypneic with complaints of dizziness; vital signs: temperature 36.7°C (98.1°F), heart rate 104/min, respiratory rate 36/min, blood pressure 126/78 mm Hg, oxygen saturation 100% on room air. ABG results: pH 7.49, PaCO2 30 mm Hg, HCO3 22 mEq/L, PaO2 102 mm Hg. The nurse should anticipate which intervention for this ABG finding?
    Answer: Assess pain and anxiety and implement measures to reduce hyperventilation This question tests ABG interpretation and the nurse's clinical response to post-operative respiratory alkalosis. The ABG indicates pH 7.49 (alkalosis), PaCO2 30 mm Hg (hypocapnia from hyperventilation), HCO3 22 mEq/L (normal), and PaO2 102 mm Hg (normal). Assessing pain and anxiety with measures to reduce hyperventilation is anticipated to restore normal breathing patterns. Sodium bicarbonate (B) exacerbates alkalosis; increasing oxygen (C) is unnecessary; delegating deep breathing (D) may worsen hypocapnia. The principle prioritizes identifying and treating triggers like pain to normalize ventilation. This prevents progression to compensated states. A transferable strategy is to link ABG findings to clinical context and intervene at the source of imbalance.
  15. A 47-year-old client is 1 hour post-operative and is on a mechanical ventilator; the client is restless with a respiratory rate set high on the ventilator, heart rate 120/min, blood pressure 150/90 mm Hg, oxygen saturation 99%. Arterial blood gas results are pH 7.55, PaCO2 26 mm Hg, HCO3 22 mEq/L, PaO2 110 mm Hg. The nurse should anticipate which intervention for this ABG finding?
    Answer: Decrease minute ventilation by collaborating with the respiratory therapist/provider to adjust ventilator settings This question tests ABG interpretation and clinical response in ventilator-induced respiratory alkalosis. The ABG shows pH 7.55 (severe alkalosis), PaCO2 26 mm Hg (very low), HCO3 22 mEq/L (normal), and PaO2 110 mm Hg (elevated), indicating acute respiratory alkalosis from hyperventilation on mechanical ventilation. Decreasing minute ventilation by adjusting ventilator settings (A) is correct because the high respiratory rate setting is causing excessive CO2 elimination and severe alkalosis, requiring reduction in rate or tidal volume. Increasing the rate (B) would worsen alkalosis; sodium bicarbonate (C) would dangerously increase pH further; delegating ventilator changes to UAP (D) is outside their scope and unsafe. The principle is recognizing iatrogenic respiratory alkalosis from mechanical ventilation and collaborating to adjust settings appropriately. When analyzing ABGs in ventilated patients, severe respiratory alkalosis indicates excessive minute ventilation requiring prompt ventilator adjustment to prevent complications like seizures or arrhythmias.
  16. A 22-year-old client with type 1 diabetes reports polyuria, polydipsia, abdominal pain, and nausea; vital signs: temperature 37.6°C (99.7°F), heart rate 126/min, respiratory rate 28/min and deep, blood pressure 92/54 mm Hg, oxygen saturation 98% on room air. ABG results: pH 7.12, PaCO2 24 mm Hg, HCO3 8 mEq/L, PaO2 96 mm Hg. The nurse should anticipate which intervention for this ABG finding?
    Answer: Start intravenous 0.9% sodium chloride and prepare to begin an insulin infusion per protocol This ABG shows pH 7.12 with a low HCO3 of 8 mEq/L — a metabolic acidosis — and a low PaCO2 of 24 mm Hg, which is the respiratory system compensating by blowing off CO2. The clinical picture (polyuria, polydipsia, abdominal pain, rapid deep breathing) in a client with type 1 diabetes is diabetic ketoacidosis. The first-line intervention is to start 0.9% sodium chloride to restore volume and prepare an insulin infusion to stop the ketone production driving the acidosis. Sodium bicarbonate at 50 mEq is not the first-line treatment here; bicarbonate is reserved for extremely low pH levels and can cause rebound alkalosis, so pushing it first is incorrect. A nonrebreather mask at 15 L/min treats hypoxemia, but this client's oxygen saturation is 98% on room air and PaO2 is 96 — oxygenation is not the problem, so it will not correct the acidosis. Delegating a fingerstick glucose to unlicensed assistive personnel before any treatment delays the urgent fluid and insulin therapy needed to reverse the ketoacidosis. The strategy: identify the primary imbalance, connect it to the presentation, and intervene on the cause while supporting — not overtreating — the compensation.
  17. A 66-year-old client with COPD exacerbation is restless and somnolent; vital signs: temperature 37.0°C (98.6°F), heart rate 110/min, respiratory rate 9/min, blood pressure 160/86 mm Hg, oxygen saturation 86% on 2 L/min nasal cannula. ABG results: pH 7.30, PaCO2 58 mm Hg, HCO3 28 mEq/L, PaO2 55 mm Hg. The nurse should anticipate which intervention for this ABG finding?
