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Chapter 6: Blood Gases and Related Tests
Test Bank
MULTIPLE CHOICE
1. If a patient has a fever of 40° C, the pH, as measured by an automated blood gas analyzer,
will be which of the following?
a. Higher than measured at 37° C
b. Lower than measured at 37° C
c. Unchanged with temperature correction
d. Dependent on the corrected PO2
ANS: B
PF Tip: Blood gas analyzers usually report blood gas values at 37° C. If the patient has an
extreme body temperature (hypothermia or hyperthermia), correction may be useful. At low
body temperatures, more gas dissolves in the blood, so PO2 and PCO2 show lower values
when exposed to electrodes that measure their activity. At elevated temperatures, the
opposite occurs; less gas dissolves and partial pressures appear higher. The pH changes in
relation to PCO2.
2. Before drawing a specimen for blood gas analysis from the radial artery, the modified
Allen’s test should be performed. Collateral circulation is adequate if the hand is reperfused
within _____ seconds.
a. 1 to 2
b. 10
c. 30 to 40
d. Less than 60
ANS: B
Allen’s test: The ulnar artery is released while the radial remains occluded. The hand should
be reperfused rapidly (within 5–15 seconds).
3. A blood gas syringe is prepared using liquid heparin. A volume of 0.5 ml of heparin solution
is left in the syringe, and a 1.5-ml specimen is obtained. Which of the following problems
will occur with this specimen?
a. The pH will be more acidotic than expected.
b. The PCO2 will be lower because of dilution.
c. The PO2 will be greater than 150 mm Hg.
d. Calculated HCO3– will be higher because of changes in PCO2.
ANS: B
Contamination by solution may affect PO2 and PCO2 values by dilution.
DIF: 3 REF: p. 160 OBJ: EL-3
MSC: NBRC: CPFT 2C-4
4. A patient complaining of shortness of breath has the following blood gases obtained on an
FIO2 of 0.21:
pH 7.28
P CO2 51 mm Hg
PO2 55 mm Hg
–
HCO3 25.8 mEq/L
BE 2.1 mEq/L
O2Hb 82%
Which of the following best describes the acid-base status of this patient?
a. Metabolic acidosis
b. Respiratory acidosis
c. Compensated metabolic alkalosis
d. Partially compensated respiratory alkalosis
ANS: B
See Interpretive Strategies 6-1, Chapter 6.
6. A patient is referred for arterial blood gas testing. She has an SpO2 of 84% by pulse
oximetry, but blood oximetry reveals an SaO2 of 94%. Which of the following best explains
the difference between results?
a. The patient may be severely anemic (Hb less than 8 g/dl).
b. The patient may have respiratory alkalosis (hyperventilation).
c. The patient may have an elevated COHb level.
d. The pulse oximeter reading may have been in error.
ANS: D
See Criteria for Acceptability 6-2, Chapter 6.
7. A subject referred for shortness of breath has the following arterial blood gas test results:
pH 7.46
PaCO2 34
PaO2 57
–
HCO3 22
9. A patient is connected to a 12-lead ECG monitor and pulse oximeter before an exercise test.
The HR displayed by the ECG monitor is 97; the pulse oximeter reads an HR of 141 with an
SpO2 of 85%. Which of the following would be the most appropriate action?
a. Move the pulse oximeter sensor to an alternate site.
b. Check all ECG lead wires for a good connection.
c. Obtain an arterial blood gas sample as quickly as possible.
d. Document the readings and proceed with the test.
ANS: A
See Criteria for Acceptability 6-2, Chapter 6.
Shunt calculation
11. When the pH falls from 7.40 to 7.10, with no change in the PCO2 , the concentration of H+
has:
a. Decreased by half
b. Increased twofold
c. Changed by 0.3 mEq/L
d. Decreased to 45 mEq/L
ANS: B
If the pH decreases from 7.40 to 7.10 with no change in PCO2, the concentration of
hydrogen ions has doubled.
12. A subject who displays the signs and symptoms of severe hypoxemia has the following
blood gases:
pH 7.44
PCO2 36 mm Hg
PO2 83 mm Hg
SaO2 94%
COHb 1.7%
Hb 7.3 g/dl
13. What is the C(a – )O2 in a patient with the following arterial and mixed venous blood
gases?
