A patient is post-op from knee surgery. The patient has been receiving Morphine 4 mg IV every 2 hours. The nurse notices the patient is exhibiting a respiratory rate of 8 and is extremely drowsy. Which of the following conditions is the patient at risk for?

Respiratory acidosis

Hypokalemia

Metabolic acidosis

Respiratory alkalosis

Answer and Explanation

The Correct Answer is A

A. Respiratory acidosis:
This occurs when there is inadequate removal of carbon dioxide (CO2) by the respiratory system. In the case of the patient post-op from knee surgery receiving Morphine, the opioid can cause respiratory depression, leading to the retention of CO2 and the development of respiratory acidosis. Signs include a decreased respiratory rate and drowsiness.

B. Hypokalemia:
This is a condition characterized by low levels of potassium in the blood. While opioids can cause constipation, they are not directly associated with hypokalemia.

C. Metabolic acidosis:
This occurs when there is an increase in acid production or a loss of bicarbonate, leading to an imbalance in the body's acid-base status. The symptoms of metabolic acidosis are not typically associated with opioid use.

D. Respiratory alkalosis:
This occurs when there is excessive elimination of CO2, leading to decreased carbon dioxide levels in the blood. Opioids, especially in higher doses, are more likely to cause respiratory depression and acidosis rather than alkalosis. The patient's low respiratory rate and drowsiness are indicative of respiratory acidosis rather than alkalosis.

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Correct Answer is A

Explanation

A. Metabolic Alkalosis:
pH: Elevated (alkalotic).
PaCO2: Normal or slightly decreased (compensation may or may not be present).
HCO3: Elevated.
Explanation: Metabolic alkalosis is characterized by an excess of bicarbonate (HCO3) in the blood, leading to an elevated pH. In this case, the elevated pH and HCO3 levels suggest that the primary imbalance is metabolic alkalosis.

B. Respiratory Alkalosis:
pH: Elevated (alkalotic).
PaCO2: Decreased (due to hyperventilation, which blows off CO2).
HCO3: Normal or slightly decreased (compensation).
Explanation: Respiratory alkalosis is characterized by low levels of carbon dioxide (PaCO2) due to hyperventilation. However, in the provided ABG, the PaCO2 is not significantly decreased, suggesting that respiratory alkalosis is not the primary issue.

C. Respiratory Acidosis:
pH: Decreased (acidotic).
PaCO2: Increased (due to inadequate ventilation).
HCO3: Normal or slightly elevated (compensation).
Explanation: Respiratory acidosis is characterized by an increase in carbon dioxide (PaCO2) levels. In this case, the PaCO2 is within the normal range, indicating that respiratory acidosis is not the primary problem.

D. Metabolic Acidosis:
pH: Decreased (acidotic).
PaCO2: Normal or slightly decreased (compensation).
HCO3: Decreased.
Explanation: Metabolic acidosis is characterized by a decrease in bicarbonate (HCO3) levels. In this ABG, the HCO3 is elevated, ruling out metabolic acidosis as the primary issue.

A. Urinalysis shows trace protein B. Hemoglobin A1C of 5.6% C. Fasting blood glucose of 110 mg/dL D. Urine ketones are negative

Correct Answer is B

Explanation

A. Urinalysis shows trace protein:
Explanation: While trace protein in the urine is generally better than higher levels, it doesn't provide a specific measure of blood glucose control. Protein in the urine can be an early sign of kidney damage in diabetes, but it doesn't directly indicate blood glucose control.

B. Hemoglobin A1C of 5.6%:
Explanation: Hemoglobin A1C (HbA1C) is a long-term indicator of blood glucose control. An HbA1C level of 5.6% is within the target range for individuals with diabetes and suggests good control of blood glucose over the past 2-3 months.

C. Fasting blood glucose of 110 mg/dL:
Explanation: Fasting blood glucose gives a snapshot of blood glucose at a specific moment. While 110 mg/dL is a fairly normal fasting level, it doesn't provide information about long-term control. A single fasting glucose measurement may not reflect overall glucose management.

D. Urine ketones are negative:
Explanation: Negative urine ketones indicate that the body is not currently using fat for energy. While this is a good sign in the moment, it doesn't give information about overall blood glucose control over time. Urine ketones can fluctuate based on various factors, including diet and activity level.

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A patient is post-op from knee surgery. The patient has been receiving Morphine 4 mg IV every 2 hours. The nurse notices the patient is exhibiting a respiratory rate of 8 and is extremely drowsy. Which of the following conditions is the patient at risk for?

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