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?

Choice A rationale:

Discarding any partial doses found in the cabinet in the sharps container is not the correct procedure. Partial doses should be wasted in the presence of another nurse.

Choice B rationale:

Verifying that the amounts of each medication counted match the amounts on the inventory record is the correct procedure. This ensures accurate accounting of controlled substances.

Choice C rationale:

Setting aside any controlled substances the nurse plans to give during her shift is not the correct procedure. Medications should be removed from the secure cabinet as needed.

Choice D rationale:

Co-signing any notations of wasting controlled substances on the previous shift is not the correct procedure. Wasting should be witnessed and co-signed at the time it occurs.

The correct answer is choice B.

Choice A rationale:

A client who has NPO (nothing by mouth) status since midnight for an endoscopy could be at risk for fluid volume deficit. NPO status means the client has not been able to consume fluids orally, which could lead to a decrease in fluid intake. However, the risk is relatively low if the NPO status has only been in place since midnight and the client is otherwise healthy.

Choice B rationale:

A client who has heart failure and is receiving diuretic therapy is at a high risk for fluid volume deficit. Diuretics are used in heart failure to remove excess fluid from the body, but they can also lead to fluid volume deficit if not properly managed. This is because diuretics increase urine output, which can lead to a loss of fluid and electrolytes.

Choice C rationale:

A client who has gastroenteritis and is receiving oral fluids is not typically at risk for fluid volume deficit. Gastroenteritis can cause fluid loss through diarrhea and vomiting, but if the client is able to consume and retain oral fluids, they can usually maintain their fluid balance.

Choice D rationale:

A client who has end-stage kidney disease and will undergo dialysis could be at risk for fluid volume deficit, but this risk is typically well-managed during dialysis. Dialysis removes waste and excess fluid from the blood, and fluid intake is carefully monitored and adjusted based on the individual’s needs. Therefore, while there is a potential risk, it is usually well-controlled under the care of healthcare professionals.