A nurse is reinforcing discharge teaching with a client who has acute pancreatitis and a prescription for fat-soluble vitamin supplements.
Which of the following supplements should the nurse include in the teaching?

Choice A rationale:

Metabolic alkalosis is incorrect because it would present with a high pH and high HCO3. This client’s pH is low, indicating acidosis, not alkalosis.

Choice B rationale:

Respiratory acidosis is correct. It is characterized by a low pH and high PaCO2, as seen in this client’s results. This condition occurs when the lungs can’t remove enough CO2, causing it to build up in the blood and lower the pH.

Choice C rationale:

Metabolic acidosis is incorrect because it would present with a low pH and low HCO3. This client’s HCO3 is normal.

Choice D rationale:

Respiratory alkalosis is incorrect because it would present with a high pH and low PaCO2. This client’s pH is low and PaCO2 is high.

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.