NORCET 9 Mains - 2025
Medical & Surgical Nursing
Medium
In COPD, the arterial blood gas (ABG) imbalance commonly shows:
Appeared in: NORCET 9 Mains - 2025
Explanation
- COPD is characterized by chronic airflow limitation, which impairs the ability to exhale effectively.
- This leads to the retention of carbon dioxide (CO2), an acidic gas, in the blood—a condition called hypercapnia.
- An elevated level of CO2 (PaCO2) directly lowers the blood pH, resulting in a state of respiratory acidosis.
- In chronic COPD, the kidneys compensate by retaining bicarbonate (HCO3−) to buffer the excess acid, leading to compensated respiratory acidosis.
Why Other Options Were Wrong
- Option A: Respiratory alkalosis is caused by hyperventilation, where too much CO2 is exhaled. This is the opposite of the gas exchange problem in advanced COPD.
- Option C: Metabolic alkalosis is a primary disturbance in bicarbonate levels, not CO2. It is not directly caused by the respiratory dysfunction seen in COPD.
- Option D: Metabolic acidosis is caused by a primary loss of bicarbonate or an increase in metabolic acids. While a COPD patient can develop this for other reasons, it is not the characteristic imbalance of COPD itself.
Related Visual
Clinical Relevance
- Nursing practice connection: Knowing Arterial Blood Gas (ABG) interpretation in Chronic Obstructive Pulmonary Disease (COPD) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
- Nurses must be cautious when administering oxygen to patients with chronic CO2 retention. High-flow oxygen can diminish their hypoxic drive to breathe, worsening hypercapnia. The target SpO2 is often lower, typically 88-92%.
- Monitoring for signs of worsening respiratory acidosis (CO2 narcosis) is critical. Key signs include confusion, lethargy, headache, and drowsiness, which can progress to coma.
- What if? A patient with known COPD is admitted with severe diarrhea. The nurse should anticipate a potential mixed acid-base disorder: the underlying chronic respiratory acidosis from COPD combined with a new metabolic acidosis from the loss of bicarbonate in the stool.
How to Approach the Question
- First, identify the core disease process mentioned in the question: COPD.
- Recall the primary pathophysiology of COPD, which is chronic airflow obstruction, making it difficult to exhale.
- Connect this pathophysiology to its effect on gas exchange. Difficulty exhaling leads to the trapping and retention of carbon dioxide (CO2).
- Remember the acid-base properties of CO2. In the blood, CO2 acts as an acid.
- Combine these facts: If the body is retaining an acid (CO2) due to a lung (respiratory) problem, the resulting imbalance must be respiratory acidosis.
- Evaluate the options based on this conclusion, eliminating those that involve alkalosis or a primary metabolic cause.
Concept Tested & Keywords
- Concept Tested: Arterial Blood Gas (ABG) interpretation in Chronic Obstructive Pulmonary Disease (COPD).
- Stem keywords: COPD, arterial blood gas, ABG, imbalance
- Lead-in keywords: commonly shows
- Negative lead-in flag: false
Question ID
QV-HuzRETtDASQM51teCZc
Reference Book
E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 56-58
E6 Textbook of Biochemistry for medical StudentsDM Vasudevan Part 2 — Subpart A (pp 1-239 of 478) p. 82-84
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