The nurse is reading the results of an arterial blood gas showing pH 7.52, CO2 25, and HCO3- 24. The nurse interprets this as which of the following

Respiratory acidosis

Metabolic acidosis

Respiratory alkalosis

Metabolic alkalosis

Answer and Explanation

The Correct Answer is C

A. Respiratory acidosis:
Respiratory acidosis is characterized by an increased CO2 level (above 45 mmHg) due to hypoventilation or impaired gas exchange, leading to a decrease in pH (below 7.35). In this case, the CO2 level is 25 mmHg, which is lower than normal and suggests a loss of CO2, not an accumulation. Therefore, respiratory acidosis is not the correct interpretation of these ABG results.
B. Metabolic acidosis:
Metabolic acidosis occurs when the pH drops below 7.35 due to conditions like kidney failure, diarrhea, or diabetic ketoacidosis. This would typically be accompanied by a low bicarbonate (HCO3-) level (less than 22 mEq/L). However, in this case, the pH is 7.52 (alkalotic), and the HCO3- level is 24 mEq/L, which is within the normal range. Thus, metabolic acidosis is not the correct interpretation.

C. Respiratory alkalosis:
Respiratory alkalosis is characterized by a decrease in CO2 (less than 35 mmHg) due to hyperventilation, which causes an increase in pH (above 7.45). In this case, the pH is 7.52 (alkalotic), and the CO2 is 25 mmHg, which is lower than the normal range (35–45 mmHg). The bicarbonate (HCO3-) level is 24 mEq/L, which is normal and compensatory. This matches the pattern of respiratory alkalosis, where the body compensates with a normal bicarbonate level as CO2 decreases.

D. Metabolic alkalosis:
Metabolic alkalosis occurs when the pH rises above 7.45, often due to excessive vomiting, diuretic use, or antacid overuse, leading to an increase in bicarbonate (HCO3-) levels. While the pH is 7.52, indicating alkalosis, the bicarbonate (HCO3-) level is 24 mEq/L, which is within the normal range for bicarbonate. In metabolic alkalosis, you would typically see an elevated HCO3- level, which is not the case here. Therefore, metabolic alkalosis is not the correct interpretation of these ABG results.

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Correct Answer is A

Explanation

A. Troponins I & T:
Troponins I and T are the most specific biomarkers for myocardial damage. These proteins are released into the bloodstream when the heart muscle is injured, such as during a myocardial infarction (MI). Troponins remain elevated for a prolonged period (typically up to 1-2 weeks) after myocardial injury, making them highly sensitive for detecting both acute and recent myocardial damage. Because of their high specificity for heart muscle, they are considered the gold standard for diagnosing acute myocardial infarction.

B. Creatine Kinase:
Creatine kinase (CK) is an enzyme found in the heart, brain, and skeletal muscle. While CK-MB (the heart-specific isoenzyme) can be elevated in cases of myocardial damage, it is less specific than troponins because it can also be elevated due to skeletal muscle injury or other conditions. CK-MB levels rise more rapidly than troponins but return to baseline within 48-72 hours, making it less useful for detecting myocardial damage over a longer period.

C. C-Reactive Protein (CRP):
C-Reactive Protein (CRP) is an acute-phase reactant produced by the liver in response to inflammation or tissue injury. While CRP levels can be elevated in various inflammatory conditions, including atherosclerosis, it is not specific to myocardial damage. Elevated CRP is associated with increased risk for cardiovascular events but does not provide specific information about acute myocardial injury, making it less helpful for diagnosing myocardial infarction.

D. Myoglobin:
Myoglobin is an oxygen-binding protein found in both skeletal and cardiac muscle. While it is an early marker that rises rapidly after muscle injury, it lacks specificity for myocardial damage because it is also released from skeletal muscle. Myoglobin levels peak quickly (within 1-4 hours of injury) and return to baseline within 24 hours, so it is not as useful for diagnosing a myocardial infarction or monitoring long-term cardiac injury.

A. "Be sure to bend at the hip, not the knee, to pick up items." B. internally rotating your leg is okay, but do not externally rotate it." C. If we need so help you roll in bed, we will roll you towards the operative side. D. You should keep your knees apart using a wedge or pillow.

Correct Answer is D

Explanation

A) "Be sure to bend at the hip, not the knee, to pick up items."
After hip replacement surgery, patients are instructed to avoid bending at the hip beyond 90 degrees, as this can dislocate the newly replaced hip. The correct guidance would be to avoid bending at the hip and instead bend at the knee when picking up items, ensuring the hip joint stays in a safe position.

B) "Internally rotating your leg is okay, but do not externally rotate it."
Internal rotation of the hip joint should also be avoided post-surgery, as it can increase the risk of dislocation. The correct teaching is to prevent both internal and external rotation of the hip to ensure the joint remains stable. Patients should be instructed to avoid twisting motions that can compromise the surgical repair.

C) "If we need to help you roll in bed, we will roll you towards the operative side."
This can place undue pressure on the newly replaced hip, potentially leading to dislocation or injury. The operative side should be kept stable and protected, so it is safer to roll the patient onto the non-operative side if necessary.

D) "You should keep your knees apart using a wedge or pillow."
It is essential to keep the knees apart, typically using a wedge or pillow between the legs. This prevents the hip from adducting (moving toward the midline) and reducing the risk of dislocation. Maintaining this position ensures the hip remains in a safe, stable alignment during the healing process.

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