Understanding the Effects of Fluid Therapy on Acute Respiratory Failure, Exams of Nursing

Download Understanding the Effects of Fluid Therapy on Acute Respiratory Failure and more Exams Nursing in PDF only on Docsity! Adult Health lll Exam Questions And Answers With Detailed Explanation 1. The nurse is assessing a client who experienced metabolic alkalosis from food poisoning and received intermittent parenteral fluid therapy. Which of the following findings would indicate that the fluid therapy was successful? a. pH and HCO3 levels have decreased b. pH and PaCO2 levels have increased c. pH level has decreased and HCO3 level has increased d. pH level has decreased and PaCO2 level has increased Feedback: The client experiencing metabolic alkalosis would have high pH and HCO3 levels, so if the IV fluids were successful the pH and HCO3 levels should have decreased. If the pH or HCO3 increased the client’s metabolic alkalosis would be worsening. The PaCO2 would be normal or increased with metabolic alkalosis, so if the fluids were successful the level should not increase more.Lewis 2017, pgs. 290-291, 288. 2. The nurse reviews the nursing care plan of a client with pneumonia and notes documentation of a nursing diagnosis of Activity intolerance. The nurse should implement which of the following in the client’s plan of care? a. obtain vital signs and oxygen saturation periodically during activity b. encourage deep, rapid breathing during activity c. maintain bedrest except for meals, assist client out of bed d. schedule activities before giving prescribed respiratory medications or treatments Feedback: The nurse monitors vital signs, including oxygen saturation, before, during, and after activity to gauge client response. Activities should be planned after giving the client respiratory medications or treatments to increase activity tolerance. The client should use pursed-lip and diaphragmatic breathing to lower oxygen consumption during activity. Finally, the environment should be conducive to rest because the client is easily fatigued. Lewis 2017, pgs. 506abkd 3. The nurse is evaluating the care plans for a group of assigned clients who have acute respiratory failure with a new nursing diagnoses of ineffective airway clearance related to excessive secretions. Which of the following clients requires immediate revision of the care plan? a. The client receiving non-invasive positive pressure ventilation. b. The client who cannot perform huff coughing. c. The client taking in 1,200 to 1,500 L/day of oral fluids. d. The client whose SaO2 decreased from 96% on 2 L nasal canula to 93%. Feedback: The client receiving non-invasive positive pressure ventilation needs immediate revision of the care plan because it is not appropriate for clients who have excessive secretions. The clients in the distractors do not require immediate revisions, but they do require revisions. Huff coughing can help clients expectorate secretions and if the client is unable to perform huff coughing there are other therapeutic cough techniques that can be used. The client with excessive secretions should be able to take in 2 to 3 L/day of oral fluids otherwise should receive IV hydration to help thin the secretions. An SaO2 decreasing from 96% to 93% is not an emergency unless the client had other signs of hypoxia. Lewis 2017, p. 1616-1617 4. The nurse is caring for a client with acute respiratory failure from an opioid overdose. Which of the following findings would indicate the treatment goals were achieved? Select all that apply. a. The client’s arterial blood gas (ABG) results show signs of compensation. b. The client’s PaCO2 has returned to baseline. c. The client denies having any pain. d. The client’s SaO2 is 97% on room air. e. The client has a respiratory rate of 20 with a regular rhythm. Feedback: Acute respiratory failure from an opioid overdose causes central nervous system abnormalities. The goals of treatment include independent maintenance of the airway, normal ABG values or within the client’s baseline and returning to baseline or within normal limits of breathing patterns. Metabolic compensation for an overdose is not likely to occur since it is an acute issue therefore the kidneys do not have time to compensate for the respiratory failure. Absence of pain is not a goal of treatment for respiratory overdose