A nurse is collecting data from a patient who has alcohol use disorder and is experiencing metabolic acidosis. Which of the following manifestations should the nurse expect?
Hyperventilation
Cold, clammy skin
Increased blood pressure
Bradycardia
The Correct Answer is A
Choice A reason: Hyperventilation is a compensatory mechanism in metabolic acidosis where the body tries to decrease carbon dioxide levels to balance the acidity.
Choice B reason: Cold, clammy skin is not a typical manifestation of metabolic acidosis; it may be associated with shock or hypoglycemia.
Choice C reason: Increased blood pressure is not directly related to metabolic acidosis. It can be influenced by various factors, including stress or other underlying conditions.
Choice D reason: Bradycardia, or a slow heart rate, is not a common manifestation of metabolic acidosis. Tachycardia, or a fast heart rate, might be observed instead.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The correct answer is choice B. Raise the head of the bed.
Choice A rationale:
Increasing the patient’s oral fluid intake is important for hydration and thinning secretions, but it is not the immediate priority when oxygen saturation is critically low.
Choice B rationale:
Raising the head of the bed helps improve lung expansion and facilitates easier breathing, which can quickly improve oxygen saturation levels. This is a critical first step in managing low oxygen saturation.
Choice C rationale:
Initiating humidified oxygen therapy is essential for improving oxygenation, but it should follow the immediate action of raising the head of the bed to optimize breathing.
Choice D rationale:
Encouraging the patient to cough and deep breathe is beneficial for clearing secretions and improving lung function, but it is not the first action to take when oxygen saturation is critically low.
Correct Answer is ["A","B","C"]
Explanation
Choice A reason: Trousseau's sign is indicative of hypocalcemia and is elicited by inflating a blood pressure cuff on the arm.
Choice B reason: Carpopedal spasm is a muscular spasm involving the hands and feet that can occur with hypocalcemia.
Choice C reason: Chvostek's sign is a facial twitching that occurs when tapping on the facial nerve in front of the ear, which can be a sign of hypocalcemia.
Choice D reason: Korsakoff's psychosis is associated with chronic alcoholism and thiamine deficiency, not directly with hypocalcemia.
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