A nurse is caring for a client who has acute kidney injury. The client's ABGS are:

PH:7.26

PaCO2: 30 mm Hg

HCO3: 14 mEq/L

Which of the following acid-imbalances should the nurse identify the client is experiencing?

(A) Lean back in the chair: Leaning back in the chair can be perceived as a relaxed posture, but it might also convey disinterest or detachment in the conversation. Active listening involves being engaged and showing interest in what the client is saying.

(B) Use intermittent eye contact: This is the most appropriate answer. Maintaining eye contact is an important part of active listening as it shows that the nurse is focused and interested in what the client is saying. However, constant eye contact can be intimidating or uncomfortable for some clients, so intermittent eye contact is often more appropriate.

(c) Have a pen and paper: Having a pen and paper can be useful for note-taking, but it is not a direct action of active listening. It’s important to maintain focus on the client during the conversation, and excessive note-taking can be distracting.

(D) Sit side-by-side with the client: While sitting side-by-side with the client can create a more relaxed and equal atmosphere, it is not a direct action of active listening. The nurse should face the client and maintain appropriate eye contact to show engagement and interest.

(A) Heart murmur: This is the most appropriate answer. Mitral valve stenosis can cause a heart murmur due to turbulent blood flow across the narrowed mitral valve. This is often heard best at the apex of the heart with the patient in the left lateral decubitus position.

(B) Clubbing of the fingers: Clubbing of the fingers is typically associated with conditions that cause chronic hypoxia, such as lung disease or congenital heart disease. It is not a common finding in mitral valve stenosis.

(C) Bradycardia: Mitral valve stenosis does not typically cause bradycardia. In fact, some patients may have a rapid heart rate (tachycardia) due to atrial fibrillation, which is a common complication of mitral valve stenosis.

(D) Barrel chest: A barrel chest is typically associated with chronic obstructive pulmonary disease (COPD) and is not a common finding in mitral valve stenosis. It refers to a rounded, bulging chest that resembles the shape of a barrel. This occurs due to overinflation of the lungs over a long period of time.