Arterial Mixed Venous
Hb (g/dl) 15.1 15.1
Saturation (%) 92 70
PO2 (mm Hg) 73 39
a. 3.01 vol%
b. 3.92 vol%
c. 4.55 vol%
d. 5.11 vol%
ANS: C
Calculation: CaO2 = (92 1.34) +73 0.0031
C O2 = (73 1.34) + 39 0.0031
16. The following serial blood gases are obtained from the same patient breathing room air:
9:10 AM 9:20 AM
pH 7.39 7.38
PCO2 (mm Hg) 41 26
PO2 (mm Hg) 92 109
Hb (g/dl) 14.4 11.5
Which of the following best explains these results?
a. The subject was hyperventilating.
b. Supplementary O2 was started on the subject between blood gases.
c. The second sample was contaminated with heparin solution.
d. The first sample contained air bubbles.
ANS: C
See Interpretive Strategies 6-2, Chapter 6.
18. Which of the following can cause a profound decrease in the concentration of expired CO2?
1. Pulmonary embolization
2. Pulmonary shunting
3. Decreased minute ventilation
4. Decreased cardiac output
a. 1 and 3
b. 2 and 4
c. 1 and 4
d. 2 and 3
ANS: C
Analysis of the individual CO2 waveforms, along with PaCO2, may help identify abrupt
changes in dead space. This can be useful in detecting pulmonary embolization or reduced
cardiac output.
19. Measurement of oxygen saturation by pulse oximetry may produce an erroneous reading in
the presence of:
a. Increased concentration of Hb
b. Shivering
c. Metabolic acidosis
d. Respiratory alkalosis
ANS: B
See Box 6-2, Chapter 6.
20. A patient with a pulmonary artery (Swan-Ganz) catheter in place has the following blood
gas results while breathing 100% O2 at a barometric pressure of 750 mm Hg:
Arterial Mixed Venous
PO2 (mm Hg) 377 44
PCO2 (mm Hg) 40 46
Saturation (%) 100 76
Hb 14.2 14.2
What is the approximate percentage of shunt in this subject?
a. 6%
b. 8%
c. 13%
d. 16%
ANS: B
Shunt calculation
21. Which of the following can cause inaccurate measurement in arterial blood gas testing?
1. Protein contamination
2. Inadequate mixing of the sample
3. Rupture of membranes
4. Bicarbonate buffer mistakenly placed in the PCO2 electrode jacket
a. 1 and 3
b. 1, 2, and 3
c. 1, 3, and 4
d. 1, 2, 3, and 4
ANS: B
Technical problems with blood gas electrodes and related measuring devices include
contamination by protein or blood products listed in Box 6-1 (see Chapter 6).
22. A patient has the following blood gas results performed on room air:
pH 7.45
PCO2 35 mm Hg
PO2 109 mm Hg
Hb 15 g/dl
O2Hb 97%
These results are best described as:
a. Respiratory alkalosis
b. Metabolic alkalosis
c. Normal
d. Physiologically impossible
ANS: D
See Interpretive Strategies 6-1, Chapter 6.
23. A 67-year-old patient complaining of shortness of breath has the following blood gases
obtained on an FIO2 of 0.21:
pH 7.38
PCO2 63 mm Hg
PO2 58 mm Hg
–
HCO3 32 mEq/L
O2Hb 92%
Which of the following best describes the acid-base status of this patient?
a. Mild hypoxemia
b. Respiratory acidosis with hypoxemia
c. Compensated respiratory acidosis with mild hypoxemia
d. Partially compensated respiratory alkalosis
ANS: C
See Interpretive Strategies 6-1, Chapter 6.
24. A 55-year-old male with a history of diabetes complaining of shortness of breath has the
following blood gases obtained on an FIO2 of 0.21:
pH 7.28
PCO2 30 mm Hg
PO2 102 mm Hg
–
HCO3 10 mEq/L
O2Hb 96%
Which of the following best describes the acid-base status of this patient?
a. Compensated metabolic acidosis
b. Respiratory acidosis
c. Compensated metabolic alkalosis
d. Partially compensated metabolic acidosis
ANS: D
See Interpretive Strategies 6-1, Chapter 6.
25. A 28-year-old lethargic female is admitted to the emergency department and has the
following blood gases obtained on an FIO2 of 0.21:
pH 7.24
PCO2 60 mm Hg
PO2 70 mm Hg
–
HCO3 25.9 mEq/L
BE 1.1 mEq/L
O2Hb 83%
Which of the following best describes the acid-base status of this patient?
a. Metabolic acidosis
b. Respiratory acidosis
c. Compensated metabolic alkalosis
d. Partially compensated respiratory acidosis
ANS: B
See Interpretive Strategies 6-1, Chapter 6.
