The nurse identifies which client to be at risk for developing metabolic alkalosis? The client who:

has been vomiting for three days.

has had diarrhea for the past 24 hours.

has overdosed on heroin.

is admitted with an asthma exacerbation.

Answer and Explanation

The Correct Answer is A

A. Vomiting results in loss of hydrochloric acid (HCl) from the stomach, leading to a loss of chloride ions (Cl-) and hydrogen ions (H+) from the body. This loss of hydrogen ions can result in an accumulation of bicarbonate ions (HCO3-) relative to hydrogen ions, leading to metabolic alkalosis. Therefore, this client is at risk for developing metabolic alkalosis due to prolonged vomiting.
B. Client who has had diarrhea for the past 24 hours: Diarrhea leads to loss of bicarbonate ions (HCO3-) from the body along with fluid and electrolytes. However, metabolic alkalosis is less likely to occur with diarrhea alone because the loss of bicarbonate ions is usually balanced by the loss of chloride ions (Cl-) and hydrogen ions (H+). Therefore, while diarrhea can lead to metabolic acidosis in some cases, it is less likely to cause metabolic alkalosis.
C. Client who has overdosed on heroin: Heroin overdose is not directly associated with metabolic alkalosis. In the context of heroin overdose, respiratory depression leading to respiratory acidosis is a more immediate concern. Therefore, this client is not at risk for developing metabolic alkalosis due to heroin overdose.
D. Client who is admitted with an asthma exacerbation: Asthma exacerbation can lead to respiratory alkalosis due to hyperventilation and excessive elimination of carbon dioxide (CO2) from the body. However, metabolic alkalosis is not a typical consequence of asthma exacerbation alone. Therefore, while this client may experience respiratory alkalosis, they are not at risk for developing metabolic alkalosis solely due to asthma exacerbation.

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Correct Answer is B

Explanation

B. Tachycardia (elevated heart rate) can be a sign of various underlying conditions, including pain, anxiety, or cardiovascular compromise. While tachycardia may occur as a response to stress or pain associated with the catheter insertion procedure, it can also indicate complications such as hemorrhage, cardiac dysrhythmias, or pulmonary embolism, which require prompt evaluation and intervention.
A. While this can be concerning, it is not typically directly related to complications of a subclavian central venous catheter insertion unless there is evidence of arterial injury or thrombosis.
C. Bibasilar crackles are abnormal lung sounds that can indicate fluid accumulation in the lungs, such as pulmonary edema or pneumonia. However, this may not be directly related to the subclavian central venous catheter insertion itself.
D. Headache is a non-specific symptom that can have numerous causes, including stress, dehydration, or tension.

A. Battery B. Negligence C. Assault D. Felony

Correct Answer is B

Explanation

B. Negligence refers to the failure to exercise reasonable care that results in harm to another person. It occurs when a healthcare provider fails to perform their duties according to the standard of care expected in their profession, leading to injury or harm to the patient. In the scenario described, the failure to follow orders for turning and positioning, resulting in pressure injuries, is an example of negligence. Negligence can result from actions (acts of commission) or omissions (acts of omission).
A. Battery refers to the intentional harmful or offensive touching of another person without their consent. In healthcare, battery may occur if a medical procedure is performed on a patient without their informed consent or if a procedure goes beyond the scope of what was consented to. In the context of the scenario provided, the development of pressure injuries due to inadequate turning and positioning is not an example of battery because it does not involve intentional harm.

C. Assault refers to the intentional threat of harm or the creation of fear of imminent harm in another person. In healthcare, assault may occur if a healthcare provider threatens a patient with harm or performs a procedure without their consent, creating fear or apprehension in the patient. In the context of the scenario provided, the development of pressure injuries due to inadequate turning and positioning is not an example of assault because it does not involve intentional threats or actions creating fear in the patient.
D. A felony is a serious criminal offense punishable by imprisonment or death. It typically involves actions that are considered extremely harmful or dangerous to society. The scenario described does not involve actions that rise to the level of a felony offense.

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The nurse identifies which client to be at risk for developing metabolic alkalosis? The client who:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client who just had a subclavian central venous catheter inserted. Which symptom should the nurse recognize as setting a priority for this client's care?

Correct Answer is B

Explanation

A client develops pressure injuries because turning and positioning were not done as ordered. The nurse is aware that this is an example of which type of liability?

Correct Answer is B

Explanation

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