as the client would not be expected to have pain. Lewis 2017, pgs. 1615k, ac by omission, 1610stem, 1612k 5. The parents of a child with asthma ask the nurse how a prescribed inhaled beta-agonist works. Which of the following would be the best response by the nurse? a. "Beta agonists relax smooth muscles in the airway, which then dilate rapidly." b. "Beta agonists increase airway inflammation and hyper-responsiveness." c. "The medication is given to stop your child's wheezing." d. "Beta agonists reduce mucosal edema in the airway, thereby increasing the diameter." Feedback: The action of a beta agonist is to relax smooth airway muscle, resulting in bronchodilation. When inhaled, it exerts action directly on the airway. While it is true that albuterol may 'stop the wheezing' this is not the best selection and does not answer the parent's question. Beta agonists do not reduce edema or inflammation. Vallerand 2017, pgs. 120-121 6. The nurse is caring for a client who is postoperative lung surgery. The client has a shallow, monotonous respiratory pattern and is reluctant to cough. The nurse should assess the client for which of the following? a. atelectasis b. increased oxygen saturation c. increased risk for aspiration d. malnutrition Feedback: The reluctance to cough is likely due to poor pain control. A shallow, monotonous respiratory pattern places the client at an increased risk of developing atelectasis. The client would not be at increased risk for increased oxygen saturation, aspiration, or malnutrition. Lewis 2017, pgs. 1621-1622k, acd by omission, 334k 7. The nurse is caring for a group of assigned clients. The nurse should prepare to administer prescribed bicarbonate intravenously to the client with which of the following clinical manifestations? a. pH 7.28, HCO3– 16 mEq/L, PCO2 45 mm Hg, PO2 98 mm Hg secondary to excessive diarrhea b. pH 7.28, HCO3– 22 mEq/L, PCO2 52 mm Hg, PO2 82 mm Hg secondary to an acute asthma attack c. pH 7.30, HCO3– 30 mEq/L, PCO2 60 mm Hg, PO2 72 mm Hg secondary to chronic bronchitis and emphysema d. pH 7.31, HCO3– 20 mEq/L, PCO2 34 mm Hg, PO2 96 mm Hg secondary to a urinary tract infection (UTI) and diabetes mellitus, type 2 (DM-2) Feedback: The only client who has lower than normal bicarbonate levels is the client with diarrhea. This deficit is most likely the result of an actual bicarbonate loss, and bicarbonate should be replaced to help return this client’s acid-base balance to normal. Giving bicarbonate to any of the other clients listed would be adding too much base and would risk the development of alkalosis. Lewis 2017, pgs. 290-291kbcd 8. The nurse is caring for a client in the emergency room who reports increased urination, and appetite, headache and blurred vision. The client’s ABG results are; pH 7.30, PaCO2 35 c. Obtain a prescription for a muscle relaxer. d. Implement seizure precautions. Feedback: The nurse should recognize the client’s symptoms as Trousseau’s sign and that the client is at risk for ineffective breathing patterns. Assisting the client to breath into a paper bag can promote CO2 retention until an IV of calcium gluconate can be administered to correct the low calcium level. The nurse should implement seizure precautions once the client’s breathing is under control, but seizure precautions would not be the priority. A muscle relaxer and obtaining the blood pressure on the ankle is not necessary or part of the treatment for hypocalcemia. Lewis 2017, pgs. 284-285kd, ac by omission. 16. The nurse is assessing a client with chronic obstructive pulmonary disease (COPD). The nurse auscultates diminished breath sounds, which is a change from the client's baseline. The nurse should monitor the client for which of the following potential complications? a. dyspnea and hypoxemia b. kyphosis and clubbing of the fingers c. sepsis and pneumothorax d. bradypnea and pursed lip breathing Feedback: These changes in the airway require that the nurse monitor the client for dyspnea and hypoxemia. Kyphosis is a musculoskeletal problem. Sepsis and pneumothorax are atypical complications. Tachypnea is much more likely than bradypnea. Pursed lip breathing can relieve dyspnea. Lewis 2017, p. 564k, acd by omission, 1610-1611k 17. The nurse is providing telephone triage and is speaking with the spouse of a client with asthma who has a prescription