Choice A rationale:

A phosphorus level of 4.5 mEq/L falls within the normal range, which is typically between 2.5 to 4.5 mEq/L. Although it's essential to monitor phosphorus levels, it is not the priority finding in this scenario.

Choice B rationale:

A potassium level of 2.9 mEq/L is the priority finding. The normal range for potassium is typically between 3.5 to 5.0 mEq/L. A potassium level of 2.9 mEq/L indicates severe hypokalemia, which can lead to life-threatening cardiac arrhythmias and muscle weakness. Immediate intervention is necessary to address the potassium imbalance.

Choice C rationale:

A calcium level of 8.2 mg/dL falls within the normal range (typically 8.5 to 10.2 mg/dL). While calcium levels are essential to monitor, they do not take precedence over the critically low potassium level in this situation.

Choice D rationale:

A sodium level of 145 mEq/L falls within the normal range, which is usually around 135 to 145 mEq/L. Although monitoring sodium levels is important, it is not the priority finding when compared to the critically low potassium level.

Choice A rationale:

The client with end-stage renal failure scheduled for dialysis is at risk for fluid volume deficit. Dialysis involves the removal of excess fluid and waste products from the body, which can lead to hypovolemia if not carefully monitored.

Choice B rationale:

The client who has been NPO (nothing by mouth) since midnight for endoscopy is at risk for fluid volume deficit due to prolonged fasting and potential fluid losses during the procedure.

Choice C rationale:

The client with left-sided heart failure and a brain natriuretic peptide (BNP) level of 600 pg/mL is at risk for fluid volume excess (not deficit). Elevated BNP levels indicate increased fluid volume in heart failure patients.

Choice D rationale:

The client with gastroenteritis and fever is at risk for fluid volume deficit due to increased fluid losses from diarrhea and fever-induced diaphoresis.

Other electrolyte disturbances.

Choice A rationale:

Drug toxicity is not directly related to hypocalcemia. The main concern in hypocalcemia is the calcium imbalance itself, not drug toxicity.

Choice B rationale:

Other electrolyte disturbances should be assessed because imbalances in other electrolytes, such as potassium and magnesium, are often associated with hypocalcemia. Electrolyte imbalances can interact and exacerbate each other, potentially leading to more severe complications.

Choice C rationale:

Hypertension is not a typical assessment finding in hypocalcemia. Hypertension is not directly related to calcium levels but may have other underlying causes.

Choice D rationale:

Visual disturbances are not commonly associated with hypocalcemia. Hypocalcemia is more likely to present with neuromuscular and cardiovascular symptoms, rather than visual disturbances.

Choice A rationale:

Fluid volume overload is an excess of fluid in the intravascular and/or interstitial spaces. One of the hallmark signs of fluid volume overload is distended neck veins, which indicates increased venous pressure due to the accumulation of fluid. The neck veins become more visible and prominent, especially when the patient is in a semi-Fowler's position.

Choice B rationale:

Poor skin turgor is a sign of dehydration, not fluid volume overload. It is characterized by the skin's inability to return to its normal position after being gently pinched. In fluid volume overload, the skin may become edematous and puffy, but it does not exhibit poor turgor.

Choice C rationale:

Concentrated hemoglobin and hematocrit levels are seen in conditions of dehydration or hemoconcentration, not in fluid volume overload. In fluid volume overload, there is excess fluid, which may lead to dilutional effects, resulting in decreased concentration of blood components.

Choice D rationale:

Decreased urine output is associated with fluid volume deficit (dehydration) rather than fluid volume overload. In fluid volume overload, there is often an increase in urine output as the body tries to eliminate the excess fluid.

Respiratory acidosis.

Choice A rationale:

Metabolic alkalosis occurs when there is an increase in pH and bicarbonate (HCO₃⁻) levels, which is not the case here. The pH value in this scenario is 7.22, indicating acidosis.

Choice B rationale:

Respiratory acidosis results from the retention of carbon dioxide (PaCO₂) in the blood, leading to a decrease in pH. In this case, the pH is low (7.22), and the PacO₂ is elevated (68 mm Hg), supporting the diagnosis of respiratory acidosis.

Choice C rationale:

Metabolic acidosis is characterized by a decrease in pH and bicarbonate levels, along with a possible negative base excess. However, in this scenario, the base excess is -2, which does not indicate metabolic acidosis.

Choice D rationale:

Respiratory alkalosis occurs when there is a decrease in PaCO₂, leading to an increase in blood pH. The ABG values provided (pH 7.22, PacO₂ 68 mm Hg) are not consistent with respiratory alkalosis.

Widened QRS Complexes.

