A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what?

Choice A: Oncogene Activation

Oncogene activation refers to the process by which normal genes (proto-oncogenes) become oncogenes, leading to uncontrolled cell growth and potentially cancer. This process involves mutations or overexpression of genes that regulate cell proliferation and survival. While oncogene activation is a critical factor in cancer development, it is not directly related to hydropic swelling, which is a form of cellular injury characterized by the accumulation of water within cells.

Choice B: Sodium/Potassium Pump Dysfunction

Hydropic swelling, also known as cellular swelling, results from the malfunction of the sodium/potassium (Na+/K+) pump. This pump is essential for maintaining the ionic balance within cells by actively transporting sodium out of the cell and potassium into the cell. When the Na+/K+ pump fails, sodium accumulates inside the cell, leading to an influx of water to balance the osmotic pressure. This results in cellular swelling, which is a hallmark of reversible cell injury.

Choice C: Membrane Rupture

Membrane rupture refers to the breaking of the cell membrane, which can lead to cell death and the release of cellular contents into the surrounding tissue. This process is typically associated with irreversible cell injury and necrosis. While membrane rupture can result from severe cellular damage, it is not the primary cause of hydropic swelling, which occurs due to ionic imbalances rather than physical disruption of the cell membrane.

Choice D: ATP Accumulation

ATP (adenosine triphosphate) is the primary energy currency of the cell, used to power various cellular processes. Accumulation of ATP within the cell is not typically associated with cellular swelling. In fact, a decrease in ATP levels, rather than an accumulation, is more likely to contribute to cellular injury. Reduced ATP levels can impair the function of the Na+/K+ pump, leading to ionic imbalances and subsequent hydropic swelling.

Choice A: Alkalosis

Alkalosis refers to a condition where the blood pH is higher than the normal range (above 7.45). In this case, the pH is 7.25, which indicates an acidic environment rather than an alkaline one. Therefore, alkalosis is not the correct answer.

Choice B: Respiratory

Respiratory acidosis or alkalosis is determined by the levels of PaCO2. In respiratory acidosis, PaCO2 is elevated, while in respiratory alkalosis, PaCO2 is decreased. Here, the PaCO2 is 20 mm Hg, which is below the normal range, indicating a respiratory component. However, the primary issue is not respiratory because the HCO3- is also significantly low, pointing towards a metabolic cause.

Choice C: Metabolic

Metabolic acidosis is characterized by a low pH and a low HCO3- level. In this case, the pH is 7.25, and the HCO3- is 10 mEq/L, both of which are below the normal ranges. This indicates that the primary acid-base imbalance is metabolic acidosis.

Choice D: Acidosis

Acidosis refers to a condition where the blood pH is lower than the normal range (below 7.35). The given pH of 7.25 confirms that the patient is experiencing acidosis. However, this choice alone does not specify whether it is metabolic or respiratory acidosis.

Choice E: With Compensation (Being Compensated)

Compensation refers to the body’s attempt to return the pH to normal by adjusting the levels of PaCO2 or HCO3-. In this case, the low PaCO2 suggests that there is a respiratory compensation for the metabolic acidosis. However, the primary imbalance remains metabolic acidosis.