for a short-acting inhaled beta-agonist to utilize as needed. The spouse states, "My spouse’s personal best peak flow reading is 290 L/minute and today the reading is 220 L/minute." Which of the following would be an appropriate response by the nurse? a. "This is a medical emergency take your spouse to the nearest emergency department (ED)." b. "Your spouse should use the prescribed beta-agonist inhaler." c. "A prescription for intravenous corticosteroids is most likely necessary." d. "Your spouse’s asthma is under good control." Feedback: The peak flow measurement is in the mild zone (75-80%) of the client's personal best. The asthma is not currently well-controlled and the client should start using the short-acting bronchodilator. Lewis 2017, pgs. 543stem, 546abkd, 1610, 1618k 18. The nurse is caring for a client who has just experienced a 90-second tonic-clonic seizure and has the following arterial blood gas values: pH 6.88, HCO3 22 mEq/L, PCO2 60 mm Hg, PO2 50 mm Hg. Which of the following actions should the nurse take? a. Apply a paper bag over the client's nose and mouth. b. Apply the prescribed oxygen by mask or nasal cannula. c. Administer 50 mL of prescribed sodium bicarbonate intravenously. d. Obtain a prescription and administer 50 mL of 20% glucose and 20 units of regular insulin. Feedback: The client has experienced a combination of metabolic and acute respiratory acidosis through heavy skeletal muscle contractions and no gas exchange. When the seizures have stopped and the client can breathe again, the fastest way to return to acid-base balance is to administer oxygen. Sodium bicarbonate should not be administered because the client’s arterial bicarbonate level is normal. Applying a paper bag over the client’s nose and mouth would worsen the acidosis. Glucose and regular insulin would not be appropriate to administer to the client.Lewis 2017, p. 290, 1615k 19. The nurse is caring for a client who is intubated and receiving mechanical ventilation. Which of the following actions by the nurse would help prevent ventilator associated pneumonia (VAP)? a. practicing meticulous hand hygiene b. maintaining the head of the client's bed elevated at least 10 degrees c. suctioning of the client's oral cavity secretions every shift d. ensuring the respiratory therapist changes the ventilator circuit tubing every 4 hours Feedback: Because normal upper airway defenses are bypassed, clients who are intubated with mechanical ventilation are at risk for VAP. Prevention includes effective hand washing before and after suctioning, when touching ventilator equipment, and when in contact with respiratory secretions. The client will need oral suctioning more frequently than every shift and at least 30-degree head of the bed elevation. It is not necessary to change the ventilator circuit tubing every 4 hours. The more frequently the circuit is broken, the greater the risk for pathogen entry. Lewis 2017, p. 1623 20. The nurse is caring for a client experiencing acute respiratory failure (ARF) from acute bronchitis. Which of the following medication prescriptions should the nurse question? a. methylprednisolone via nebulization b. albuterol via nebulization c. furosemide via IV d. azithromycin via IV Feedback: The nurse should question the methylprednisolone via nebulization. This is a corticosteroid and when they are inhaled, they require 4 to 5 days for optimum therapeutic effects. This would not be appropriate for a client experiencing ARF. The other medications and routes are appropriate for this client. Lewis 2017, p. 1618abcK 21. The nurse is assessing a client with end stage kidney disease (ESKD). The client's serum laboratory results indicate hypocalcemia and hyperphosphatemia. Which of the following findings should the nurse anticipate? Select all that apply. a. Trousseau's sign b. cardiac arrhythmia's c. constipation d. decreased clotting time e. drowsiness and lethargy f. fractures Feedback: Hypocalcemia is a deficit that causes nerve fibers irritability and repetitive muscle spasms. Signs and symptoms of hypocalcemia include cardia arrhythmias, diarrhea, increased clotting times, anxiety and irritability. The calcium/phosphorus imbalance leads to brittle bones and pathologic fractures. Lewis 2017, pgs. 284-258 22. The nurse is assessing a client who reports shortness of breath (SOB) and