A nurse is caring for a 78-year-old client who was recently admitted from the emergency room and is reporting weakness.

Exhibits

Select words from the choices below to fill in each blank in the following sentence.

The nurse has reviewed the client's medical record.

The client is at risk for developing metabolic acidosis hypernatremia

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and

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A. Fever can cause tachycardia (increased heart rate) rather than bradycardia. It is not typically associated with slowing of the heart rate unless there are other complicating factors such as severe infection or medication side effects.
B. Significant blood loss can lead to hypovolemia (low blood volume), which can result in bradycardia as a compensatory mechanism to maintain blood pressure. However, the blood pressure in this scenario is

normal (120/80), which makes severe hemorrhage less likely unless compensated by fluid resuscitation or other factors.
C. COPD can cause chronic hypoxia and respiratory acidosis, which can lead to chronic respiratory compensation and potentially bradycardia. However, COPD alone is less likely to cause bradycardia in the absence of severe exacerbation or other complicating factors.
D. Calcium channel blockers (CCBs) are medications commonly prescribed for conditions such as hypertension, angina, and arrhythmias. They work by blocking calcium channels in cardiac and smooth muscle cells, resulting in decreased heart rate and vasodilation. Bradycardia is a known side effect of CCBs, especially when taken in excess or in combination with other medications that affect heart rate.

A. PaCO2 (partial pressure of carbon dioxide) reflects the respiratory component of acid-base balance. In metabolic acidosis, the respiratory system compensates by increasing ventilation to decrease PaCO2 (hyperventilation). Therefore, PaCO2 is typically below normal (less than 35-45 mm Hg) in metabolic acidosis, not above 45 mm Hg.
B. HCO3 (bicarbonate) is a buffer that helps regulate pH in the body. In metabolic acidosis, there is a primary decrease in HCO3 due to either increased acid production (e.g., lactic acidosis, ketoacidosis) or decreased acid elimination (e.g., renal failure). Therefore, HCO3 is typically below normal (< 22-26 mEq/L) in metabolic acidosis, not above 26 mEq/L.
C. PaO2 (partial pressure of oxygen) measures the oxygen level in the blood. It is not directly related to the diagnosis of metabolic acidosis. Low PaO2 levels may indicate respiratory dysfunction or impaired gas exchange but are not specific to metabolic acidosis.
D. pH below 7.35 indicates acidosis. In metabolic acidosis, the primary defect is a decrease in blood pH due to an excess of acids or a loss of bases. The pH typically decreases below the normal range of 7.35-7.45 in metabolic acidosis.