The nurse is caring for four patients with chronic kidney disease. Which patient would the nurse assess first upon initial rounding?
a) Woman with a blood pressure of 158/90 mm Hg.
b) Patient with Kussmaul respirations.
c) Man with skin itching from head to toe.
d) Patient with halitosis and stomatitis.

The correct answer is: b) Patient with Kussmaul respirations.


Choice A reason: A blood pressure of 158/90 mm Hg in a patient with chronic kidney disease (CKD) is elevated and requires management to prevent complications. However, it is not as immediately life-threatening as Kussmaul respirations, which indicate severe metabolic acidosis.
Choice B reason: The patient with Kussmaul respirations should be assessed first. Kussmaul respirations are deep, labored breathing patterns typically associated with severe metabolic acidosis, such as diabetic ketoacidosis (DK

Choice A reason: The arterial blood gas values pH 7.25, HCO3- 19 mEq/L, and PaCO2 30 mm Hg are indicative of metabolic acidosis, which is commonly seen in chronic kidney disease (CKD). In CKD, the kidneys lose their ability to excrete hydrogen ions and retain bicarbonate, leading to a decrease in blood pH (acidosis) and a reduction in bicarbonate (HCO3-). The PaCO2 value is slightly lower as a compensatory mechanism by the lungs to help balance the pH.

Choice B reason: The values pH 7.30, HCO3- 26 mEq/L, and PaCO2 50 mm Hg suggest a state of respiratory acidosis with partial metabolic compensation. This is not typically expected in chronic kidney disease. Respiratory acidosis occurs when there is hypoventilation, leading to an accumulation of carbon dioxide (CO2) in the blood. The bicarbonate (HCO3-) level is within the normal range, indicating that it is not the primary disorder in this context.

Choice C reason: The values pH 7.50, HCO3- 20 mEq/L, and PaCO2 32 mm Hg are consistent with respiratory alkalosis, where the pH is elevated due to hyperventilation leading to a loss of CO2. This condition is not typically associated with chronic kidney disease. The bicarbonate level is slightly below normal but not enough to indicate a significant metabolic disorder.

Choice D reason: The values pH 7.55, HCO3- 30 mEq/L, and PaCO2 31 mm Hg indicate metabolic alkalosis, which is characterized by an elevated pH and increased bicarbonate. This condition can occur due to excessive loss of acids (e.g., vomiting) or an increase in bicarbonate but is not typically expected in chronic kidney disease.

Choice A reason: Maintaining NPO (nothing by mouth) status is essential for patients with acute pancreatitis. This allows the pancreas to rest and decreases the secretion of pancreatic enzymes, reducing inflammation and promoting healing. NPO status is typically maintained until the patient's symptoms improve and the inflammation subsides.

Choice B reason: A soft, bland diet is not appropriate for the initial management of acute pancreatitis. Introducing food too early can stimulate pancreatic enzyme production and worsen inflammation. Once the patient stabilizes, dietary recommendations may include a gradual reintroduction of low-fat, bland foods.

Choice C reason: A regular diet is not suitable for patients with acute pancreatitis. Consuming a regular diet can exacerbate symptoms and inflammation by stimulating pancreatic enzyme secretion. Patients need to follow a more controlled dietary plan to manage their condition effectively.

Choice D reason: A low-fat, high-fiber diet is beneficial for general health but not for the initial management of acute pancreatitis. Once the patient's condition stabilizes and they are no longer NPO, a low-fat diet may be introduced gradually to avoid stimulating pancreatic enzyme production.