notes diminished breath sounds in the right lower lobe. A chest radiograph (x-ray) reveals a large right pleural effusion with significant atelectasis. The nurse should anticipate which of the following procedures to be prescribed for this client? a. thoracentesis b. bronchoscopy c. ventilation/perfusion (V/Q) scan d. repeat chest radiograph (x-ray) Feedback: Thoracentesis is an uncomplicated procedure done at the bedside for the removal of fluid or air from the pleural space. It is used most often as a diagnostic measure; it may also be performed therapeutically for the drainage of a pleural effusion or empyema. No evidence is present that would necessitate a V/Q scan. A bronchoscopy cannot assist in fluid removal. A problem with this chest radiograph is not indicated. Lewis 2017 pgs. 527-528stem and k, bcd by omission, 1610-1611c 23. The nurse provided discharge teaching for a client with mild chronic obstructive pulmonary disease (COPD) about breathing exercises. Which of the following statements by the client would indicate a correct understanding of the teaching? Feedback: Complications that can occur from mechanical ventilation includes barotrauma which can lead to pneumothorax which requires the PEEP to be decreased. Suctioning the client is unrelated to pneumothorax. Increasing the tidal volume and RR would only exacerbate the problem. Decreasing the FIO2 would not assist in correcting the complication of pneumothorax. Lewis 2017, pgs. 1616, 1623 28. The nurse is evaluating the arterial blood gas (ABG) results for a client experiencing acute respiratory distress syndrome who has received prone positioning. Which of the following would indicate the prone positioning was successful? a. PaO2 level changed from 60 mm Hg to 85 mm Hg b. pH is 7.34 and PaCO2 is 33 mm Hg c. HCO3 level changed from 25 mEq/L to 35 mEq/L d. pH is 7.45 and HCO3 is 26 Feedback: The nurse should check the client’s PaO2 level for an increase to show that the client’s perfusion/ventilation is better matched. The prone positioning allows for fluid filled alveoli that were in the dependent area, when the client was supine, to drain to the anterior portion of the lungs, which become the dependent lungs when in the prone position. This helps to improve ventilation of better- perfused lung areas. The changes in the HCO3 level indicate the HCO3 has increased which would not indicate the position helped with ventilation. The other two distractors do not provide enough information to know if there is an improvement. Lewis 2017, p. 290kbcd, 1624-1625k 29. The nurse is caring for a client who received long-term prescribed aminoglycoside antibiotic therapy for an infection. The nurse notes the client's potassium level is 5.4 mEq/L and the client's electrocardiogram (ECG) shows peaked T-waves. Which of the following actions should the nurse take? a. Notify the healthcare provider and request a prescription for polystyrene sulfonate. b. Notify the healthcare provider and request a prescription for a hypotonic IV solution. c. Encourage the client to increase intake of potassium rich foods. d. Monitor skin turgor and presence of edema every shift. Feedback: Hyperkalemia, a common complication of acute kidney injury, is life-threatening if immediate action is not taken to reverse it. The administration of polystyrene sulfonate reduces serum potassium levels. Increasing potassium will increase the problem of hyperkalemia. Giving a hypotonic solution is treatment for hypernatremia not hyperkalemia.Lewis 2017, pgs. 280-282abkd 30. The nurse should interpret the arterial blood gas results shown below as which of the following? pH 7.48, PaO2 85 mm Hg, PaCO2 32 mm Hg, and HCO3 25 mEq/L a. respiratory alkalosis b. metabolic acidosis c. metabolic alkalosis d. respiratory acidosis Feedback: The ABGs shown indicate the pH is high which would mean alkalosis. The PaCO2 is low which is the opposite of the pH and indicates that the respiratory system is the primary problem. The HCO3 is within normal levels. Remember the acronym ROME when interpreting ABGs.Lewis 2017, pgs 290-291abcK 31. The nurse is caring for a client who is receiving prescribed intravenous (IV) fluids at 50 ml/hr, has voided 300 ml in 24-hours and reports having a headache. The nurse notes the client's laboratory results show a low urine specific gravity level. Which