A nurse is reinforcing teaching with a client about how to prevent the onset of manifestations of Raynaud's phenomenon. Which of the following statements should the nurse identify as an indication that the client needs further teaching?

(A) Decreased stimulation of the sympathetic nervous system (SNS): The sympathetic nervous system (SNS) plays a key role in regulating blood pressure. When the SNS is stimulated, it causes vasoconstriction, or narrowing of the blood vessels, which increases blood pressure. Therefore, decreased stimulation of the SNS would typically lead to vasodilation, or widening of the blood vessels, which would lower blood pressure, not increase it.

(B) Decreased elasticity of blood vessels: As people age, their blood vessels can lose elasticity, which can lead to hypertension. When blood vessels are elastic, they can easily expand and contract with each heartbeat, maintaining a healthy blood pressure. But when they become stiff or rigid, they can’t expand as easily, causing the pressure inside to increase.

(c) Increased peripheral vascular resistance (PVR): Peripheral vascular resistance is the resistance that blood must overcome to flow through the blood vessels. The more resistance, the harder the heart has to work to pump blood through the body, which can lead to increased blood pressure. Factors that can increase PVR include vasoconstriction, or narrowing of the blood vessels, and increased blood viscosity, or thickness.

(D) Decreased fluid volume: Decreased fluid volume, or hypovolemia, would typically lead to a decrease in blood pressure, not an increase. This is because blood pressure is directly related to the volume of blood in the blood vessels. When there’s less blood, the pressure inside the blood vessels is usually lower.

(E) Increased blood viscosity: Blood viscosity refers to the thickness of the blood. When blood is thicker, it’s harder for it to flow through the blood vessels, which increases the resistance to blood flow, leading to increased blood pressure.

(A) Metabolic alkalosis: This condition is characterized by a high blood pH (>7.45) and a high bicarbonate level (>26 mEq/L). The client’s pH and bicarbonate levels are both lower than normal, which rules out metabolic alkalosis.

(B) Respiratory acidosis: This condition is characterized by a low blood pH (<7.35) and a high PaCO2 level (>45 mm Hg). Although the client’s pH is low, the PaCO2 level is also low, which rules out respiratory acidosis.

(c) Respiratory alkalosis: This condition is characterized by a high blood pH (>7.45) and a low PaCO2 level (<35 mm Hg). The client’s pH is low, which rules out respiratory alkalosis.

(D) Metabolic acidosis: This condition is characterized by a low blood pH (<7.35) and a low bicarbonate level (<22 mEq/L). The client’s pH is 7.26 and bicarbonate level is 14 mEq/L, both of which are lower than normal. This indicates metabolic acidosis, which is common in clients with acute kidney injury as the kidneys are unable to excrete hydrogen ions and reabsorb bicarbonate. Therefore, the nurse should identify that the client is experiencing metabolic acidosis.