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A patient's ABG shows: pH 7.32. PaCO2 50 mmHg. HCO3 24 mEq/L. What is the correct diagnosis?

A.

Metabolic acidosis

B.

Respiratory acidosis

C.

Respiratory alkalosis

D.

Metabolic alkalosis

Answer and Explanation

The Correct Answer is B

A. Metabolic acidosis would be indicated by a low pH and a low HCO3, which is not present in this case since HCO3 is normal.  

 

B. The pH of 7.32 indicates acidemia, and a PaCO2 of 50 mmHg suggests respiratory acidosis as the body is retaining carbon dioxide, contributing to the low pH. The HCO3 is normal, indicating that there is no metabolic compensation occurring.  

 

C. Respiratory alkalosis would show a high pH and low PaCO2, which is not the case here.  

 

D. Metabolic alkalosis would present with a high pH and elevated HCO3, which is also not present in these ABG results.


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Correct Answer is D

Explanation

A. Encouraging oral intake may not be effective due to the patient's likely need for more rapid rehydration given his low blood pressure and heart rate.

B. A potassium-sparing diuretic is inappropriate in this situation, as the patient is already experiencing fluid loss and requires rehydration, not diuresis.

C. Restricting fluid intake would be contraindicated as the patient is in a state of dehydration and hypotension.

D. Administering an IV bolus of normal saline is the priority intervention to quickly restore fluid volume and improve blood pressure and hydration status.

Correct Answer is C

Explanation

A. Obstructive shock occurs when blood flow is physically obstructed, such as in cases of pulmonary embolism or cardiac tamponade, which is not indicated here as the cause is blood loss.

B. Septic shock is related to infection and systemic inflammatory response, not directly caused by blood loss.

C. Hypovolemic shock is caused by a significant loss of blood volume, leading to decreased blood pressure, which directly relates to the client losing 800 mL of blood during surgery. This condition results in inadequate perfusion and oxygen delivery to tissues.

D. Neurogenic shock results from spinal cord injuries leading to vasodilation and bradycardia, which is not applicable to this scenario.

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