The nurse can record that the compensatory mechanism for the correction of metabolic acidosis is in effect when the nurse observes?

Rationale:

A. 167 mEq/L: This indicates hypernatremia, which is typically associated with fluid volume deficit due to water loss, not fluid overload.

B. 142 mEq/L: This is a normal sodium level and does not indicate fluid imbalance on its own.

C. 136 mEq/L: Also within the normal reference range (135–145 mEq/L) and does not signal fluid excess.

D. 116 mEq/L: This level represents severe hyponatremia, commonly seen in fluid volume excess. In conditions like heart failure or renal failure, water retention can dilute serum sodium. The patient’s symptoms (dyspnea, crackles, and edema) are consistent with fluid overload and dilutional hyponatremia.

Rationale:

A. Request a potassium replacement: The client's potassium level is 3.0 mEq/L, which indicates hypokalemia (normal range: 3.5–5.0 mEq/L). TPN can cause electrolyte shifts, so potassium supplementation is appropriate and should be initiated to prevent complications like arrhythmias and muscle weakness.

B. Administer glucagon IM: This is used to treat severe hypoglycemia. The client’s glucose is 72 mg/dL, which is within the normal range (70–100 mg/dL fasting), so glucagon is not needed.

C. Check the client for a positive Chvostek's sign: Chvostek’s sign is associated with hypocalcemia, not hypokalemia, and calcium levels were not mentioned as abnormal here.

D. Discontinue the TPN infusion: Discontinuing TPN is not appropriate without a critical reason. Electrolyte imbalances are common during TPN therapy and are typically managed by adjusting the TPN formulation rather than stopping it altogether.