A nurse is caring for a client who has heart failure (HF). Which of the following should the nurse identify as a cause for the client's decreased serum osmolality?

A decrease in intracellular fluid volume

An increase in hydrostatic pressure

An increase in serum sodium

An increase in vascular fluid volume

Answer and Explanation

The Correct Answer is D

A. A decrease in intracellular fluid volume: A reduction in intracellular fluid volume often results from hypertonic conditions in the extracellular space, which can draw water out of cells. This shift can actually increase serum osmolality rather than decrease it.
B. An increase in hydrostatic pressure: Increased hydrostatic pressure promotes fluid movement from the vascular space into the interstitial tissues, contributing to edema. However, this does not significantly impact the concentration of solutes in the serum and therefore does not directly cause a decrease in osmolality.
C. An increase in serum sodium: Sodium is the main contributor to serum osmolality, so an increase in serum sodium raises osmolality. This is the opposite of what occurs in heart failure, where sodium levels are often diluted due to fluid retention.
D. An increase in vascular fluid volume: In heart failure, the kidneys retain fluid in response to decreased cardiac output, expanding the vascular volume. This excess water dilutes the concentration of solutes in the blood, such as sodium, leading to a decrease in serum osmolality.

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Correct Answer is D

Explanation

A. Decreased pulmonary vascular resistance: Pulmonary embolism typically causes increased pulmonary vascular resistance, not decreased. The clot obstructs blood flow in the pulmonary arteries, increasing pressure within the pulmonary vasculature and impairing gas exchange, which can strain the right side of the heart.
B. Hypercapnia: Hypercapnia (elevated carbon dioxide levels) is not commonly seen in the early stages of a pulmonary embolism. Instead, patients tend to hyperventilate in response to hypoxia and anxiety, which lowers CO₂ levels rather than raising them.
C. Hypoventilation: Hypoventilation is not expected with a pulmonary embolism. In fact, most patients initially experience hyperventilation due to the body’s attempt to compensate for impaired oxygenation, leading to decreased CO₂ levels.
D. Respiratory alkalosis: Respiratory alkalosis occurs as a result of hyperventilation caused by anxiety, pain, and hypoxemia in response to the embolism. This leads to excessive loss of CO₂, increasing blood pH and resulting in respiratory alkalosis, which is a common initial finding in pulmonary embolism.

A. Metabolic alkalosis B. Metabolic acidosis, uncompensated C. Respiratory acidosis D. Respiratory alkalosis, partially compensated

Correct Answer is B

Explanation

A. Metabolic alkalosis: This condition is characterized by an elevated pH above 7.45 and an increased bicarbonate level. In this case, the pH is low and the HCO₃⁻ is also decreased, ruling out metabolic alkalosis.
B. Metabolic acidosis, uncompensated: A pH of 7.25 indicates acidemia, and a bicarbonate level of 16 mEq/L confirms a metabolic origin. The PaCO₂ is normal at 40 mmHg, indicating that respiratory compensation has not yet occurred, making this an uncompensated metabolic acidosis.
C. Respiratory acidosis: Respiratory acidosis involves a low pH and elevated PaCO₂ due to hypoventilation. This client’s PaCO₂ is within normal range, so respiratory causes can be ruled out.
D. Respiratory alkalosis, partially compensated: This condition presents with a high pH and low PaCO₂, typically due to hyperventilation. The client has an acidic pH and a normal PaCO₂, which does not support respiratory alkalosis.

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A nurse is caring for a client who has heart failure (HF). Which of the following should the nurse identify as a cause for the client's decreased serum osmolality?

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