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Practice Question

A nurse is caring for a client who has just experienced a "second tonic-clonic seizure. The blood gas values are pH 6.88, Pa02 SO PaC02 60 mmHg, and HC03 22mEq/L Which action should the nurse take first?

Answer Choices:

Correct Answer:

Apply oxygen by mask or nasal cannula

Rationale:

🔵 The pH of 6.88 and PaCO₂ of 60 mmHg indicate respiratory acidosis, likely due to inadequate ventilation following the seizure.

🔵 The client’s hypoxia (PaO₂ of 50) suggests that the first priority should be improving oxygenation to prevent further respiratory distress or brain damage.

🔵 Applying oxygen via mask or nasal cannula will help increase oxygen levels and improve the pH by reducing CO₂ retention.

🔵 Immediate oxygenation is more critical than administering sodium bicarbonate, which can be considered later if acidosis persists.

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This question is from NUR 133~Acid-base & Electrolytes Exam 2 which contains 74 questions.

More Questions from This Exam
During a change-of-shift report, a nurse sees that a client’s IV bag of 0.9% sodium chloride has 909 mL of fluid left in it. The nurse makes rounds 30 min later and notes that the IV bag is empty. Which of the following actions should the nurse take?

Answer Choices:

A. Elevate the head of the bed to high Fowler's.
B. Check the client’s respiratory rate and lung sounds
C. Measure the client's temperature.
D. Request NPO status for the client.
Interpret the following. ABG: pH 7.49, pC02 30 mmHg, HC03 23 Meq/L, Pa02 96 mmHg SaO2 98%

Answer Choices:

A. respiratory alkalosis
B. respiratory acidosis
C. metabolic acidosis
D. metabolic alkalosis
Interpret the ABG: pH 7.41. PaCO2 45mmHg. HCO3 26. PaO2 84 mmHg. SaO2 normal ABG

Answer Choices:

A. normal ABG
B. metabolic alkalosis
C. respiratory acidosis
D. respiratory alkalosis
The nurse is aware that the compensating mechanism that is most likely to occur in the presence of respiratory acidosis is:

Answer Choices:

A. Retention of HCO₃ by the kidneys to increase the PH level
B. Hypoventilation to increase the CO₂ levels
C. Excretion of HCO₃ by the kidneys to decrease PH Level
D. Hyperventilation to decrease the CO₂ levels.
From Exam
NUR 133~Acid-base & Electrolytes Exam 2

74 Questions

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Question Details
  • Category: RN Nursing Exam(s)
  • Subcategory: ATI Exam(s)
  • Domain: Fluids and Electrolytes
  • Answer Choices: 4
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