26. A patient complaining of shortness of breath has the following blood gases obtained on an
FIO2 of 0.21:
pH 7.42
PCO2 28 mm Hg
PO2 50 mm Hg
–
HCO3 18 mEq/L
O2Hb 86%
Which of the following best describes the acid-base status of this patient?
a. Respiratory alkalosis
b. Moderate hypoxemia
c. Compensated respiratory alkalosis with hypoxemia
d. Compensated metabolic acidosis with hypoxemia
ANS: C
See Interpretive Strategies 6-1, Chapter 6.
27. A 47-year-old female patient admitted to the emergency department after 5 days of flulike
symptoms had the following blood gases obtained on an FIO2 of 0.21:
pH 7.49
PCO2 42 mm Hg
PO2 92 mm Hg
–
HCO3 29.1 mEq/L
Which of the following best describes the acid-base status of this patient?
a. Metabolic alkalosis
b. Respiratory acidosis
c. Compensated metabolic alkalosis
d. Partially compensated respiratory alkalosis
ANS: A
See Interpretive Strategies 6-1, Chapter 6.
28. A 40-year-old female patient was admitted to the emergency department with shortness of
breath and had the following blood gases obtained on an FIO2 of 0.21:
pH 7.56
PCO2 25 mm Hg
PO2 112 mm Hg
–
HCO3 24 mEq/L
Which of the following best describes the acid-base status of this patient?
a. Metabolic alkalosis
b. Respiratory acidosis
c. Acute respiratory alkalosis
d. Partially compensated respiratory alkalosis
ANS: C
See Interpretive Strategies 6-1, Chapter 6.
29. Which of the following variables are needed to calculate the alveolar air equation?
1. Barometric pressure
2. Fraction of inspired oxygen
3. Partial pressure of carbon dioxide
4. Temperature
a. 1 and 2
b. 2, 3, and 4
c. 1, 3, and 4
d. 1, 2, and 3
ANS: D
Alveolar air equation calculation is (PB – PH2O)FIO2 – PaCO2(1 – FIO2/RQ).
30. A 66-year-old female patient was admitted to the emergency department with shortness of
breath and had the following blood gases obtained on an FIO2 of 0.21:
pH 7.48
PCO2 32 mm Hg
PO2 52 mm Hg
SaO2 86
Hb 16 g
What is the calculated arterial content?
a. 18.6
b. 18.3
c. 17.8
d. 1.34
ANS: A
CaHbO2 = (1.34 SaO2) + (PaO2 0.0031).
31. A patient is admitted to the emergency department with smoke inhalation. The patient is
short of breath, but his color is pink. A pulse oximeter finger probe is placed and reads 94%
with a heart rate of 130. What is the technologist’s interpretation of the data?
1. The subject is well oxygenated.
2. The unit is correctly reading functional oxygen saturation.
3. An arterial blood gas should be obtained.
4. The unit is correctly reading fractional oxygen saturation.
a. 1 only
b. 2 and 3
c. 1 and 4
d. 3 and 4
ANS: B
See Interpretive Strategies 6-1 and Criteria for Acceptability 6-2, Chapter 6.
33. What are the most common wavelengths of light used in pulse oximetry?
a. 600 nm and 760 nm
b. 660 nm and 760 nm
c. 660 nm and 940 nm
d. 600 nm and 940 nm
ANS: C
The relative absorptions at 660 nm (red) and 940 nm of light (near infrared).
These nurseries rest on the clay-like framework of the nest, but are not
attached thereto; they in no way support it, or one another, indeed they
have the appearance of being constantly added to on their upper margins
and constantly eaten away on their under parts. Fig. 240 represents the
appearance of the upper boundary of a nursery taken from a nest of
Termes angustatus. The small white bodies, mentioned above, have
disappeared: the mycelium of the fungus, though not shown in the figure,
is still visible on the specimen from which it was drawn, and gives rise to a
whitish, glaucous appearance.
