An important nursing intervention for the patient with an arteriovenous fistula is to: Select all that apply)

A. Infuse 1 unit of platelet: Platelet transfusion is indicated for thrombocytopenia or active bleeding related to low platelet counts. Acute adrenal insufficiency does not involve platelet depletion or coagulation defects. This intervention does not address the underlying hormonal crisis.

B. Restrict daily fluid intake: Clients with acute adrenal insufficiency are at risk for hypovolemia and hypotension due to aldosterone deficiency. Fluid restriction would worsen dehydration and circulatory collapse. Fluid replacement is typically required rather than restriction.

C. Admin hydrocortisone sodium: Acute adrenal insufficiency requires immediate glucocorticoid replacement to restore cortisol levels. Hydrocortisone sodium provides both glucocorticoid and some mineralocorticoid effects, helping stabilize blood pressure and metabolism. Prompt administration is critical to prevent adrenal crisis complications.

D. Give oral spironolactone: Spironolactone is a potassium-sparing diuretic and aldosterone antagonist. In adrenal insufficiency, aldosterone levels are already low, making this medication inappropriate. Its use could worsen hyperkalemia and hypotension.

A. Metabolic acidosis fully compensated: Full compensation would result in a near-normal pH despite abnormal PaCO₂ and HCO₃⁻ levels. In this case, the pH is 7.23, indicating persistent acidemia. The presence of acidemia shows that compensation is incomplete.

B. Metabolic alkalosis partially compensated: Metabolic alkalosis presents with elevated pH and increased bicarbonate levels. This client has a low pH and decreased HCO₃⁻, which are inconsistent with alkalosis. The laboratory values reflect an acid–base imbalance in the opposite direction.

C. Metabolic acidosis partially compensated: The low pH and decreased bicarbonate indicate a primary metabolic acidosis. The PaCO₂ is decreased, reflecting respiratory compensation through hyperventilation. Because the pH remains acidic, compensation is partial rather than complete.

D. Respiratory alkalosis not compensated: Respiratory alkalosis is characterized by elevated pH and decreased PaCO₂ with normal bicarbonate initially. The low bicarbonate level here indicates a metabolic component rather than a primary respiratory disorder.