During a home visit, the client with fibromyalgia is concerned about being constantly tired. Which response should the nurse make to this client?

Choice A reason: Taking art lessons to relieve stress suggests a healthy coping mechanism, not a substance use disorder. Alcohol use disorder involves impaired functioning, like work performance, not positive activities like art, which indicates adaptive behavior rather than addiction.

Choice B reason: Loss of appetite can indicate alcohol use disorder, as chronic alcohol consumption disrupts appetite-regulating hormones (e.g., ghrelin) and causes gastrointestinal irritation, reducing desire to eat. Combined with work reprimands from drinking, this suggests impaired functioning, a hallmark of substance use disorder.

Choice C reason: Being focused with many goals does not indicate a substance use disorder, which typically impairs concentration and goal-directed behavior due to alcohol’s neurotoxic effects. This statement suggests intact functioning, inconsistent with the negative consequences described in the scenario.

Choice D reason: Having supportive friends is a positive factor, not indicative of substance use disorder. Alcohol use disorder often leads to social isolation or strained relationships, not reliance on a support system, making this statement unrelated to addiction criteria.

Choice A reason: Metabolic acidosis is characterized by a pH below 7.35 due to increased hydrogen ions or decreased bicarbonate. This results from conditions like diarrhea or lactic acid buildup, reducing the blood’s buffering capacity. The kidneys attempt compensation, but low pH is the hallmark, making this the correct choice.

Choice B reason: PaO2 below 70 mm Hg indicates hypoxemia, affecting oxygen levels, not acid-base balance. Metabolic acidosis is driven by bicarbonate loss or acid accumulation, not oxygenation. This parameter is irrelevant to confirming metabolic acidosis, making this choice incorrect.

Choice C reason: PaCO2 above 45 mm Hg suggests respiratory acidosis, not metabolic acidosis, as it indicates CO2 retention. In metabolic acidosis, PaCO2 may decrease due to compensatory hyperventilation to expel CO2, making this choice incorrect for the expected ABG results.

Choice D reason: HCO3 above 26 mEq/L indicates metabolic alkalosis, not acidosis. In metabolic acidosis, HCO3 is typically below 22 mEq/L due to loss (e.g., diarrhea) or acid overload, reducing buffering capacity. This choice is incorrect as it contradicts the condition’s definition.