A nurse is teaching a client who has respiratory alkalosis about the causes and prevention of this condition. Which of the following statements by the client indicates an understanding of the teaching?

Choice A reason:

Hyperkalemia is a common electrolyte imbalance in metabolic acidosis. The excess hydrogen ions in the blood cause a shift of potassium from the intracellular to the extracellular space, resulting in increased serum potassium levels.

Choice B reason:

Hyponatremia is a possible electrolyte imbalance in metabolic acidosis. The excess hydrogen ions in the blood can cause a dilutional effect on sodium, resulting in decreased serum sodium levels.

Choice C reason:

Hypercalcemia is not an electrolyte imbalance in metabolic acidosis. In fact, metabolic acidosis can cause hypocalcemia due to increased binding of calcium to albumin and decreased ionized calcium levels.

Choice D reason:

Hypophosphatemia is not an electrolyte imbalance in metabolic acidosis. In fact, metabolic acidosis can cause hyperphosphatemia due to increased renal excretion of hydrogen ions and decreased renal excretion of phosphate.

Choice E reason:

Hypochloremia is a common electrolyte imbalance in metabolic acidosis. The excess hydrogen ions in the blood cause a loss of chloride from the kidneys, resulting in decreased serum chloride levels.

The correct answer is: c. Crackles in the lungs

Choice A: Dry mucous membranes

Reason: Dry mucous membranes are typically associated with dehydration, not fluid overload. In fluid overload, the body retains excess fluid, leading to symptoms such as edema and pulmonary congestion, rather than dryness of mucous membranes.

Choice B: Decreased urine output

Reason: Decreased urine output can occur in conditions like dehydration or renal failure. In fluid overload due to heart failure, the kidneys may initially try to excrete excess fluid, leading to increased urine output. However, as heart failure progresses, renal perfusion may decrease, potentially leading to reduced urine output. This is not a primary or consistent symptom of fluid overload.

Choice C: Crackles in the lungs

Reason: Crackles in the lungs are a hallmark sign of fluid overload, particularly in the context of heart failure. This occurs due to pulmonary edema, where excess fluid accumulates in the alveoli, causing the characteristic crackling sound during auscultation. This is a direct result of the heart’s inability to effectively pump blood, leading to fluid backing up into the lungs.

Choice D: Hypotension

Reason: Hypotension, or low blood pressure, is not typically associated with fluid overload. In fact, fluid overload can often lead to hypertension (high blood pressure) due to the increased volume of fluid in the circulatory system. Hypotension might occur in severe heart failure if the heart’s pumping ability is significantly compromised, but it is not a primary manifestation of fluid overload.