Report a cool, pale, or pulseless hand distal to the puncture indicating compromised circulation.
Before you read
Test yourself first: 5 questions
Question 1 of 5
The nurse is reviewing normal arterial blood gas reference ranges with a new graduate. Which value represents the normal range for arterial pH?
Answer: A. The normal arterial pH range is 7.35 to 7.45. A value below 7.35 indicates acidosis and a value above 7.45 indicates alkalosis. The other ranges listed correspond to PaCO2 (35-45 mmHg), HCO3 (22-26 mEq/L), and an abnormal acidotic value.
Question 2 of 5
A client is admitted with pneumonia and worsening hypoxemia. The nurse anticipates that pulse oximetry corresponds best to which arterial blood gas value?
Answer: A. Pulse oximetry (SpO2) estimates the oxygen saturation of hemoglobin, which corresponds to the PaO2 on the arterial blood gas through the oxyhemoglobin dissociation curve. It assesses oxygenation, not acid-base status; pH, PaCO2, and HCO3 reflect acid-base balance rather than oxygen saturation.
Question 3 of 5
A client sustained a head injury and was lucid immediately after, then rapidly deteriorated into unconsciousness. The CT shows an arterial bleed between the skull and dura. Which injury does this lucid-interval pattern classically describe?
Answer: A. An epidural (extradural) hematoma classically presents with a brief lucid interval followed by rapid deterioration as arterial bleeding (often the middle meningeal artery) accumulates between the skull and dura. Subdural hematomas (venous) develop more slowly; a concussion is transient; a contusion is bruised brain tissue without this hallmark pattern.
Question 4 of 5
While titrating a norepinephrine infusion for a client in shock, the nurse monitors which parameter to evaluate the drug's effectiveness?
Answer: A. Vasopressors such as norepinephrine are titrated to a target mean arterial pressure (commonly at least 65 mm Hg) to ensure adequate organ perfusion. Mean arterial pressure is the key hemodynamic endpoint, not lung sounds, bowel sounds, or pupil size alone.
Question 5 of 5
A nurse is caring for a client with tuberculosis who reports coughing up blood-streaked sputum. How should the nurse interpret this finding?
Answer: A. Hemoptysis (blood-streaked or bloody sputum) is a known manifestation of pulmonary tuberculosis caused by tissue destruction in the lungs and should be assessed and reported. It is not a normal expected finding to ignore, not a sign the infection has resolved, and not solely a medication side effect.
Keep the streak going with more questions like these, each with a full rationale.
What is arterial blood gas sampling?
It guides management of respiratory and metabolic disorders. Memory aid: Allen's test first, then prolonged pressure, and put the sample on ice.
Key points to remember
- The Allen test is performed before a radial puncture to confirm adequate ulnar collateral circulation to the hand.
- Firm pressure is applied to the puncture site for at least 5 minutes, or longer if the patient is on anticoagulants.
- The sample is placed on ice and transported promptly to prevent altered results from continued cell metabolism.
- The syringe is heparinized and air bubbles are expelled to avoid falsely altered values.
- Recent suctioning, oxygen changes, or position changes should be documented because they affect results.
- ABG values interpret pH, PaCO2, PaO2, and HCO3 to identify the acid-base disturbance.
Nursing priorities
- Perform the Allen test before a radial artery puncture to verify collateral circulation.
- Note the patient's current oxygen delivery and temperature on the requisition.
- Apply firm continuous pressure to the site for at least 5 minutes, longer if anticoagulated.
- Expel air bubbles, place the sample on ice, and transport it to the lab immediately.
- Monitor the site for bleeding, hematoma, and adequate distal circulation afterward.
Labs & values
Patient teaching
- The arterial stick may hurt more than a regular blood draw because the artery is deeper.
- We will hold pressure on the site for several minutes to stop bleeding.
- Keep the area still afterward and report any swelling or renewed bleeding.
- Tell the nurse if your hand becomes cold, numb, or pale after the draw.
Red flags: report now
- Report a cool, pale, or pulseless hand distal to the puncture indicating compromised circulation.
- Report continued bleeding or an expanding hematoma at the arterial site.
- Report ABG results showing severe hypoxemia or dangerous acid-base imbalance immediately.
- Never skip the Allen test before a radial arterial puncture.
References
Clinical references for this topic