    Answer: Prepare for noninvasive ventilation and administer bronchodilators as prescribed This question tests ABG interpretation and the nurse's clinical response to respiratory acidosis in COPD exacerbation. The ABG reveals pH 7.30 (acidosis), PaCO2 58 mm Hg (hypercapnia), HCO3 28 mEq/L (partial compensation), and PaO2 55 mm Hg (hypoxemia). Preparing for noninvasive ventilation and administering bronchodilators supports airway patency and gas exchange. Breathing into a paper bag (B) is unsafe; restricting fluids (C) is irrelevant; delegating repositioning (D) delays care. The principle prioritizes ventilatory support to correct hypercapnia and hypoxemia. This addresses acute decompensation. A transferable strategy is to assess ABG for respiratory failure signs and escalate to supportive therapies promptly.
  18. A 28-year-old client with type 1 diabetes presents with vomiting and rapid breathing; vital signs: temperature 37.4°C (99.3°F), heart rate 120/min, respiratory rate 26/min, blood pressure 94/56 mm Hg, oxygen saturation 98% on room air. ABG results: pH 7.18, PaCO2 26 mm Hg, HCO3 10 mEq/L, PaO2 95 mm Hg. What is the nurse's PRIORITY action based on these ABG results?
    Answer: Begin isotonic intravenous fluids and obtain ordered labs including potassium before starting insulin This question tests ABG interpretation and the nurse's clinical response to metabolic acidosis in diabetic ketoacidosis. The ABG shows pH 7.18 (acidosis), PaCO2 26 mm Hg (respiratory compensation), HCO3 10 mEq/L (metabolic acidosis), and PaO2 95 mm Hg (normal). Beginning isotonic IV fluids and obtaining labs including potassium before insulin is the priority to safely correct deficits. Loop diuretic (A) is inappropriate; Trendelenburg (C) doesn't address acidosis; delegating urine ketones (D) is secondary. The principle prioritizes electrolyte monitoring to prevent hypokalemia with insulin. This supports safe resolution of acidosis. A transferable strategy is to integrate ABG with lab data and sequence treatments to avoid complications.
  19. A 73-year-old client with chronic kidney disease has ongoing gastric suction and reports muscle cramps; vital signs: temperature 36.5°C (97.7°F), heart rate 88/min, respiratory rate 12/min, blood pressure 104/64 mm Hg, oxygen saturation 98% on room air. ABG results: pH 7.49, PaCO2 47 mm Hg, HCO3 35 mEq/L, PaO2 93 mm Hg. What is the nurse's PRIORITY action based on these ABG results?
    Answer: Notify the provider of suspected metabolic alkalosis and anticipate orders to reduce gastric losses and replace electrolytes This question tests ABG interpretation and the nurse's clinical response to metabolic alkalosis in chronic kidney disease. The ABG shows pH 7.49 (alkalosis), PaCO2 47 mm Hg (respiratory compensation), HCO3 35 mEq/L (metabolic alkalosis), and PaO2 93 mm Hg (normal). Notifying the provider and anticipating orders to reduce gastric losses and replace electrolytes is the priority to halt progression. Encouraging increased respirations (B) is counterproductive; bronchodilator (C) is irrelevant; delegating vital signs (D) delays action. The principle prioritizes interrupting the cause and correcting electrolytes. This restores acid-base balance. A transferable strategy is to assess for ongoing losses in ABG analysis and advocate for targeted therapies.
  20. A 73-year-old client with acute kidney injury after dehydration is confused and weak; vital signs are heart rate 98/min, respiratory rate 12/min, blood pressure 104/66 mm Hg, oxygen saturation 95% on room air. Arterial blood gas results are pH 7.50, PaCO2 48 mm Hg, HCO3 36 mEq/L, PaO2 88 mm Hg. The nurse should anticipate which intervention for this ABG finding?
    Answer: Administer isotonic intravenous fluids as prescribed and monitor electrolytes (especially potassium and chloride) This question tests ABG interpretation and clinical response in metabolic alkalosis from acute kidney injury. The ABG shows pH 7.50 (alkalotic), PaCO2 48 mm Hg (slightly elevated from compensation), HCO3 36 mEq/L (elevated), and normal PaO2, indicating metabolic alkalosis with partial respiratory compensation. Administering isotonic fluids and monitoring electrolytes (A) is correct because volume depletion and electrolyte losses (especially chloride and potassium) perpetuate metabolic alkalosis, and fluid resuscitation with electrolyte replacement treats the underlying cause. Naloxone (B) is inappropriate as there's no evidence of opioid overdose; encouraging hyperventilation (C) would worsen alkalosis; delegating only to UAP (D) neglects necessary nursing assessments for confusion. The principle is correcting volume and electrolyte deficits that maintain metabolic alkalosis. When interpreting ABGs showing metabolic alkalosis, assess for volume depletion, diuretic use, or GI losses that deplete chloride and potassium, then replace deficits appropriately.

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