of the following actions should the nurse take? a. Encourage the client to increase their fluid intake. b. Decrease the intravenous fluids. c. Administer prescribed antibiotics. d. Assist the client to ambulate to increase their metabolic rate. Feedback: Acute renal failure manifests as oliguria, anuria, or normal urine volume. Oliguria (less than 400 mL/d of urine) is the most common clinical situation seen in acute renal failure along with a low urine specific gravity; anuria (less than 50 mL/d of urine) and normal urine output are not as common. In acute renal failure you want to encourage the client to increase their fluid intake to prevent dehydration. Administering antibiotics will not increase the client's decreased urine output. Decreasing IV fluids will be putting the client at risk for dehydration. Increasing the metabolic rate will not assist the client in their urine output deficit. Lewis 2017, pgs. 1071-1072abkd 32. The plan of care for a client with a low potassium level includes providing information about the effects of medications and the dietary intake of foods high in potassium. Which of the following information should the nurse use to evaluate if the outcome for the plan was met? a. laboratory data b. physical assessment c. health history d. client statements Feedback: The interventions are aimed at increasing the potassium level of the client, and achievement would be measured by evaluating laboratory data. Potassium levels cannot be measured by physical assessment, health history information, or client statements. Lewis 2017, pgs. 282-283 33. The nurse caring for a client experiencing acute hypoxemic respiratory failure due to V/Q mismatch is evaluating the client’s plan of care. Which of the following interventions would be appropriate for the client’s care plan? a. Initiate 24% to 32% oxygen via face mask. b. Provide high flow supplemental oxygen via nasal cannula. c. Provide oxygen via noninvasive positive pressure ventilation (NIPPV). d. Initiate invasive positive pressure ventilation (PPV) via endotracheal tube for SaO2 below 90%. Feedback: The nurse should understand that acute hypoxemic respiratory failure due to V/Q mismatch requires low levels of oxygen either via nasal cannula or using a face mask at 24% to 32% oxygen. This helps improve the PaO2 and SaO2 levels. Without knowing the client’s baseline SaO2 an intervention to initiate PPV vie ET tube for SaO2 would be inappropriate. NIPPV is typically the treatment of choice for hypoxemia secondary to an intrapulmonary shunt, not V/Q mismatch.Lewis 2017, pgs. 1615-1616 34. The nurse is caring for a client with right sided pneumonia (PN) and helps position the client in the left Sims position. The nurse should evaluate the client’s response to the position by doing which of the following? a. Compare the client’s PaO2 level with the previous level. b. Assessing the client’s pain level. c. Ask the client to perform coughing and deep breathing. d. Compare the client’s pH and HCO3 levels with the baseline levels. Feedback: Clients with unilateral lung disease should be positioned with the healthy lung in a dependent position. This helps to mobilize the secretions which makes it easier to expectorate. The client’s PaO2 level compared to the previous level would give the nurse a good indication if the client’s ventilation has increased. Lewis 2017, pgs. 1610-1611k, 1624-1625k, acd by omission 35. The nurse is caring for a client with acute respiratory distress syndrome (ARDS) who is mechanically ventilated with positive end-expiratory pressure (PEEP). Which of the following should alert the nurse that the client is having complications from PEEP? Select all that apply. a. tachycardia b. hypopnea c. decreased urine output d. diminished lung sounds e. hypertension Feedback: PEEP is indicated in clients with ARDS. PEEP provides positive pressure at the end of expiration to keep the alveoli open. This positive pressure can increase the intrathoracic pressure. When intrathoracic pressure increases, the client will have a decrease in preload, which can decrease cardiac output. When there is a decrease in cardiac output, the client can have tachycardia, hypotension, and decreased perfusion to the kidneys. With increased intrathoracic pressure, barotrauma or pneumothorax can occur. A client on mechanical ventilation