Which are potentially worrisome adverse effects associated with proton pump inhibitor use in older patients? (Select all that apply)

Choice A reason: Dry cough is a common, not serious, side effect of ACE inhibitors due to bradykinin accumulation. While bothersome, it’s not life-threatening like angioedema. It often necessitates switching to an ARB, but calling it serious overstates the risk, making this choice incorrect.

Choice B reason: Dry cough occurs in 5-20% of ACE inhibitor users but doesn’t typically subside with continued use, as bradykinin accumulation persists. Patients often require a medication change (e.g., to ARBs), making the claim that it will subside over time inaccurate and incorrect.

Choice C reason: Dry cough is common but not universal in ACE inhibitor users, affecting 5-20% of patients due to variable bradykinin sensitivity. Stating it occurs in all patients is inaccurate, as many tolerate ACE inhibitors without cough, making this choice incorrect.

Choice D reason: Dry cough, caused by bradykinin buildup, affects some ACE inhibitor users and is uncomfortable, often requiring a switch to an ARB, which doesn’t affect bradykinin. This accurately reflects the side effect’s impact and management, making it the correct choice for the nurse’s response.

Choice A reason: pH 7.32 (low, acidic), PaCO2 <37 mm Hg (normal/low), and HCO3- <24 mEq/L (low) indicate metabolic acidosis, as low bicarbonate causes acidosis without respiratory compensation (PaCO2 normal). This matches uncompensated metabolic acidosis, often due to conditions like lactic acidosis or diabetic ketoacidosis, making this the correct choice.

Choice B reason: Uncompensated respiratory acidosis involves elevated PaCO2 (>45 mm Hg) causing low pH, with normal HCO3-. Here, PaCO2 is <37 mm Hg (normal/low) and HCO3- is low, pointing to a metabolic, not respiratory, cause of acidosis, making this choice incorrect for the given ABG values.

Choice C reason: Partially compensated respiratory acidosis requires elevated PaCO2 and increased HCO3- as compensation. Here, PaCO2 is <37 mm Hg (normal/low) and HCO3- is low, ruling out respiratory acidosis. The low pH and low HCO3- indicate a metabolic cause, making this choice incorrect.

Choice D reason: Partially compensated metabolic acidosis involves low pH, low HCO3-, and decreased PaCO2 as respiratory compensation. While HCO3- is low, PaCO2 is not significantly reduced to indicate compensation (given as <37 mm Hg, likely normal). This suggests uncompensated metabolic acidosis, making this choice less accurate than A.