NCLEX-RN PRACTICE QUESTION/ABG

NCLEX-RN REVIEW QUESTION:

The arterial blood gasses of a patient with severe chronic obstructive pulmonary disease (COPD) are: 
pH 7.34, PaO2 80mmHg, PaCO2 47mmHg,HCO3 28mEq/L. 

Based on these findings, what is the priority action of the nurse?
1. Administer oxygen 4L/minute via mask.
2. No action is required at this time.
3. Administer an IV corticosteroid.
4. Perform vigorous suctioning

HINTS:

Look at the pH to determine if the value is normal, basic, or acidic.

Look at the HCO3−level. Is it higher or lower than normal?

What about the patient’s history makes you think there may be an alteration in the pH?

Are there some conditions where the patient normally has an altered blood gas result?

This patient has mild respiratory acidosis which can be normal for a patient with COPD. No action is needed. A patient may only be mildly hypoxic in the early stages of COPD, but as the disease progresses, increasing hypoxia stimulates hyperventilation and respiratory alkalosis. In later stages, chronic CO2 retention and respiratory acidosis occurs. Also remember that the administration of oxygen to a patient with COPD can cause a depression in the respiratory drive.

CORRECT ANSWER: 2