An older adult female client is hospitalized with a fractured femur. During a routine nursing assessment, she repeatedly asks the nurse to “speak up” so that she can hear the questions. Which action is best for the nurse to take?

Choice A reason: Avoiding gluten is specific to celiac disease, not Crohn’s, which involves inflammatory bowel disease without gluten sensitivity. Gluten restriction does not address Crohn’s mucosal inflammation, and this instruction misguides the client, as dietary triggers vary, requiring individualized management.

Choice B reason: Restricting fluids is incorrect, as Crohn’s patients need adequate hydration to manage diarrhea and prevent dehydration. Fluid restriction exacerbates electrolyte imbalances, worsening symptoms, making this an inappropriate recommendation for Crohn’s dietary management, which focuses on symptom-specific adjustments.

Choice C reason: Limiting calcium and iron is not standard for Crohn’s, as these nutrients support bone health and anemia prevention, common concerns in inflammatory bowel disease. This restriction could worsen deficiencies without addressing inflammation, making it an incorrect dietary focus for Crohn’s.

Choice D reason: Recommending a personalized diet plan with a dietitian is correct, as Crohn’s dietary triggers vary, requiring tailored plans to avoid exacerbating inflammation. Dietitians identify specific irritants, like high-fiber foods, ensuring nutritional balance while minimizing symptoms, making this the best approach for effective management.

Choice A reason: Hyperventilation rapidly eliminates carbon dioxide, causing respiratory alkalosis, not acidosis. In respiratory acidosis, hypoventilation retains CO2, increasing blood carbonic acid, lowering pH. This contradicts the client’s condition, as rapid CO2 loss would raise, not lower, blood pH.

Choice B reason: Blood oxygen levels stimulating respiration may occur in hypoxia but do not directly cause respiratory acidosis. Low oxygen can coexist with CO2 retention, but acidosis results from high CO2, not oxygen-driven respiratory changes, making this choice irrelevant to the pathophysiology.

Choice C reason: High blood carbon dioxide levels cause respiratory acidosis, as hypoventilation in respiratory distress retains CO2, forming carbonic acid, lowering blood pH. This aligns with the client’s condition, where impaired gas exchange increases CO2, driving acid-base imbalance, making this the correct pathophysiological process.

Choice D reason: Carbon dioxide conversion in kidneys occurs during bicarbonate buffering, a compensatory mechanism, not the primary cause of respiratory acidosis. Acidosis results from pulmonary CO2 retention, not renal processes, which are secondary and slower, making this choice incorrect for the acute condition.