Fluid & Electrolyte Q 92

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A client is diagnosed with metabolic acidosis, which would the nurse expect the health care provider to order?

  

    A. Potassium

    B. Sodium bicarbonate

    C. Serum sodium level

    D. Bronchodilator

    

    

Correct Answer: B. Sodium bicarbonate

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Metabolic acidosis results from excessive absorption or retention of acid or excessive excretion of bicarbonate. A base is needed. Sodium bicarbonate is a base and is used to treat documented metabolic acidosis. The management of metabolic acidosis should address the cause of the underlying acid-base derangement. For example, adequate fluid resuscitation and correction of electrolyte abnormalities are necessary for sepsis and diabetic ketoacidosis. Potassium, serum sodium determinations, and a bronchodilator would be inappropriate orders for this client.

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Option A: The chief indication for potassium administration is potassium deficiency or hypokalemia, a condition in which serum potassium level falls below a critical range. Hypokalemia can occur due to multiple reasons, mainly inadequate intake of potassium. Metabolic alkalosis can also cause hypokalemia by shifting potassium from the extracellular to the intracellular compartment.

Option C: Among the electrolyte disorders, hyponatremia is the most frequent. Diagnosis is when the serum sodium level less than 135 mmol/L. Hyponatremia has neurological manifestations. Patients may present with headache, confusion, nausea, delirium. Hypernatremia presents when the serum sodium levels greater than145 mmol/L. Symptoms of hypernatremia include tachypnea, sleeping difficulty, and feeling restless. Rapid sodium corrections can have serious consequences like cerebral edema and osmotic demyelination syndrome.

Option D: Bronchodilators are indicated for individuals that have lower than optimal airflow through the lungs. The mainstay of treatment is beta-2 agonists that target the smooth muscles in the bronchioles of the lung. Various respiratory conditions may require bronchodilators, including asthma and chronic obstructive pulmonary disease.

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