RUHS, Jaipur, PB B.Sc Nursing Entrance-2018
Medical & Surgical Nursing
Hard
An ABG analysis report shows: pH-7.55, PCO2-35mm Hg, HCO3-33mEq/L. The condition is?
Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2018
Explanation
- The patient's pH of 7.55 is above the normal range of 7.35-7.45, indicating alkalosis.
- The bicarbonate (HCO3−) level of 33 mEq/L is elevated above the normal range of 22-26 mEq/L. An elevated HCO3− is the primary defect in metabolic alkalosis.
- The partial pressure of carbon dioxide (PCO2) is 35 mm Hg, which is within the normal range (35-45 mm Hg). This shows that the respiratory system has not yet started to compensate.
- Using the ROME mnemonic (Respiratory Opposite, Metabolic Equal), the pH and HCO3− are both elevated (moving in an equal direction), which confirms a metabolic cause for the alkalosis.
Why Other Options Were Wrong
- Option A: Metabolic acidosis is characterized by a low pH (less than 7.35) and a low HCO3− (less than 22 mEq/L). The patient's values are high.
- Option C: Respiratory alkalosis is characterized by a high pH (greater than 7.45) but a low PCO2 (less than 35 mm Hg) due to hyperventilation. The patient's PCO2 is normal.
- Option D: Respiratory acidosis is characterized by a low pH (less than 7.35) and a high PCO2 (greater than 45 mm Hg) due to hypoventilation. The patient's values are the opposite.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Interpretation of Arterial Blood Gas (ABG) results to identify acid-base imbalances as background academic context rather than a clinical decision trigger.
- Nurses, especially in critical care, must be proficient in interpreting ABG results to quickly identify life-threatening conditions and initiate appropriate interventions.
- Metabolic alkalosis can lead to complications like hypokalemia, which can cause muscle weakness and cardiac dysrhythmias. Nurses must monitor electrolyte levels and cardiac rhythm in these patients.
- Common causes of metabolic alkalosis include severe vomiting, nasogastric suctioning, and diuretic therapy. A thorough patient history is crucial for identifying the underlying cause.
How to Approach the Question
- This is an analytical question requiring data interpretation.
- Step 1: Look at the pH. Is it low (acidosis), high (alkalosis), or normal?
- Step 2: Look at the PCO2 (the respiratory parameter). Is it moving in the opposite direction of the pH?
- Step 3: Look at the HCO3− (the metabolic parameter). Is it moving in the same (equal) direction as the pH?
- Step 4: Use the ROME mnemonic (Respiratory Opposite, Metabolic Equal) to determine the primary disorder.
- Step 5: Check the non-causative parameter to see if compensation is occurring. If it's moving in the opposite direction of the primary imbalance, compensation is present. If it's normal, the condition is uncompensated.
Concept Tested & Keywords
- Concept Tested: Interpretation of Arterial Blood Gas (ABG) results to identify acid-base imbalances.
- Stem keywords: ABG analysis, pH, PCO2, HCO3
- Lead-in keywords: The condition is
- Clinical cues: pH 7.55 (high)
- Clinical cues: PCO2 35 mm Hg (normal)
Question ID
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Reference Book
E6 Nursing Fundamentals Taylor p. 785-787
E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 56-58
E6 Textbook of Biochemistry for medical StudentsDM Vasudevan Part 2 — Subpart A (pp 1-239 of 478) p. 82-84
Practise the full RUHS, Jaipur, PB B.Sc Nursing Entrance-2018
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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