The nurse is administering 0.45% NaCl (sodium chloride) intravenously to a client. What effect will this have on the client's body?

A. Metabolic acidosis: The patient’s pH of 7.13 indicates acidemia, and the HCO3- is significantly decreased at 13.2 mEq/L, showing a primary metabolic derangement. The PaCO2 of 38.8 mmHg is within normal limits (35–45 mmHg), suggesting that respiratory compensation has not yet fully occurred. The base excess of -14.5 further supports a significant metabolic acid load. These findings are consistent with metabolic acidosis.

B. Respiratory acidosis: Respiratory acidosis is characterized by elevated PaCO2 (>45 mmHg) due to hypoventilation, which leads to a decreased pH. In this case, the patient’s PaCO2 is normal, indicating that CO2 retention is not the primary cause of acidemia. The primary disturbance is metabolic rather than respiratory.

C. Normal ABG results: Normal arterial blood gas values include pH 7.35–7.45, PaCO2 35–45 mmHg, HCO3- 22–28 mEq/L, and PaO2 80–100 mmHg. In this ABG, the pH is acidotic, HCO3- is low, and base excess is markedly negative, which clearly deviates from normal ranges, indicating a pathological process.

D. Respiratory alkalosis: Respiratory alkalosis is characterized by decreased PaCO2 (<35 mmHg) due to hyperventilation, resulting in an elevated pH. In this ABG, PaCO2 is normal and pH is low, which contradicts the pattern seen in respiratory alkalosis. The acidemia is therefore not caused by a respiratory mechanism.

A. Ask his wife: While family members may help interpret the client’s needs, relying solely on a family member does not promote independent communication or respect the client’s autonomy. It may also lead to misinterpretation if the family cannot accurately convey the client’s intentions.

B. Use hand signals: Hand gestures can provide some nonverbal communication, but they are limited and may be misinterpreted, especially if the client’s motor skills are impaired after a stroke. Hand signals alone are not sufficient for complex or specific communication needs.

C. Use a communication board: Communication boards allow clients with expressive aphasia to point to letters, words, or pictures to convey messages. This method accommodates both verbal and cognitive limitations, facilitates more precise communication, and encourages client autonomy while reducing frustration and miscommunication.

D. Speak slowly and clearly: Speaking slowly and clearly may improve understanding for clients with receptive aphasia, but it does not enable a client with expressive aphasia to communicate their needs effectively. The client’s inability to speak requires an alternative communication method rather than adjustments to speech alone.