Termitidae are classed by some naturalists with the Orthoptera, and they
have a great deal in common with some of the cursorial division of that
Order, more particularly Forficulidae and Blattidae; but they differ from
Orthoptera in the nature and form of the wings. They are also classed by
some, with a few other forms, as a separate Order of Pseudo-Neuroptera
called Corrodentia, but this is not a very satisfactory course, as the
Termitidae do not agree closely with the forms associated with them,
while the aggregate so formed is far from being very distinct from other
forms of Neuroptera. On the whole the best plan appears to be to treat
the Termitidae as forming a distinct family of the Order Neuroptera, or to
make it a distinct Order, as proposed by Grassi. Packard now associates
Termites in an Order with the biting-lice, and calls it Platyptera.
The Psocidae are without exception small and soft-bodied Insects, and
are only known to those who are not entomologists by the wingless forms
that run about in uninhabited or quiet apartments, and are called dust-lice
or book-lice. They are perhaps more similar to Termitidae than to any
other Insects, but the two families differ much in the structure of their
wings, and are totally dissimilar in the nature of their lives.
The life-history has never been satisfactorily sketched. The young greatly
resemble the old, but have no ocelli or wings, and sometimes the tarsi are
of two joints, while in the adult they have three. The antennae have also
in these cases a less number of joints in the young stage. The food is
animal or vegetable refuse substances; many live on fungoid matter of
various kinds, mouldy chaff being, it is said, a favourite pabulum; the
mould on palings is a source of food to many; others live on the rust-fungi
of leaves, and many frequent the bark of trees. They are able to spin
webs, probably by the aid of the lingual glands; the eggs are deposited, in
some cases, on leaves and covered with a web. Hagen says that a
peculiar organ, possibly a gland—he calls it a hose[309]—exists at the
base of the tarsal claws. In our climate most of the species pass the
winter in the egg-state. There may be two generations in a year, perhaps
more.
In the young the wings first appear as buds, or outgrowths of the sides of
the meso- and meta-thorax; afterwards the prothorax decreases, while
the other two thoracic segments and the wing-rudiments attached to them
increase. The wings from their very origin appear to be different from
those of the Orthoptera, and the changes that take place in the thoracic
segments in the course of the development, differ from those that occur in
Orthoptera.
Fig. 246.—Micropterous form of Mesopsocus unipunctatus. a, a, Wings.
(After Bertkau.)
There are several peculiarities connected with the wings. Frequently they
exist, though of no use for flight; some Psocidae that have perfectly-
formed wings are so reluctant to use them that, M‘Lachlan says, they will
allow themselves to be crushed without seeking to escape by flight. At
certain periods, however, some Psocidae float on the wing in
considerable numbers, especially in a moist still atmosphere, and then
drift about like the winged Aphididae, which are frequently found with
them. There is evidence that individuals, or generations, of some of the
winged species occur with only rudimentary wings; although this has
been denied by Kolbe, there can be no doubt about it. The form figured
above (Fig. 246) was described by Bertkau[312] as a distinct genus, but
was afterwards recognised by him[313] to be a short-winged form of
Mesopsocus unipunctatus. It is probable that the adult female of this
species has the wings always micropterous, while the male has these
organs of the full size. In other species the condition of the rudimentary
wings seems to be quite constant. The facts concerning the wings of
Psocidae are so peculiar that Kolbe came to the conclusion that the
organs exist not because they are of use for flight, so much as because it
is the nature of an Insect to develop wings.[314]
Some of the species of Psocidae have never any trace of wings. These
apterous forms are mostly included in the division Atropinae, and are
usually very minute; it has been again and again erroneously stated that
they are the young state of winged forms. Hagen kept a large colony of
Atropos divinatoria for some years in confinement, so that he saw
numerous generations as well as many specimens. He found the
apterous condition quite constant.
The Rev. W. Derham, who two hundred years ago was Rector of
Upminster, in Essex, and was well known as a distinguished writer and
philosopher, gave an account of the ticking of death-watches to the Royal
Society.[318] This gentleman was a most accurate and minute observer;
he was well acquainted with the ticking of the greater death-watch—
Anobium—which he describes very accurately, as well as the acts
accompanying it, the details he mentions being exactly such as occur at
the present time. He not only heard the ticking of the Psocid or lesser
death-watch, but repeatedly witnessed it. He says: "I am now so used to,
and skilful in the matter as to be able to see, and show them, beating
almost when I please, by having a paper with some of them in it
conveniently placed and imitating their pulsation, which they will readily
answer." He also states that he could only hear them beating when it was
done on paper, and that this death-watch will tick for some hours together
without intermission, with intervals between each beat, so that it much
resembles the ticking of a watch. The act of ticking was accompanied by
rapping the front of the head on the paper, but Mr. Derham could not be
sure that the sound was produced in that manner, because each stroke
was also accompanied by a peculiar shudder, or recoil. After a prolonged
ticking he observed that another individual of the other sex made its
appearance. The species figured by Mr. Derham more resembles a
Hyperetes than it does either of our two known book-lice, Atropos and
Clothilla.
