The nurse provides discharge teaching to a client who had a myocardial infarction.
Which statements by the client indicate an understanding? Select all that apply.

This question requires knowledge of acid-base balance and pathophysiology of chronic kidney disease. Understanding how impaired renal function leads to metabolic acidosis through decreased hydrogen ion excretion and reduced bicarbonate regeneration is essential to identify the correct values.

Choice A rationale

A pH of 7.55 and HCO3 of 30 indicate metabolic alkalosis. Normal pH is 7.35 to 7.45 and HCO3 is 22 to 28 mEq/L. Renal failure typically results in acid accumulation, not excess base.

Choice B rationale

A pH of 7.30 and PaCO2 of 50 indicate respiratory acidosis. In renal failure, the lungs typically compensate for metabolic acid by hyperventilating to lower PaCO2, which is the opposite of the hypoventilation shown here.

Choice C rationale

A pH of 7.50 and PaCO2 of 32 indicate respiratory alkalosis. This state occurs when the patient hyperventilates excessively, leading to an alkaline pH, which does not align with the metabolic acidosis expected in renal disease.

Choice D rationale

Chronic kidney disease causes metabolic acidosis. A pH of 7.25 and HCO3 of 19 mEq/L demonstrate low pH and low bicarbonate. The PaCO2 of 30 mm Hg reflects respiratory compensation for the primary metabolic acid-base imbalance.

Providing post-mortem care requires knowledge of legal requirements, hospital protocols, and psychosocial support. The nurse must apply principles of cultural sensitivity and respect for the deceased while ensuring that administrative and physical care tasks align with the specific circumstances of death.

Choice A rationale

While a physician or authorized practitioner must pronounce death and sign the certificate, it is not the immediate responsibility of the nurse to ensure the signature is completed before beginning initial post-mortem nursing care.

Choice B rationale

Removing tubes is often prohibited if an autopsy is required, especially in sudden or suspicious deaths. The nurse must first verify the cause of death and institutional policy before disturbing any medical devices or invasive lines.

Choice C rationale

Removing the body immediately is insensitive and may interfere with the grieving process. Families should be given adequate time to spend with the deceased to begin their emotional processing and perform any necessary rituals.

Choice D rationale

Allowing for religious and cultural customs is a core component of holistic nursing care. This respects the dignity of the deceased and supports the family's coping mechanisms during the immediate period following a significant loss.

Choice E rationale

Providing privacy is essential for the family to express grief without observation. This therapeutic environment allows for intimate goodbyes and facilitates the beginning of the mourning process in a respectful and safe hospital or hospice setting.