The daughter of a wheelchair-bound older adult client is concerned because her mother has been experiencing urinary incontinence. Which statement should the nurse use to explain the condition to the daughter?

Choice A reason: Vomiting typically leads to metabolic alkalosis, not acidosis. It causes loss of hydrochloric acid from the stomach, reducing hydrogen ion concentration in the blood. This elevates blood pH above 7.45, as the body retains bicarbonate. The kidneys attempt to compensate by excreting excess bicarbonate, but this does not result in metabolic acidosis, making this choice incorrect.

Choice B reason: Thiazide diuretics increase sodium and water excretion, which can lead to mild metabolic alkalosis due to increased bicarbonate reabsorption in the kidneys. They do not cause a loss of bicarbonate or accumulation of acids, which are necessary for metabolic acidosis. Thus, this choice is incorrect as it does not contribute to an acidic blood state.

Choice C reason: Salicylate intoxication, such as from aspirin overdose, causes metabolic acidosis by increasing acid production. Salicylates stimulate the respiratory center, leading to hyperventilation and respiratory alkalosis initially, but they also disrupt mitochondrial function, causing lactic acid accumulation. This lowers blood pH below 7.35, meeting the criteria for metabolic acidosis, making this choice correct.

Choice D reason: Diarrhea results in significant bicarbonate loss through the stool, as the intestines secrete bicarbonate to neutralize gastric acid. This loss reduces the blood’s buffering capacity, lowering pH below 7.35, indicative of metabolic acidosis. The body may attempt to compensate via hyperventilation to reduce CO2, but the primary issue is bicarbonate depletion, making this choice correct.

Choice A reason: Separation anxiety disorder involves excessive fear of being separated from attachment figures, primarily in children but sometimes persisting into adulthood. It manifests as distress about separation, not generalized worry across multiple situations, as described. The client’s broad, uncontrollable anxiety does not align with this specific fear-based disorder.

Choice B reason: Agoraphobia involves fear of situations where escape or help may be unavailable, like crowded places or public transport, leading to avoidance behaviors. The client’s symptoms of excessive, uncontrollable worry across various circumstances do not specifically indicate fear of such situations, making agoraphobia an incorrect diagnosis.

Choice C reason: Panic disorder is characterized by recurrent, unexpected panic attacks with intense physical symptoms like heart palpitations and shortness of breath, followed by persistent fear of future attacks. The client’s ongoing, diffuse worry without mention of discrete panic episodes does not fit this diagnosis, which is more acute and episodic.

Choice D reason: Generalized anxiety disorder involves excessive, uncontrollable worry about multiple aspects of life, such as work, health, or daily events, lasting at least six months. The client’s symptoms of pervasive anxiety and inability to control worry align directly with this disorder, reflecting its chronic, diffuse nature affecting daily functioning.