Fig. 248.—The lesser death-watch of Upminster. (After Derham.) A,
magnified; B, natural size.
Fam. V. Perlidae.
Insects of moderate or large size, furnished with four membranous
wings; these are usually complexly reticulate; the hind pair are much
the larger, and have a large anal area of more simple venation, which
becomes plicate when folded. The coxae are small, the legs widely
separated. The larvae are aquatic in habits; the metamorphosis is
slight.
The antennae of the Perlidae are long, very flexible, and composed of a
very large number of joints. The parts of the mouth vary a good deal. The
mandibles and maxillae are usually rather small, and all the parts of the
mouth are of feeble consistence or even membranous; the maxillary palpi
are, however, well developed and exserted from the mouth, five-jointed.
The labium is short and but little conspicuous. The mandibles in some
forms are almost membranous, but in other genera they are firmer and
are toothed. The labium is composed of a very large mentum, beyond
which is a large piece, usually undivided, bearing the four terminal lobes;
the three-jointed palpus is seated on the side of the large middle sclerite,
which is no doubt of composite nature. Considerable variety as to the
lower lip prevails. The head is broad and flat; there is an indistinctly-
indicated clypeus, three—more rarely two—ocelli, and on each side an
eye neither very large nor perfect. The prothorax is free, and has a flat,
margined notum. The meso- and the meta-thorax are large, equal
segments. The pro-, meso-, and meta-sternum are large pieces; between
the first and second, and between the second and third there is an
intervening membrane. The metasternum is much prolonged backwards,
and has on each side a peculiar slit; similar orifices exist on the other
sterna (Fig. 254, o). Newport, who has examined them in Pteronarcys,
says that they are blind invaginations of the integument; he calls them the
sternal or furcal orifices.[321] According to this naturalist these very
peculiar openings pass into the body "as strong bone-like tubes, diverging
from the axis to the periphery of the body in the immediate vicinity of
some of the principal tracheae, but that they do not in any way
communicate with them, as they terminate abruptly as caecal structures."
He thinks them analogous with the endo-skeleton of other Insects; a view
which cannot be considered sufficiently established. Laboulbène
states[322] that when Perla parisina is seized and placed on its back, it
does not move, but emits a liquid at the base of the articulation of the
legs. This suggests that it may come from these sternal orifices. The
abdomen consists of ten dorsal plates, the first being short, and of nine
ventral; the dorsal plates are much more ample transversely than the
ventral. Frequently the hind body is terminated by two long, many-jointed
cerci, looking like antennae. The coxae are small, not prominent, and are
directed outwards. The legs are slender, the tibiae often grooved. The
tarsi are three-jointed, terminating in two claws and a more or less distinct
pad. In the genus Isopteryx an auditory organ has been described as
existing in the legs, in a position similar to that of the analogous structures
in Termitidae and Blattidae. The wings when closed repose flat on the
back, and fold and overlap so that only one is seen (Fig. 251); in this state
the costal portion of each front wing is turned downwards, so as to protect
to some extent, the sides of the body.
Fig. 251.—Perla maxima. (After Pictet.)
The early stages are known, but have not been described minutely, and
there appears to be very little information as to the youngest life. All the
species are, when immature, aquatic in their habits; the larvae greatly
resemble the perfect Insects in form, though differing in not possessing
wings and in the ocelli being merely opaque spaces. They have rather
large compound eyes; the future wings are represented by lobe-like
prolongations—varying in length according to age—of the meso- and
meta-notum. In the Nemourae the cerci are absent in the imago though
present in the young. The larvae of Perlidae are carnivorous and are able
to swim well, the legs being provided with abundant swimming hairs; they,
however, as a rule, prefer to walk at the bottom of the pool, or on rocks or
boulders in the water they live in.
Pictet, Dufour, Newport, and Imhof[326] have studied the internal anatomy.
The alimentary canal is remarkable for the enormous oesophagus; there
is no distinction between this and the crop. A proventriculus is quite