31. A client presents to an emergency department complaining of pain on the left side and shortness of breath. Vital signs are: BP 140/80 mm Hg; P 110, and R 44. The client's ABG results are: pH 7.5, PaCO2 30 mm Hg; and HCO3 22 mEq/L, SaO2 86%, PaO2 64 mm Hg. A nurse should recognize that these symptoms are consistent with:
. Possible trauma to the chest wall.
. Possible pneumonia.
. Possible pulmonary embolism.
. Possible acute pulmonary edema.
Test-Taking Tip
Eliminate those conditions that produce respiratory acidosis.
Content Area: Adult Health, Respiratory; Integrated Process: Nursing Process, Analysis; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Reduction of Risk Potential/Laboratory Values
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Answer 1 is incorrect because chest trauma would likely result in respiratory acidosis (pH below 7.35 and CO2 above 45), not alkalosis. Answer 2 is incorrect because pneumonia would likely result in respiratory acidosis (pH below 7.35 and CO2 above 45), not alkalosis. Answer 3 is correct because the ABGs show respiratory alkalosis (pH above 7.45 and CO2 below 35) and a problem with hypoxemia (O2 Sat below 96%) from rapid respirations. The vital signs and symptoms are consistent with a pulmonary embolism, which interferes with exchange of O2. Client hyperventilates, blowing off CO2. Answer 4 is incorrect because pulmonary edema would likely result in respiratory acidosis (pH below 7.35 and CO2 above 45), not alkalosis.