A nurse is providing care to a client who has peritonitis. Which of the following conditions is the highest priority for
the nurse to monitor?

Heart atack

Diabetes

Respiratory failure

Sepsis

Answer and Explanation

The Correct Answer is D

Choice A reason: While a heart atack is a serious condition, it is not directly related to peritonitis. Peritonitis can lead to systemic infection, which may indirectly affect the heart, but it is not the primary concern in the immediate care of peritonitis.

Choice B reason: Diabetes is a chronic condition that requires ongoing management. However, it is not the most immediate threat when a client is diagnosed with peritonitis. The nurse should continue to monitor blood glucose levels as part of routine care.

Choice C reason: Respiratory failure can be a complication of peritonitis if the infection spreads and affects other systems. However, the primary concern with peritonitis is the potential for the infection to lead to sepsis.

Choice D reason: Sepsis is a life-threatening condition that can occur as a complication of peritonitis. It happens when the body's response to infection causes injury to its own tissues and organs. Monitoring for signs of sepsis is crucial because early intervention can be lifesaving.

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Correct Answer is D

Explanation

Choice A reason: A pH of 7.26 indicates acidosis, but an HCO3 of 24 and PaCO2 of 46 suggest a respiratory cause rather than metabolic, which is not typical for AKI.

Choice B reason: A pH of 7.49 indicates alkalosis, and with an HCO3 of 30 and PaCO2 of 40, this suggests metabolic alkalosis, which is not expected in AKI.

Choice C reason: A pH of 7.49 indicates alkalosis. An HCO3 of 24 is normal, and a PaCO2 of 30 would suggest respiratory alkalosis, not typically associated with AKI.

Choice D reason: A pH of 7.26 indicates acidosis, and with an HCO3 of 14, this suggests metabolic acidosis, which is consistent with AKI. The PaCO2 of 30 indicates a compensatory respiratory response to the metabolic acidosis. This ABG result aligns with the expected findings in a patient with AKI, where there is an accumulation of acids and a decrease in bicarbonate due to the kidneys' inability to filter and excrete hydrogen ions effectively.

A. Instruct the client to drink 1 liter of fluid each day. B. Instruct the client to take antibiotics until dysuria is no longer present. C. Instruct the client to avoid drinking carbonated beverages. D. Instruct the client to drink 240 mL of tomato juice each day.

Correct Answer is C

Explanation

Choice A reason: Instructing the client to drink 1 liter of fluid each day may not be sufficient for someone with cystitis. Increasing fluid intake helps ?ush out bacteria from the urinary tract, and the general recommendation is to drink about 2 liters of water per day.

Choice B reason: While taking antibiotics is a crucial part of treating bacterial cystitis, the client should complete the full course of antibiotics prescribed, not just until symptoms such as dysuria disappear. This ensures the infection is fully treated and reduces the risk of resistance.

Choice C reason: Advising the client to avoid carbonated beverages is appropriate because such drinks can irritate the bladder and exacerbate symptoms of cystitis. It is also recommended to avoid ca?eine, alcohol, and spicy foods until the infection clears.

Choice D reason: There is no specific recommendation for clients with cystitis to drink tomato juice each day. In fact, tomato juice is acidic and may irritate the bladder, similar to carbonated beverages.

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A nurse is providing care to a client who has peritonitis. Which of the following conditions is the highest priority for the nurse to monitor?

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A nurse is providing care to a client who has peritonitis. Which of the following conditions is the highest priority for
the nurse to monitor?