A nurse is administering medications to a client receiving tube feedings through a gastrostomy tube. The correct procedure for administration is to: (SELECT ALL THAT APPLY)

D. Calling the prescribing physician to clarify the order is the most appropriate action in this situation. Direct communication with the physician allows the nurse to express concerns, seek clarification, and ensure that the medication order is appropriate and safe for the client.
A. Administering a medication at a higher than recommended dose could potentially harm the client and is not in line with safe medication administration practices. It's essential to follow the established guidelines and recommendations for medication dosing to avoid adverse effects or complications.
B. Holding the ordered dose and documenting the rationale is an appropriate initial action. This allows the nurse to pause the administration of the medication, prevent potential harm to the client, and provide a clear record of the decision-making process. Holding the dose also provides an opportunity for further clarification with the prescribing physician.
C. While reporting a mistake to the pharmacy is important, it may not be the most immediate action to take when dealing with a higher than recommended dose of medication. Direct communication with the prescribing physician is necessary to clarify the order and ensure appropriate action is taken promptly.

A. Metabolic alkalosis is characterized by an elevation of the bicarbonate (HCO3) levels in the blood, leading to an increase in pH above the normal range (7.35-7.45). Antacid tablets typically contain compounds such as calcium carbonate, magnesium hydroxide, or aluminum hydroxide, which can neutralize stomach acid (hydrochloric acid). Chronic ingestion of large amounts of antacids, as in the case of this client taking approximately 15 tablets per day, can result in excessive bicarbonate intake, leading to metabolic alkalosis.
B. Respiratory alkalosis occurs when there is a decrease in carbon dioxide (CO2) levels in the blood, leading to an increase in pH above the normal range. Antacid tablets do not directly affect respiratory function or CO2 levels, so respiratory alkalosis is unlikely to occur as a result of antacid ingestion.
C. Metabolic acidosis is characterized by a decrease in bicarbonate (HCO3) levels in the blood, leading to a decrease in pH below the normal range. In the context of antacid ingestion, metabolic acidosis is less likely to occur. However, if the antacids contain compounds that are absorbed systemically and excreted by the kidneys (such as aluminum-containing antacids), they may lead to renal dysfunction or electrolyte imbalances, which could potentially contribute to metabolic acidosis.
D. Respiratory acidosis occurs when there is an increase in carbon dioxide (CO2) levels in the blood, leading to a decrease in pH below the normal range. Antacid tablets do not directly affect respiratory function or CO2 levels, so respiratory acidosis is unlikely to occur as a result of antacid ingestion.