ABG Analysis
A client is admitted to the emergency room with a respiratory rate of 7/min. Arterial blood gases (ABG) reveal the following values. Which of the following is an appropriate analysis of the ABGs?
pH 7.22
PaCO2 68 mm Hg
Bicarbonate 26 mEq/L
Respiratory acidosis
What is Respiratory acidosis?
Respiratory acidosis occurs when there is retention of CO2 due to an impairment of respiratory function.
A client who is vomiting would have....
Vomiting can cause metabolic alkalosis due to acid loss.
A nurse is assessing a client who is postoperative and has anemia due to excess blood loss following surgery. Which of the following findings should the nurse expect?
Tachycardia
Hypotension
Fatigue
The nurse is caring for a client who has been receiving 0.45% normal saline (½ NS) IV for hydration. Which assessment finding indicates the nurse should notify the healthcare provider immediately?
A. Blood pressure 110/70 mm Hg and heart rate 78 bpm
B. Crackles in the lungs and oxygen saturation 90%
C. Skin turgor improving and urine output 40 mL/hr
D. Oral mucous membranes moist and pink
Crackles in the lungs and oxygen saturation 90%
Hypotonic solutions (e.g., 0.45% NS, 0.33% NS, D2.5W) move water into cells, causing them to swell.
If too much fluid shifts into cells (including brain and lung tissue), it can lead to cellular edema and pulmonary congestion—indicated by crackles and decreased O₂ saturation.
This is a priority finding requiring immediate notification and possible adjustment of IV fluids.
A nurse is reviewing the arterial blood gas (ABG) results of a client who the provider suspects has metabolic acidosis. Which of the following results should the nurse expect to see?
With acidosis, the pH is below 7.35
With metabolic acidosis, the HCO3 is below 21 mEq/L.
What are some causes of respiratory acidosis?
It can be the result of respiratory depression, seen with anesthesia or opioid administration; inadequate chest expansion, due to a weakness of the respiratory muscles or constriction to the thorax; an obstruction of the airway, seen in aspiration, bronchoconstriction, or laryngeal edema; or from an inability of the lungs to adequately diffuse gases (O2 and CO2), resulting from conditions such as pneumonia, COPD, chest trauma, or pulmonary emboli.
A nurse is caring for a client who has metabolic alkalosis. For which of the following clinical manifestations should the nurse monitor?
Bicarbonate excess
Circumoral paresthesia
Dizziness
A nurse is planning care for a client who has pernicious anemia. Which of the following interventions should the nurse plan to implement?
The nurse should administer vitamin B12 injections to treat pernicious anemia when diet fails to improve the anemia due to poor absorption.
The nurse is caring for a postoperative client with a nasogastric tube and orders for 0.9% normal saline at 100 mL/hr. The primary purpose of this solution is to:
A. Replace intracellular fluid losses
B. Expand extracellular volume and replace sodium losses
C. Draw water out of cells into the bloodstream
D. Provide free water to the body
Expand extracellular volume and replace sodium losses
Rationale: Isotonic solutions (0.9% NS, LR) stay in the intravascular space and are used for volume replacement without causing fluid shifts between compartments.
pH 7.28, HCO3- 18 mEq/L, and PaCO2 36 mm Hg. Which of the following conditions should the nurse anticipate when interpreting these findings?
Metabolic acidosis
What is Metabolic acidosis?
Metabolic alkalosis occurs when there is an alteration in the level of HCO3 along with an increase in the pH of the blood.
The nurse recognizes which of the following as a manifestation of hypokalemia?
Hypokalemia (low serum potassium, usually < 3.5 mEq/L) affects muscles, the heart, and nerves.
