NORCET 3 - 2022 (Shift-2)
Medical & Surgical Nursing
Medium
Which of the following finding suggest to respiratory acidosis?
Appeared in: NORCET 3 - 2022 (Shift-2)
Explanation
- Respiratory acidosis is defined by a pH below 7.35 and a PaCO₂ above 45 mmHg, indicating that the lungs are retaining too much CO₂.
- The values pH 7.28 (acidic) and PaCO₂ 47 mmHg (high) directly match the criteria for respiratory acidosis.
- The elevated HCO₃ of 27 mEq/L indicates that the kidneys have started to compensate by retaining bicarbonate to buffer the excess acid.
Why Other Options Were Wrong
- Option A: This represents respiratory alkalosis, as the pH is high (alkalotic) and the PaCO₂ is low, indicating hyperventilation.
- Option C: This indicates metabolic acidosis. The pH is low (acidic), but the cause is a low bicarbonate (HCO₃) level, not a high PaCO₂.
- Option D: This suggests compensated metabolic alkalosis. The pH is at the high end of normal, and the HCO₃ is elevated, which is the primary disturbance.
Related Visual
- Visual 1: Infographic: A chart showing the four primary acid-base imbalances (respiratory/metabolic acidosis/alkalosis) with their corresponding changes in pH, PaCO₂, and HCO₃.
- Visual 2: Flowchart: A step-by-step guide for ABG interpretation, starting with checking the pH, then PaCO₂, then HCO₃, and finally assessing for compensation.
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Arterial Blood Gas (ABG) interpretation and identification of respiratory acidosis as background academic context rather than a clinical decision trigger.
- Nurses must be able to rapidly interpret ABG results to identify life-threatening conditions like respiratory acidosis and intervene appropriately by addressing the underlying cause of hypoventilation.
- Key nursing actions for a patient with respiratory acidosis include assessing respiratory status, elevating the head of the bed, encouraging deep breathing and coughing, and administering bronchodilators or reversing sedatives as ordered.
- What if? If the patient in option B had a PaCO₂ of 55 mmHg and a pH of 7.20, it would indicate a more severe, uncompensated respiratory acidosis, requiring more urgent intervention like mechanical ventilation.
How to Approach the Question
- This is an analytical (lab data interpretation) question. The goal is to match a set of lab values to a specific diagnosis.
- Step 1: Recall the normal ranges for pH (7.35-7.45), PaCO₂ (35-45 mmHg), and HCO₃ (22-26 mEq/L).
- Step 2: Analyze the pH first. A value below 7.35 is acidosis. A value above 7.45 is alkalosis.
- Step 3: Determine the cause using the ROME mnemonic (Respiratory Opposite, Metabolic Equal). For respiratory acidosis, the pH will be low (acidosis) and the PaCO₂ will be high (opposite direction).
- Step 4: Evaluate each option against this rule. Option A is alkalosis. Option C is metabolic acidosis. Option D is metabolic alkalosis. Option B has a low pH and high PaCO₂, fitting the definition of respiratory acidosis.
- Step 5: Check for compensation. An abnormal HCO₃ in the opposite direction of the pH change for a respiratory problem indicates compensation is occurring.
Concept Tested & Keywords
- Concept Tested: Arterial Blood Gas (ABG) interpretation and identification of respiratory acidosis.
- Stem keywords: respiratory acidosis, finding, pH, PaO₂, PaCO₂, HCO₃
- Lead-in keywords: Which
- Negative lead-in flag: false
Question ID
Qy6rURwP0f0IzKdOgjNpsB
Practise the full NORCET 3 - 2022 (Shift-2)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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