The nurse receives information about the assigned patients during shift report.
Which patient would the nurse assess first?

The correct answer is Choice D. Then start with Choice A rationale:

Choice A is incorrect because it representsmetabolic alkalosis, not respiratory alkalosis. Metabolic alkalosis occurs when there is a primary increase in the bicarbonate (HCO3) level, which causes the pH to rise above the normal range (7.35-7.45). The PaCO2 is normal in this case, indicating that the respiratory system is not involved in the acid-base imbalance.Some causes of metabolic alkalosis include vomiting, diuretic use, excessive antacid intake, and mineralocorticoid excess1.

Choice B is incorrect because it representsrespiratory acidosis, not respiratory alkalosis. Respiratory acidosis occurs when there is a primary decrease in the PaCO2 level, which causes the pH to fall below the normal range. The HCO3 is normal in this case, indicating that the metabolic system is not involved in the acid-base imbalance.Some causes of respiratory acidosis include hypoventilation, airway obstruction, chest trauma, neuromuscular disorders, and chronic lung diseases2.

Choice C is incorrect because it representsmetabolic acidosis, not respiratory alkalosis. Metabolic acidosis occurs when there is a primary decrease in the HCO3 level, which causes the pH to fall below the normal range. The PaCO2 is normal in this case, indicating that the respiratory system is not involved in the acid-base imbalance.Some causes of metabolic acidosis include diabetic ketoacidosis, lactic acidosis, renal failure, diarrhea, and poisoning3.

Choice D is correct because it representsrespiratory alkalosis. Respiratory alkalosis occurs when there is a primary decrease in the PaCO2 level, which causes the pH to rise above the normal range. The HCO3 is normal in this case, indicating that the metabolic system is not involved in the acid-base imbalance. Some causes of respiratory alkalosis include hyperventilation, anxiety, panic, fever, pain, tumor, trauma, severe anemia, liver disease, overdose of certain medicines, pulmonary embolism, pregnancy, and any lung disease that leads to shortness of breath . Respiratory alkalosis is characterized by symptoms such as breathlessness, dizziness, numbness, tingling, muscle spasms, chest discomfort, confusion, and fainting.

Choice A rationale:

Neutropenia is a condition characterized by a low number of neutrophils, a type of white blood cell. Neutropenic patients are at increased risk of infections, but neutropenia does not cause specific changes in the tongue surface. The smooth and shiny tongue surface described in the question is not indicative of neutropenia.

Choice B rationale:

Polycythemia is a condition characterized by an abnormally high concentration of hemoglobin in the blood. It can cause the skin to appear reddish or flushed, but it does not directly cause changes in the tongue surface such as smoothness and shininess.

Choice C rationale:

Pernicious anemia is a type of anemia caused by a deficiency of vitamin B12, which is essential for the formation of red blood cells and the maintenance of the nervous system. One of the characteristic signs of pernicious anemia is glossitis, which is inflammation of the tongue that can make the tongue appear smooth and shiny. This finding aligns with the description provided in the question.

Choice D rationale:

Elevated estrogen levels can cause changes in the skin, such as increased pigmentation or the development of spider veins, but they do not directly cause changes in the tongue surface as described in the question.