RN Nursing · Electrolyte Imbalances · Practice question
A nurse is reviewing a client’s laboratory report of arterial blood gas (ABG) findings: pH 7.28, HCO₃⁻ 18 mEq/L, and PaCO₂ 36 mm Hg. Which of the following conditions should the nurse anticipate when interpreting these findings?
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Respiratory alkalosis
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Metabolic alkalosis
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Respiratory acidosis
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✓
Metabolic acidosis
Answer & explanation
Correct: Metabolic acidosis
Interpreting arterial blood gases requires a systematic approach. First, evaluate the pH: 7.28 is below the normal range of 7.35–7.45, indicating acidosis. Next, examine the respiratory component, PaCO₂: at 36 mm Hg it is within the normal range of 35–45 mm Hg, ruling out a respiratory cause. Then examine the metabolic component, HCO₃⁻: at 18 mEq/L it is below the normal range of 22–26 mEq/L, confirming a metabolic origin. Because the pH is acidotic, the PaCO₂ is normal, and the bicarbonate is low, this picture is consistent with metabolic acidosis. Respiratory acidosis would show an elevated PaCO₂ with a low pH. Metabolic alkalosis would show an elevated pH with a high HCO₃⁻. Respiratory alkalosis would show an elevated pH with a low PaCO₂. Common causes of metabolic acidosis include diabetic ketoacidosis, renal failure, severe diarrhea, and lactic acidosis — the nurse should anticipate further evaluation to identify the underlying cause and initiate appropriate treatment.
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