A nurse is caring for a client who has rheumatoid arthritis (RA). The nurse understands that this condition is caused by what type of hypersensitivity?

Choice A reason:

Gram-positive cocci are bacteria that have a spherical shape and stain purple with Gram stain due to their thick peptidoglycan cell wall. Streptococcus pyogenes is an example of gram-positive cocci that can cause infections such as pharyngitis, impetigo, cellulitis, necrotizing fasciitis, or rheumatic fever.

Choice B reason:

Gram-negative cocci are bacteria that have a spherical shape and stain pink with Gram stain due to their thin peptidoglycan cell wall and outer membrane. Neisseria gonorrhoeae and Neisseria meningitidis are examples of gram-negative cocci that can cause infections such as gonorrhea, meningitis, or septicemia.

Choice C reason:

Gram-positive bacilli are bacteria that have a rod-shaped shape and stain purple with Gram stain due to their thick peptidoglycan cell wall. Bacillus anthracis and Clostridium botulinum are examples of gram-positive bacilli that can cause infections such as anthrax, botulism, or tetanus.

Choice D reason:

Gram-negative bacilli are bacteria that have a rod-shaped shape and stain pink with Gram stain due to their thin peptidoglycan cell wall and outer membrane. Escherichia coli and Pseudomonas aeruginosa are examples of gram-negative bacilli that can cause infections such as urinary tract infection, wound infection, or sepsis.

Choice A reason:

Administering antiemetics as prescribed is an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Antiemetics are medications that can prevent or treat nausea and vomiting, which are the main causes of metabolic alkalosis in this case. By stopping vomiting, antiemetics can help prevent further loss of gastric acid and bicarbonate retention, which can correct metabolic alkalosis.

Choice B reason:

Monitoring serum potassium levels is an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Metabolic alkalosis can cause hypokalemia due to increased renal excretion of potassium and intracellular shift of potassium in exchange for hydrogen ions. Hypokalemia can worsen metabolic alkalosis by impairing renal acid excretion and increasing bicarbonate reabsorption. The nurse should monitor serum potassium levels regularly and report any abnormalities or signs of hypokalemia, such as muscle weakness, cramps, arrhythmias, or ECG changes.

Choice C reason:

Administering sodium bicarbonate IV as prescribed is not an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Sodium bicarbonate is an alkalinizing agent that can increase serum bicarbonate levels and pH, which can worsen metabolic alkalosis. Sodium bicarbonate IV should be avoided or used with caution in clients who have metabolic alkalosis, unless they have severe acid-base imbalance or coexisting metabolic acidosis.

Choice D reason:

Encouraging intake of acidic foods and beverages is not an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Acidic foods and beverages can lower the pH of the stomach, but they have little effect on the pH of the blood or urine, which are regulated by other mechanisms such as buffers, lungs, and kidneys. Acidic foods and beverages can also irritate the gastric mucosa and trigger more vomiting, which can aggravate metabolic alkalosis.

Choice E reason:

Providing supplemental oxygen as needed is an intervention that the nurse should implement for a client who has metabolic alkalosis due to prolonged vomiting. Metabolic alkalosis can cause respiratory compensation by decreasing the respiratory rate and depth, which can lead to hypoxemia and hypercapnia. Supplemental oxygen can help maintain adequate oxygenation and prevent tissue hypoxia and organ damage. The nurse should monitor the client's oxygen saturation and arterial blood gas levels and adjust the oxygen therapy accordingly.