Walkthrough: Physiological Adaptation Q2 – NCLEX-RN®

00:01 The nurse cares for an older adult client diagnosed with a history of emphysema.

00:05 The client reports fatigue, confusion, and a headache.

00:09 Respirations are 26 breaths per minute. Respiratory acidosis is suspected.

00:14 So which arterial blood gas value would be present for this condition? Select all that apply. Now, wait a minute.

00:22 Before we look at the answer choices, don't jump too quickly.

00:25 Let's make sure we're absolutely clear what the question is asking us.

00:29 So I know what's particular about this client is they're older.

00:32 They have a history of emphysema.

00:35 So they have COPD because emphysema is part of COPD. The client reports.

00:42 Hey, whatever comes after this is always important in an NCLEX question.

00:46 So what is the client reporting? Because the client is the center, always the most important.

00:53 So they're telling us they're fatigued. That's not normal.

00:56 Confusion, that's not normal. And a headache, that's not normal assessment.

01:02 So starting to think in your brain, does fatigue, confusion, and a headache, how is that related to emphysema? Because think about what's going on in that patient's lungs with emphysema.

01:13 Remember, emphysema is those blown up alveoli, so not really efficient gas exchange.

01:20 Respirations are 26 breaths a minute. Okay. That's higher than normal.

01:26 So that's another normal assessment. Respiratory acidosis.

01:31 We know from interpreting AVGs that with respiratory acidosis, what kind of values would we suspect in an arterial blood gas? Really, we're not ready to look at the answer choices yet.

01:44 You know the three main parts of an ABG that we're going to look at are pH, CO2 and bicarb.

01:51 Before you look at the answer choices, see if you can jot down what the normal values are for each one of those three.

02:00 Okay. Ready? Now, let's look at the answer choices.

02:11 Now, we're going to be able to sort this out. So we know it's a respiratory acidosis.

02:15 And really, that's what the question is asking us.

02:18 Now, we have this extra information about emphysema and respiratory rate and these complaints.

02:24 That's just some extra information.

02:26 We can boil this down to which of these lab results would we expect on ABGs for a patient who we think is in respiratory acidosis. So a paO2 of 72.

02:39 What do you have down as normal for that? Oh, that's one we didn't cover.

02:43 All right. PaO2 normal is 80 to 100.

02:48 So would you expect a lower than normal PaO2 for a patient who's in respiratory acidosis.

02:54 Yes, I would. That would not surprise me.

02:58 What about number two? A PaCO2 of 48 millimeters of mercury.

03:03 Now, what did you put down as normal? Usually, it's around 35 to 45.

03:10 Remember, every lab can be different, but you always have those values on the lab results.

03:14 On this one, that's higher than normal.

03:18 So that means I'm not getting rid of as much CO2 as I need to. And CO2 is like an acid in the blood.

03:26 So extra CO2 would push me towards acidosis.

03:30 So, yeah. I would expect number two. So, so far, I've selected number one and number two.

03:36 Let's look at number three. A pH of 7.31.

03:42 All right. What did you write down as a normal value? Usually around 7.35 to 7.45.

03:49 This one is lower than normal. And that means it's more acidic.

03:54 So in respiratory acidosis, would I expect a pH that's acidotic? Yeah. I would. Whoa, wait a minute. Okay. So, so far, I've selected one, two, and three.

04:06 That seems like an awful lot to pick in a select all that apply question.

04:11 Remember, it doesn't matter. In the NCLEX on any question that is a select all that apply, you can have a range of one to five of the answers, all of them being correct.

04:23 So if there was six options up there, one through six could be correct or anything in between.

04:29 So don't shoot yourself in the foot as we say.

04:32 Don't try and gauge, is this enough answers or not enough? Because that has no bearing on getting the question correct.

04:39 So one, two, and three were rock solid. We've got it.

04:43 We've circled them on our write on, wipe off board. Now, we're pressing on to number four.

04:47 Bicarb of 20. Well, let's see. A bicarb of 20 is at high, low, or normal? Well, normal bicarb is roughly 22 to 26. This is a little on the low end.

05:02 If they're in respiratory acidosis, I would expect that they'd at least be normal, or if the body is compensating, it would be higher than normal, because bicarb is a base and the body we try to compensate when it's ready to compensate, it would bring that up. So I would not anticipate this being lower.

05:22 Number five, a pH of 7.46. Well, that's higher than normal and that would also be alkalotic, not acidosis like the stem of the question. So I've selected one, two, and three.

05:38 Does that make sense? Remember, you do the last run-through. A low O2? Yup.

05:44 That makes sense with respiratory acidosis. A high CO2, does that make sense? Sure does.

05:49 A low pH that indicates acidosis? Excellent. Bicarb of 20? Yeah. I would expect it to be somewhat in normal, but they didn't tell us it was compensated, so, yeah, no. No. I'm eliminating that, pH of 7.46.

06:04 That's an alkalotic pH, so one, two, three is my answer and I'm ready for the next question.