Choice A rationale:

Hyperactive deep tendon reflexes are not typical findings in respiratory acidosis. They are more commonly associated with conditions like hypocalcemia or hypercalcemia.

Choice B rationale:

Warm, flushed skin is not directly related to respiratory acidosis. It is not a typical manifestation of this acid-base imbalance.

Choice C rationale:

Widened QRS complexes on an ECG are characteristic findings in respiratory acidosis. Acidosis can lead to changes in the electrical conduction of the heart, resulting in QRS complex widening.

Choice D rationale:

Bounding peripheral pulses are not directly associated with respiratory acidosis. They may be seen in conditions like hyperthyroidism or anemia but are not specific to respiratory acidosis. Remember, always interpret lab results and clinical findings in the context of the patient's overall condition, medical history, and other relevant factors to provide the best care possible.

Extracellular fluid deficit.

Choice A rationale:

Intracellular fluid deficit is a decrease in the fluid inside the cells, which may occur in conditions such as diabetic ketoacidosis. Severe burns are more likely to cause extracellular fluid shifts rather than intracellular fluid deficits.

Choice B rationale:

Interstitial fluid deficit involves a decrease in fluid in the interstitial spaces between cells. While burns can lead to fluid shifts, the primary concern is fluid loss from the vascular space (extracellular fluid).

Choice C rationale:

Intracellular fluid overload is not a typical health problem associated with severe burns. Burn injuries are more likely to cause fluid loss and shifts out of the intracellular space.

Choice D rationale:

Severe burns can result in significant loss of plasma and extracellular fluid, leading to hypovolemia and extracellular fluid deficit. This fluid loss can lead to hypovolemic shock and other complications if not adequately managed.

Choice A rationale:

Lethargy is not typically associated with metabolic alkalosis. Instead, it is commonly seen in metabolic acidosis or other conditions affecting the central nervous system.

Choice B rationale:

Kussmaul's respirations are rapid, deep, and labored breathing patterns that are compensatory mechanisms in response to metabolic alkalosis. They help to decrease the carbon dioxide levels in the blood, attempting to restore the acid-base balance.

Choice C rationale:

Circumoral paresthesia refers to a tingling sensation around the mouth and is a neurological manifestation of metabolic alkalosis, often caused by hypocalcemia.

Choice D rationale:

Bicarbonate excess is essentially the cause of metabolic alkalosis rather than a clinical manifestation. Elevated bicarbonate levels in the blood lead to an increase in pH, resulting in alkalosis.

Choice E rationale:

Flushing is another clinical manifestation of metabolic alkalosis, caused by the altered acid- base balance affecting the peripheral blood vessels.

Choice A rationale:

Dysrhythmias are not a direct consequence of diabetic ketoacidosis (DKA) or the acid-base imbalance indicated by the patient's pH of 7.2 and bicarbonate level of 20 mEq/L. DKA primarily affects the respiratory system, leading to Kussmaul respirations, not dysrhythmias.

Choice B rationale:

Kussmaul respirations are an expected finding in a patient with diabetic ketoacidosis (DKA) and metabolic acidosis. These deep, rapid breaths are the body's attempt to compensate for the acidosis by eliminating excess CO2.

Choice C rationale:

Weakness is a common symptom of DKA. The hyperglycemia and acidosis result in intracellular dehydration and impaired cellular function, leading to weakness and fatigue.

Choice D rationale:

Cold, clammy skin is not typically associated with DKA. Instead, patients with DKA may have warm, dry skin due to dehydration and impaired thermoregulation.

Choice E rationale:

Tachycardia is an expected finding in a patient with DKA. The metabolic acidosis and dehydration lead to an increase in heart rate as the body attempts to maintain perfusion.

Choice A rationale:

Normal saline is not indicated for the treatment of high serum phosphate levels. It is a solution used for fluid resuscitation or hydration but does not have any direct effect on phosphate levels.

Choice B rationale:

Potassium phosphate is a suitable treatment for a patient with a low serum phosphate level (hypophosphatemia). In this case, the patient has a high serum phosphate level, and administering more phosphate would exacerbate the condition.

Choice C rationale:

Additional milk intake is not a suitable treatment for high serum phosphate levels. Milk contains phosphate, which would further elevate the phosphate level.

Choice D rationale:

Increased Vitamin D intake is a valid treatment for high serum phosphate levels (hyperphosphatemia). Vitamin D helps regulate phosphate levels by promoting its excretion.

Choice E rationale:

Calcium-containing antacids are used to bind phosphate in the gastrointestinal tract and reduce its absorption, thus lowering serum phosphate levels. This makes it a suitable treatment for hyperphosphatemia.