A nurse is caring for a client who has a below-the-knee amputation. Which of the following statements should indicate to the nurse that the client has adapted to role changes after their injury?

Rationale for Correct Choices:

• "I should increase green leafy vegetables in my diet.": Green leafy vegetables such as spinach and kale are plant-based sources of non-heme iron, which can help improve iron stores, especially in clients following a vegan diet. Pairing them with vitamin C-rich foods can further enhance iron absorption.
• "The iron supplement might cause my stools to be black.": Black, tarry stools are a common and harmless side effect of oral iron supplements. It results from unabsorbed iron in the gastrointestinal tract and does not indicate gastrointestinal bleeding.
• "I will take my iron supplement 1 hour before a meal.": Iron is best absorbed on an empty stomach, ideally 1 hour before or 2 hours after meals. Taking it before a meal enhances absorption, although food may be added later if gastric irritation occurs.

Rationale for Incorrect Choices:

• "The iron supplement might cause ringing in my ears.": Tinnitus (ringing in the ears) is not a typical or expected side effect of iron supplementation. Its presence may indicate another issue and should be reported rather than expected as normal during iron therapy.
• "I should expect to have swelling in my feet.": Peripheral edema is not associated with iron supplements. Swelling in the feet could suggest cardiac, renal, or vascular issues and should prompt further assessment rather than being anticipated.

A. Metabolic alkalosis: In metabolic alkalosis, the pH is elevated (above 7.45), and the bicarbonate (HCO3) is increased (above 28 mEq/L). In this scenario, the pH is low (7.12), and HCO3 is low (20 mEq/L), which is not consistent with alkalosis.

B. Metabolic acidosis: In metabolic acidosis, the pH is low (below 7.35), and the bicarbonate (HCO3) is low (below 21 mEq/L), which is consistent with the client's ABG values (pH 7.12, HCO3 20 mEq/L). This suggests the client has metabolic acidosis, which is common in chronic kidney failure due to impaired excretion of acid and decreased bicarbonate.

C. Respiratory acidosis: In respiratory acidosis, the pH is low, and the PaCO2 is elevated (above 45 mm Hg). The PaCO2 in this client is within the normal range (40 mm Hg), making respiratory acidosis unlikely.

D. Respiratory alkalosis: In respiratory alkalosis, the pH would be high, and the PaCO2 would be low (below 35 mm Hg). The client's pH is low (7.12), and the PaCO2 is normal, so respiratory alkalosis is not present.