A nurse is assisting with the care of a client.

Which of the following findings requires further action by the nurse? Select all that apply.

ACE inhibitors are commonly prescribed antihypertensive medications that reduce blood pressure by blocking the conversion of angiotensin I to angiotensin II, leading to vasodilation and decreased peripheral resistance. A common early adverse effect is orthostatic hypotension, which can cause dizziness or lightheadedness when standing due to sudden drops in blood pressure. Patient education focuses on safety measures, gradual position changes, and monitoring for side effects. Proper teaching helps prevent falls and improves medication adherence.

Rationale:
A. Sitting back down when lightheadedness occurs is appropriate because it helps restore cerebral perfusion and reduces the risk of falls. This is a key safety strategy for managing orthostatic hypotension associated with ACE inhibitor therapy. Clients should also be taught to rise slowly from sitting or lying positions to minimize symptoms.

B. Restricting fluid intake is incorrect because dehydration can worsen orthostatic hypotension by reducing circulating blood volume. Adequate hydration helps maintain blood pressure stability and reduces dizziness. Fluid restriction would therefore increase the risk of adverse effects.

C. Taking a daily potassium supplement is incorrect because ACE inhibitors can increase potassium levels, leading to hyperkalemia. Supplementation without medical indication may result in dangerous cardiac dysrhythmias. Potassium levels should be monitored rather than routinely supplemented.

D. Discontinuing the medication if symptoms occur again is inappropriate because orthostatic hypotension is a common early side effect that often improves with time and proper management. Abrupt discontinuation can lead to uncontrolled hypertension and increased cardiovascular risk. The provider should be notified if symptoms persist or worsen, rather than stopping the medication independently.

Interpretation of arterial blood gas (ABG) results in a client with metabolic acidosis involves evaluating acid-base balance, particularly the bicarbonate level as the primary indicator of metabolic status. Metabolic acidosis occurs when there is an accumulation of hydrogen ions or loss of bicarbonate, leading to a decreased blood pH. The respiratory system may attempt compensation by altering carbon dioxide levels, but the defining abnormality remains reduced bicarbonate concentration. Accurate interpretation helps guide treatment of underlying causes such as renal failure, diabetic ketoacidosis, or severe diarrhea.

Rationale:
A. A PaCO₂ of 32 mm Hg reflects respiratory alkalosis or compensatory respiratory response to metabolic acidosis. In metabolic acidosis, the lungs often hyperventilate to “blow off” carbon dioxide in an attempt to raise pH. Therefore, this value represents compensation rather than the primary disorder.

B. A PaO₂ of 64 mm Hg indicates hypoxemia but is not specific to metabolic acidosis. While oxygenation status is important in overall patient assessment, it does not define acid-base imbalance. This value may suggest a respiratory or perfusion issue but is not diagnostic for metabolic acidosis.

C. A bicarbonate (HCO₃) level of 20 mEq/L is consistent with metabolic acidosis because it reflects a primary decrease in base concentration. In conditions such as renal failure or lactic acidosis, bicarbonate is consumed or not adequately regenerated. This reduction is the hallmark laboratory finding in metabolic acidosis.

D. A pH of 7.48 indicates alkalemia, not acidosis. This value is associated with either metabolic alkalosis or respiratory alkalosis depending on associated CO₂ and bicarbonate levels. Therefore, it is inconsistent with the diagnosis of metabolic acidosis.