A nurse is reinforcing teaching with a client about how to prevent the onset of manifestations of Raynaud's phenomenon. Which of the following statements should the nurse identify as an indication that the client needs further teaching?

(A) Bradycardia: Bradycardia, or a slower than normal heart rate, is not typically associated with metabolic acidosis. Metabolic acidosis often leads to an increased heart rate (tachycardia) as the body tries to compensate for the acid-base imbalance.

(B) Hyperventilation: This is the most appropriate answer. Hyperventilation is a common response to metabolic acidosis. The body attempts to compensate for the high acid levels by increasing the rate and depth of breathing to expel more carbon dioxide (which is acidic) and raise the blood pH.

(C) Increased blood pressure: Metabolic acidosis does not typically cause an increase in blood pressure. In fact, severe acidosis can lead to vasodilation and a decrease in blood pressure.

(D) Cool, clammy skin: While cool, clammy skin can be a sign of shock or other serious conditions, it is not a typical manifestation of metabolic acidosis. However, in severe cases, metabolic acidosis can lead to shock, which might present with cool, clammy skin.

A. Qualitative studies are considered to be one type of Level I evidence: Qualitative studies are not typically considered Level I evidence. The hierarchy of evidence is a rating system used to evaluate the strength of evidence presented in medical research. Level I evidence usually includes systematic reviews, meta-analyses, and randomized controlled trials.

B. Level Vil evidence comes from a meta-analysis of multiple peer-reviewed studies: This statement is not accurate. Meta-analyses and systematic reviews are usually considered Level I evidence, as they provide the highest level of evidence. They synthesize and analyze multiple studies on a topic to provide a comprehensive view of the current evidence.

C. Level I evidence includes evidence found in nursing textbooks: Nursing textbooks are not considered Level I evidence. They often include a mix of different levels of evidence, from expert opinion to systematic reviews. While they are a valuable resource for background information and clinical guidelines, they do not represent the highest level of evidence.

D. Level I evidence is considered to be the best evidence to support EBP: This is correct. Level I evidence, which includes systematic reviews, meta-analyses, and randomized controlled trials, is considered the highest level of evidence and provides the most reliable basis for decision-making in evidence-based practice