Question

The client is admitted with a \(\mathrm{pH}\) of \(7.48\), a \(\mathrm{HCO}_3\) level of \(34 \mathrm{mEq} / \mathrm{L}\), and a \(\mathrm{CO}_2\) level of \(48 \mathrm{mEq} / \mathrm{L}\). The nurse is aware that these laboratory values reveal: A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory alkalosis D. Respiratory acidosis

Short answer

A. Respiratory acidosis B. Metabolic alkalosis C. Metabolic acidosis D. Respiratory alkalosis

Step-by-step solution

Determine if pH is high or low

The given pH value is 7.48, which is higher than the normal range (7.35-7.45). A high pH indicates alkalosis.

Analyze the HCO3 level

The given HCO3 level is 34 mEq/L, which is higher than the normal range (22-26 mEq/L). A high HCO3 indicates a metabolic factor contributing to alkalosis.

Analyze the CO2 level

The given CO2 level is 48 mmHg, which is higher than the normal range (35-45 mmHg). A high CO2 level indicates a respiratory factor contributing to acidosis.

Identify the primary imbalance

Since pH and HCO3 are both high (alkalosis), and CO2 is high (acidosis), we have a mixed condition. However, since the pH reflects a more alkalotic state, we will consider the primary imbalance to be metabolic alkalosis.

Conclusion

Based on the given laboratory values, the correct answer is: B. Metabolic alkalosis.

Key concepts

Acid-Base Imbalance

Acid-base imbalance is a condition where the levels of acid and base in the blood are not in their normal range. Our body needs to maintain a delicate pH balance for proper function, typically between 7.35-7.45.
In metabolic alkalosis, the pH of the blood is higher than normal, indicating reduced acidity or increased alkalinity. This can result from various factors including excessive loss of stomach acids (vomiting), overuse of diuretics, or excessive bicarbonate intake.

• Alkalosis: Condition where body fluids have excess base (alkali).
• Acidosis: Condition where body fluids contain excess acid.
• Mixed conditions may occur, where both metabolic and respiratory systems are involved.

Understanding the type of acid-base imbalance is critical for determining appropriate treatment. In the case presented, the primary imbalance is metabolic alkalosis, indicated by an elevated pH and increased bicarbonate ( HCO_3 ) level.

Laboratory Values Interpretation

Interpreting laboratory values is crucial for diagnosing acid-base imbalances. In a typical lab report for these imbalances, you will often examine the pH, HCO_3 (bicarbonate), and CO_2 (carbon dioxide) levels to determine the underlying issue.
- **pH:** A measure of acidity or alkalinity. A high pH (> 7.45) signifies alkalosis, while a low pH (< 7.35) indicates acidosis. - ** HCO_3 Levels:** Bicarbonate acts as a buffer in blood. Elevated levels (> 26 mEq/L) suggest metabolic alkalosis. - ** CO_2 Levels:** Carbon dioxide is related to respiratory activity. An increased level (> 45 mmHg) could lead to respiratory acidosis. In our scenario, the high pH and high bicarbonate levels indicate a metabolic origin of alkalosis. The elevated CO_2 level points to a compensatory respiratory mechanism or mixed disorder, hence the term "metabolic alkalosis" for the primary condition.

NCLEX-PN Exam Preparation

Preparing for the NCLEX-PN exam involves understanding key nursing concepts, including acid-base imbalance and their laboratory evaluations. It’s crucial to grasp how to assess and conclude the type of imbalance from given lab values during the exam.
Here are some tips to consider for NCLEX-PN preparation related to acid-base imbalances:

• Understand the normal physiological ranges: Memorize normal ranges for pH, HCO_3 , and CO_2 levels.
• Know the interpretation process: Identify whether the condition is acidosis or alkalosis and determine if it's respiratory or metabolic.
• Practice critical thinking: Apply this knowledge to various clinical scenarios to determine the primary imbalance.
• Use practice tests: Regular practice with NCLEX-PN style questions to build confidence and speed in problem-solving.

This holistic approach to these topics will prepare you for not just the theoretical aspects, but also practical scenarios in nursing, elevating your readiness for the exam.