The nurse is caring for a client with severe diarrhea. The nurse monitors the client closely, understanding that this client is at risk for developing which acid-base disorder?

Choice A reason: This is correct because prolonged bed rest can cause hypocalcemia, or low serum calcium level. Calcium is stored in the bones and is released into the blood when the bones are stressed by weight-bearing activities. When a person is on bed rest, the bones are not stimulated and the calcium remains in the bones, leading to a decrease in serum calcium level.

Choice B reason: This is incorrect because too much butter consumption does not affect the serum calcium level directly. Butter is a source of fat and calories, which can affect the cholesterol and triglyceride levels, but not the calcium level. However, too much butter consumption can cause obesity, which can increase the risk of osteoporosis and fractures.

Choice C reason: This is incorrect because hyperparathyroidism can cause hypercalcemia, or high serum calcium level. Hyperparathyroidism is a condition where the parathyroid glands produce too much parathyroid hormone (PTH), which regulates the calcium and phosphorus balance in the body. PTH stimulates the release of calcium from the bones into the blood, leading to an increase in serum calcium level.

Choice D reason: This is incorrect because excessive ingestion of vitamin D can also cause hypercalcemia, or high serum calcium level. Vitamin D is a fat-soluble vitamin that helps the body absorb calcium from the food and supplements. When a person takes too much vitamin D, the calcium absorption is increased and the serum calcium level rises.

Choice A reason: The client with an ileostomy is at risk for fluid volume deficit because an ileostomy is a surgical opening in the ileum, the last part of the small intestine, that allows the drainage of intestinal contents. This can result in a loss of fluids and electrolytes, especially sodium and potassium, which can lead to dehydration and hypovolemia.

Choice B reason: The client with cirrhosis is not at risk for fluid volume deficit, but rather fluid volume excess. Cirrhosis is a chronic liver disease that causes scarring and impaired liver function. This can lead to portal hypertension, which is an increase in the pressure in the portal vein that carries blood from the digestive organs to the liver. Portal hypertension can cause ascites, which is the accumulation of fluid in the abdominal cavity, and edema, which is the swelling of the tissues due to fluid retention.

Choice C reason: The client with heart failure is not at risk for fluid volume deficit, but rather fluid volume excess. Heart failure is a condition where the heart is unable to pump enough blood to meet the body's needs. This can lead to congestion of the blood vessels, which can cause pulmonary edema, which is the accumulation of fluid in the lungs, and peripheral edema, which is the swelling of the extremities due to fluid retention.

Choice D reason: The client with decreased renal function is not at risk for fluid volume deficit, but rather fluid volume excess. Decreased renal function is a condition where the kidneys are unable to filter the blood and remove excess fluids and wastes. This can lead to oliguria, which is a decrease in urine output, and anuria, which is the absence of urine output. This can cause fluid overload, which can affect the heart and the lungs.