A female patient with chronic hypertension is admitted to the emergency department with a sudden rise in blood pressure (BP) Which question is the priority for the nurse to ask the patient?

The correct answer is Choice D. Then start with Choice A rationale:

Choice A is incorrect because it representsmetabolic alkalosis, not respiratory alkalosis. Metabolic alkalosis occurs when there is a primary increase in the bicarbonate (HCO3) level, which causes the pH to rise above the normal range (7.35-7.45). The PaCO2 is normal in this case, indicating that the respiratory system is not involved in the acid-base imbalance.Some causes of metabolic alkalosis include vomiting, diuretic use, excessive antacid intake, and mineralocorticoid excess1.

Choice B is incorrect because it representsrespiratory acidosis, not respiratory alkalosis. Respiratory acidosis occurs when there is a primary decrease in the PaCO2 level, which causes the pH to fall below the normal range. The HCO3 is normal in this case, indicating that the metabolic system is not involved in the acid-base imbalance.Some causes of respiratory acidosis include hypoventilation, airway obstruction, chest trauma, neuromuscular disorders, and chronic lung diseases2.

Choice C is incorrect because it representsmetabolic acidosis, not respiratory alkalosis. Metabolic acidosis occurs when there is a primary decrease in the HCO3 level, which causes the pH to fall below the normal range. The PaCO2 is normal in this case, indicating that the respiratory system is not involved in the acid-base imbalance.Some causes of metabolic acidosis include diabetic ketoacidosis, lactic acidosis, renal failure, diarrhea, and poisoning3.

Choice D is correct because it representsrespiratory alkalosis. Respiratory alkalosis occurs when there is a primary decrease in the PaCO2 level, which causes the pH to rise above the normal range. The HCO3 is normal in this case, indicating that the metabolic system is not involved in the acid-base imbalance. Some causes of respiratory alkalosis include hyperventilation, anxiety, panic, fever, pain, tumor, trauma, severe anemia, liver disease, overdose of certain medicines, pulmonary embolism, pregnancy, and any lung disease that leads to shortness of breath . Respiratory alkalosis is characterized by symptoms such as breathlessness, dizziness, numbness, tingling, muscle spasms, chest discomfort, confusion, and fainting.

Choice A rationale:

Enteric-coated iron is designed to be absorbed in the small intestine, not the stomach. Taking it with each meal might decrease its absorption due to interaction with food.

Choice B rationale:

Cobalamin (vitamin B12) deficiency can cause macrocytic anemia, not microcytic hypochromic anemia. Taking cobalamin with green, leafy vegetables does not address the specific iron deficiency seen in microcytic hypochromic anemia.

Choice C rationale:

Take the iron with orange juice 1 hour before meals is the correct answer. Vitamin C enhances the absorption of non-heme iron (the type of iron found in plant-based foods and iron supplements) by reducing it to a more absorbable form. Taking iron supplements with orange juice, which is high in vitamin C, can significantly improve iron absorption. Taking it before meals ensures better absorption due to reduced interaction with other dietary components.

Choice D rationale:

Decreasing the intake of antiseizure medications will not improve microcytic hypochromic anemia. Antiseizure medications do not directly influence iron absorption or the production of red blood cells.