should have equal and bilateral breath sounds, diminished breath sounds may indicate a pneumothorax.Lewis 2017, pg. 1577Kbe 36. The nurse received report from the previous shift for a client who was intubated for acute respiratory failure (ARF) less than one hour ago. Which of the following test results would be a priority for the nurse to follow-up? a. end-tidal CO2 (ETCO2) b. complete blood count (CBC) c. electrocardiogram (ECG) d. mixed venous O2 saturation (SvO2) Feedback: After a client is intubated the ETCO2 should be evaluated because this confirms proper tube placement within the airway immediately after intubation. A CBC, ECG and SvO2 are also done after intubation but would not be a priority over correct tube placement.Lewis 2017, p. 1614 Feedback: Providing the client with alternative methods of communication may provide the client with control and become less frustrated. Assuring the client that everything will be all right offers false reassurance and telling him not to be upset minimizes his feelings. Neither of these methods helps the client to communicate. In a client with an endotracheal or tracheostomy tube, the family members are also likely to encounter difficulty interpreting the client's wishes. Making them responsible for interpreting the client's gestures may frustrate the family. The client may be weaned off a mechanical ventilator only when the physiologic parameters for weaning have been met. Lewis 2017, pgs. 1556k abc by omission 44. The nurse in the emergency department is caring for a client experiencing acute respiratory failure who is restless and has decreased cardiac output. Which of the following interventions would be a priority by the nurse? a. Prepare to intubate the client. b. Provide airway suctioning. c. Administer a prescribed bronchodilator. d. Connect the client to a cardiac monitor. Feedback: A client with decreased cardiac output who is already experiencing ARF indicates severe acute respiratory distress syndrome (ARDS) and requires intubation to maintain the PaO2 at acceptable levels. The client will need cardiac monitoring and bronchodilators and probably suctioning once intubated, but those are not the priority.Lewis 2017, p. 1624kacd by omission, 1615stem 45. The nurse is caring for a client who is in acute respiratory failure (ARF) from exacerbated chronic obstructive pulmonary disease (COPD). The client is intubated with an endotracheal (ET) tube and placed on mechanical ventilation. Which of the following actions would be a priority for the nurse to take following intubation? a. Auscultate the lungs for presence of bilateral breath sounds. b. Arrange for a chest radiograph (x-ray). c. Monitor the client for signs of aspiration. d. Reposition the client every hour. Feedback: When a client is intubated with a endotracheal tube for mechanical ventilation, the nurse should immediately assess for chest expansion symmetry and auscultate breath sounds bilaterally. The client will have a chest radiograph to confirm placement, but that is not the immediate priority. Repositioning the client and assessing for aspiration are important to prevent complications, but 46. The nurse is caring for a client who was admitted with diabetic ketoacidosis (DKA) and has a serum potassium level of 2.9 mEq/L. Which of the following actions, if prescribed by the health care provider, should the nurse take first? a. Place the client on a cardiac monitor. b. Administer regular insulin intravenously (IV) at 20 units/hr. c. Administer intravenous (IV) potassium supplements. d. Obtain urine glucose and ketone levels. Feedback: Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with ECG monitoring. Since potassium must be infused over at least 1 hour, the nurse should initiate cardiac monitoring before infusion of potassium. Insulin should not be administered without cardiac monitoring, since insulin infusion will further decrease potassium levels. Urine glucose and ketone levels are not urgently needed to manage the patient’s care. Lewis 2017, pgs. 282-283akcd 47. The nurse received change of shift report about assigned clients. Which of the following clients should the nurse assess first? a. The client with serum magnesium level of 1.1 mEq/L who has tremors and hyperactive deep tendon reflexes. b. The client with serum potassium level 5.0 mEq/L who is reporting