A nurse is reviewing the ABG results of a client who has COPD. The results include a pH of 7.3 (7.35 to 7.45), PaO2 56 mm Hg (80 to 100 mm Hg), PaCO2 54 mm Hg (35 to 45 mm Hg), HCO3- 26 mEq/L (21 to 28 mEq/L), and SaO2 87%. Which of the following is the correct interpretation of these values?
Compensated metabolic acidosis
Compensated respiratory acidosis
Uncompensated respiratory acidosis
Uncompensated metabolic acidosis
The Correct Answer is C
Rationale:
A. Compensated metabolic acidosis would show a normal pH with a decrease in HCO3- and a decrease in PaCO2.
B. Compensated respiratory acidosis would show a normal pH with an elevated PaCO2 and a compensatory increase in HCO3-.
C. The low pH indicates acidosis, and the elevated PaCO2 suggests that it is respiratory in origin, with the HCO3- remaining normal, indicating no compensation has occurred yet.
D. Uncompensated metabolic acidosis would present with a low pH, low HCO3-, and normal PaCO2.
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Correct Answer is B
Explanation
Rationale:
A. Arterial blood gases (ABGs) are typically used to assess respiratory function and acid-base balance, which are not primary concerns with valproic acid use.
B. Serum liver enzyme levels are critical to monitor due to the risk of hepatotoxicity associated with valproic acid therapy, making this test essential for safe management.
C. A chest X-ray is generally used to assess respiratory conditions, not relevant for monitoring the effects of valproic acid.
D. Urine culture and sensitivity are used to diagnose urinary tract infections and are not relevant to the monitoring of valproic acid therapy.
Correct Answer is B
Explanation
Rationale:
A. A quick inhalation is not the correct technique; the child should take a slow, deep breath in while pressing down on the inhaler to ensure effective medication delivery.
B. Taking the medication 15 minutes before playing sports allows time for the medication to take effect, making this the best choice.
C. The mouthpiece should be cleaned more frequently, typically after each use, to prevent buildup of medication and bacteria.
D. Waiting 10 seconds between inhalations is generally advised; however, the more important instruction here is the timing of medication before sports.