A nurse is caring for a client who has fluid overload due to renal failure. Which of the following interventions should the nurse include in the plan of care?

Choice A reason:

Decreased sodium is not a typical feature of metabolic acidosis. Sodium levels may be low, normal or high depending on the cause and severity of the acidosis, as well as the fluid status of the patient. Sodium is not directly involved in the acid-base balance of the body.

Choice B reason:

Increased potassium is a common finding in metabolic acidosis, especially in renal failure. This is because acidosis causes hydrogen ions to move into cells in exchange for potassium ions, which move out of cells into the blood. Also, impaired kidney function reduces the excretion of potassium in the urine.

Choice C reason:

Decreased calcium is not a typical feature of metabolic acidosis. Calcium levels may be low, normal or high depending on the cause and severity of the acidosis, as well as the presence of other disorders affecting calcium metabolism. Calcium is not directly involved in the acid-base balance of the body.

Choice D reason:

Increased chloride is a feature of normal anion gap metabolic acidosis, also known as hyperchloremic acidosis. This is because chloride replaces bicarbonate as the major anion in the blood when bicarbonate is lost or consumed by acids. However, increased chloride is not a feature of high anion gap metabolic acidosis, which is caused by accumulation of organic acids such as ketones or lactate.

Choice A reason:

Muscle weakness is a symptom of hypokalemia, which is a low level of potassium in the blood. Potassium is an important electrolyte that helps regulate the function of the heart and muscles. Diuretics can cause potassium loss through increased urine output, which can lead to hypokalemia. Hypokalemia can affect the heart rhythm and cause muscle cramps, weakness, fatigue, and constipation. Therefore, the client should report muscle weakness to the provider as it may indicate a need for potassium supplementation or a change in diuretic therapy.

Choice B reason:

Nausea and vomiting are not specific symptoms of diuretic use or fluid and electrolyte imbalance. They can be caused by many other factors, such as infection, food poisoning, medication side effects, or psychological stress. Nausea and vomiting can also lead to dehydration and electrolyte imbalance if not treated promptly. Therefore, the client should drink plenty of fluids and seek medical attention if nausea and vomiting persist or are severe, but they are not directly related to diuretic use or heart failure.

Choice C reason:

Headache and blurred vision are not common symptoms of diuretic use or fluid and electrolyte imbalance. They can be caused by many other factors, such as high blood pressure, migraine, eye strain, or neurological disorders. Headache and blurred vision can also be signs of a serious condition, such as stroke or brain tumor, that requires immediate medical attention. Therefore, the client should report headache and blurred vision to the provider as soon as possible, but they are not directly related to diuretic use or heart failure.

Choice D reason:

Constipation and abdominal pain are not common symptoms of diuretic use or fluid and electrolyte imbalance. They can be caused by many other factors, such as dietary changes, lack of fiber, medication side effects, or bowel obstruction. Constipation and abdominal pain can also be signs of a serious condition, such as appendicitis or diverticulitis, that requires immediate medical attention. Therefore, the client should report constipation and abdominal pain to the provider as soon as possible, but they are not directly related to diuretic use or heart failure.