abdominal cramping. c. The client with serum sodium level 145 mEq/L who reports dry mouth and is asking for water. d. The client with serum phosphorus level of 4.5 mg/dL who has multiple soft tissue calcium- phosphate precipitates. Feedback: The client with low magnesium needs to be seen first because hypomagnesemia can lead to cardiac dysrhythmias. The client with a high phosphorus is just barely high and has manifestations that are expected and not life threatening. The client with a high normal potassium level is experiencing expected symptoms of abdominal cramping and also does not have life-threatening symptoms. Finally, the client whose sodium is 145 is within normal limits and so would not be the priority. Lewis 2017, p. 286k, 279b,280-281a, 285d 48. A client is admitted to the intensive care unit (ICU) after a motor vehicle collision (MVC) in which the client received blunt trauma to the chest. The client is in acute respiratory failure and is intubated and minimally sedated. Which of the following should the ICU nurse monitor when caring for the client? Select all that apply. a. ability to communicate verbally b. respiratory system c. oral intake d. arterial blood gases (ABGs) e. vital signs (VS) Feedback: Clients are usually managed in the intensive care unit. The nurse assesses the client's respiratory status by monitoring the level of responsiveness, arterial blood gases, pulse oximetry, and vital signs. In addition, the nurse assesses the entire respiratory system and implements strategies (eg, turning schedule, mouth care, skin care, range of motion of extremities) to prevent complications. The nurse also assesses the client's understanding of the management strategies that are used and initiates some form of communication to enable the client to express concerns and needs to the health care team. The other options are incorrect; a client in respiratory failure is intubated. The client cannot communicate verbally and cannot take in anything orally. Lewis 2017, pgs. 49. The nurse is assessing for therapeutic effects of a newly prescribed bronchodilator for a client with chronic obstructive pulmonary disease (COPD). Which of the following findings would indicate to the nurse an improvement in respiratory status has occurred? Select all that apply. a. increased expiratory flow rate b. relief of dyspnea reported c. negative sputum culture results d. increased viscosity of lung secretions e. increased respiratory rate Feedback: The relief of bronchospasm is confirmed by measuring improvement in expiratory flow rates and volumes (the force of expiration, how long it takes to exhale, and the amount of air exhaled) as well as by assessing the dyspnea and making sure that it has lessened. Increased respiratory rate and viscosity of secretions would suggest a worsening of the client's respiratory status. Bronchodilators would not have a direct result on the client’s infectious process. Lewis 2017, p. 1618 and 562-563de, abc by omission 50. The nurse is caring for a client experiencing acute metabolic alkalosis from gastroenteritis and notes the client’s pulse is 110 beats/min, and on telemetry the client has flattened T waves and presence of U waves. Which of the following information should the nurse explain to the client? a. “Your body is showing signs of decreased potassium and will require potassium replacement therapy.” b. “You are experiencing low blood sugar and will need to receive intravenous glucose.” c. “You are experiencing symptoms of kidney failure and will need peritoneal dialysis.” d. “Your body is going into hypovolemic shock and requires rapid intravenous fluid replacement.” Feedback: Gastroenteritis is accompanied by diarrhea and vomiting which can result in decreased potassium levels and cause metabolic alkalosis. Flattened T waves, presence of a U wave, and rapid pulse are all manifestations of hypokalemia. The client will require potassium replacement therapy. A client experiencing metabolic alkalosis would more likely have a high blood sugar not low. A client with acute kidney failure would have an increased potassium level with peaked T waves. The client may be hypovolemic from gastroenteritis, however there is not enough information in the stem to determine that the client is experiencing shock.Lewis 2017, pgs. 944 stem, 282k, 289-291k, 1072b, 1589c, 1591c