Neuromuscular Symptoms
Muscle weakness (starts in the legs, may progress upward)
Fatigue or lethargy
Muscle cramps or twitching
Decreased reflexes (hyporeflexia)
Paresthesias (tingling or numbness)
❤️ Cardiac Symptoms
Irregular heart rhythm (arrhythmias) — especially dangerous in cardiac patients or those on digoxin
Weak or thready pulse
ECG changes:
Flattened T waves
Appearance of U waves
ST depression
Prolonged QT interval
💩 Gastrointestinal Symptoms
Decreased bowel motility
Constipation
Nausea, vomiting
Abdominal distention
🫁 Respiratory Symptoms
Shallow respirations due to weakened respiratory muscles (in severe cases)
A nurse is caring for a client who reports weakness, fatigue, and heavy menstrual periods. The client has a hemoglobin level of 8 g/dL and a hematocrit level of 28 g/dL. The nurse suspect which of the following types of anemia?
Iron-deficiency anemia
Iron-deficiency anemia results from poor gastrointestinal absorption of iron, a diet that is deficient in iron, or blood loss. The nurse should expect a client who has iron-deficiency anemia to have weakness, pallor, fatigue, reduced tolerance for activity, and cheilosis (ulcerations of the corners of the mouth).
A patient with severe hyponatremia is prescribed 3% sodium chloride IV. The nurse should monitor closely for which potential complication?
A. Hypotension
B. Pulmonary edema
C. Dehydration of cells
D. Bradycardia
B. Pulmonary edema
Rationale: Hypertonic solutions pull fluid out of cells into the intravascular space, which can cause vascular volume overload and lead to pulmonary edema. Monitor lungs and vital signs closely.
What are clinical manifestations of Metabolic Acidosis?
Manifestations of metabolic acidosis include diarrhea, circulatory shock, decreased level of consciousness, abdominal pain, cardiac dysrhythmia, and increased depth and rate of respirations.
What are causes of metabolic alkalosis?
It can be the result when a client ingests too much antacid from blood transfusions or total parenteral nutrition. It can also occur if the client has prolonged vomiting or NG suction, takes thiazide diuretics, or has a metabolic disorder such as hypercortisolism or hyper aldosteronism.
What are symptoms of Hyponatremia (serum sodium < 135 mEq/L)
Causes fluid to shift into cells, leading to cellular swelling, especially in the brain.
Neurological (most significant)
Headache
Confusion
Lethargy
Apprehension or restlessness
Seizures
Coma (in severe cases, Na < 120 mEq/L)
Altered level of consciousness due to cerebral edema
💖 Cardiovascular
Postural hypotension
Weak, rapid pulse
Decreased blood pressure (especially in hypovolemic hyponatremia)
Bounding pulse or hypertension (in hypervolemic hyponatremia)
🩸 Musculoskeletal
Muscle weakness
Muscle cramps or twitching
Decreased deep tendon reflexes
💧 Gastrointestinal
Nausea and vomiting
Abdominal cramping
Diarrhea
Sickle cell anemia patho...
Sickle cell anemia is an autosomal recessive disorder in which the RBCs develop a sickle shape following conditions in which decreased oxygen is available. These sickled cells then clump together and become fragile, causing tissue ischemia leading to eventual organ damage.
What is Erythropoiesis?
The process of red blood cell (RBC) production.
It occurs primarily in the red bone marrow of flat bones (sternum, ribs, pelvis, vertebrae) and the ends of long bones.
What would a client who has diarrhea would have.....
Diarrhea can cause metabolic acidosis due to the loss of bicarbonate.
What is Respiratory alkalosis?
Respiratory alkalosis occurs when there is an excessive loss of CO2 through hyperventilation, mechanical ventilation, fever, overdose of salicylates, or lesions to the central nervous system.
Nursing considerations for Severe/Acute Hyponatremia
(<120 mEq/L)
Cerebral edema
Seizures
Respiratory arrest
Death if untreated
Clinical Manifestations of Sickle Cell Anemia
Manifestations of sickle cel anemia include pain, pallor, cyanosis, dyspnea, fatigue, and weakness.
What is Erythropoietin?
A hormone produced by the kidneys in response to hypoxia (low O₂ levels).
Stimulates the bone marrow to increase RBC production.
The liver produces small amounts as well.