Elevate Module 1

What should the nurse assess when examining a client who has had a fasciotomy of the forearm?SATA 1. Brachial pulse 2. Capillary refill 3. Color 4. Presence of thrill 5. Skin turgur

2., & 3. Correct: Fasciotomy is a surgical procedure that cuts away the fascia to relieve tension or pressure. So after the procedure, the nurse wants to make certain that pressure has been relieved and circulation distally is good. The nurse will thus need to monitor skin color, capillary refill, distal pulses, and sensation. Since this is a surgical procedure, bleeding will also need to be monitored. 1. Incorrect: We want to know if circulation below the fasciotomy is impaired or not. So check distal pulses. 4. Incorrect: If you want to check for a thrill, you are thinking about a shunt, like a dialysis shunt. You check patency by feeling for a thrill and listening for a bruit. 5. Incorrect: Checking skin turgur is a hydration check.

An elderly, bed-bound client receiving G-tube feedings at home is admitted to the unit after onset of behavioral changes and hallucinations. Which nursing actions should the nurse initiate? SATA 1. Administer furosemide 20 mg IVP 2. Frequent mouth care 3. Provide 250 mL water via G-tube every 6 hours 4. Seizure precautions 5. Start IV of 0.9% Normal Saline

2., 3., & 4. Correct: Oral mucous membranes become dry and sticky due to loss of fluid in the interstitial spaces so mouth care should be provided frequently. The client is dehydrated with a high sodium level because of the high solute tube feeding. The client needs water and a sodium free IV fluid. high sodium levels in the blood leads to dehydration of brain cells resulting in changes in mental status, ranging from drowsinness, restlessness, confusion, and lethargy to seizures and coma. Seizure precautions is necessary. 1. Incorrect: The client is dehydrated. A diuretic would make it worse. 5. Incorrect: This is an isotonic sodium fluid. The client does not need more sodium.

What should the nurse monitor for when caring for a client receiving an IV infusion of 5% Normal Saline? 1. Hypotension 2. Fluid volume deficit 3. Hyponatremia 4. Phlebitis

4. Correct: 5% NS is a hypertonic solution. Hypertonic fluids contain a higher concentration of solute compared to plasma and interstitial fluid. This creates an osmotic gradient and drives fluid from the interstitial space into the intravascular space. which causes fluid to stay in the vascular space. Hypertonic solutions are irritating to veins and can cause phlebitis. 1. Incorrect: Hypertension can occur with isotonic and hypertonic IV solutions. Hypotension can occur with hypotonic IV solutions such as 1/2 Normal Saline. 2. Incorrect: Fluid volume excess can occur with isotonic and hypertonic solutions. 3. Incorrect: Hypernatremia can occur with isotonic and hypertonic sodium solutions.

A nurse is caring for a client who was admitted with severe dehydration due to excessive vomiting. Which data noted by the nurse validates this diagnosis? SATA 1. Atrial fibrillation 2. Capillary refill 2 seconds 3. Eyes appear sunken 4. Hematocrit 55% 5. Several small furrows on tongue

1., 3., 4., & 5. Correct: These are signs and symptoms indicating that a client is dehydrated (fluid volume deficit). 2. Incorrect: This is a normal capillary refill.

Based on the results of the arterial blood gases (ABGs), what imbalance does the nurse understand the client to be exhibiting? 1. Respiratory acidosis compensated 2. Respiratory acidosis partially compensated 3. Metabolic acidosis compensated 4. Metabolic acidosis partially compensated

1. Correct: The pH is normal but is on the acidic side of normal. The PaCO2 is elevated, causing acid formation. The HCO3 is alkalotic and is increased to buffer the acid. The pH and PaCO2 match, so the original problem was respiratory acidosis, but compensation has occurred since the pH is now normal. 2. Incorrect: The pH is normal but is on the acidic side of normal. The PaCO2 is acid. The HCO3 is alkalotic. The pH and PaCO2 match, so the original problem was respiratory acidosis, but compensation has occurred since the pH is now low. 3. Incorrect: The pH is normal but is on the acidic side of normal. The PaCO2 is acid. The HCO3 is alkalotic. The pH and PaCO2 match, so the original problem was respiratory acidosis, but compensation has occurred since the pH is now low. 4. Incorrect: The pH is normal but is on the acidic side of normal. The PaCO2 is acid. The HCO3 is alkalotic. The pH and PaCO2 match, so the original problem was respiratory acidosis, but compensation has occurred since the pH is now low.

A client has been unable to eat due to protracted vomiting. Which alterations in the arterial blood gases would the nurse expect to find? 1. pH: 7.48, PaCO2: 36, HCO3: 29 2. pH: 7.34, PaCO2: 48, HCO3: 29 3. pH: 7.33, PaCO2: 35, HCO3: 18 4. pH: 7.42, PaCO2: 40, HCO3: 24

1. Correct: The stomach as a lot of acid in it. So, if the client is vomiting a lot, then the client is losing acid. This will make the client alkalotic inside. Is this going to be a lung problem? No. So we are looking for ABGs that indicate that this client is in metabolic alkalosis. A pH of 7.48 is higher than the normal pH value of 7.45, which indicates alkalosis. The PaCO2 is 36, which is on the low end of normal (34-45). The HCO3 is 29, which is higher than the normal HCO3 of 26, which indicates alkalosis. So the Bicarb (Kidney chemical) matches the pH. Metabolic alkalosis. 2. Incorrect: This is partially compensated respiratory acidosis. pH: 7.34 (acid), PaCO2: 48 (acid), HCO3: 29 (alkaline) 3. Incorrect: This is metabolic acidosis. pH: 7.33 (acid), PaCO2: 35 (normal), HCO3: 18 (acid) 4. Incorrect: These are normal ABGs. pH: 7.42 (normal), PaCO2: 40 (normal), HCO3: 24 (normal)

The community health nurse has been educating a group of college students living in a dormitory about receiving an immune globulin (IG) injection for hepatitis A virus (HAV). Which statement made by the students would indicate to the nurse that further teaching is necessary? SATA 1. Immune globulin contains antibiotics that destroy the HAV, preventing infection. 2. Immune globulin protection is temporary. 3. Common side effects of Immune globulin include soreness and swelling around the injection site. 4. It is important to take IG within four weeks of any exposure to hepatitis A. 5. Crowded living environments such as dormitories place people at risk for HAV.

1., & 4. Correct: Immune globulin contains antibodies that destroy the HAV, preventing infection. It's very important to take IG within two weeks of any exposure to hepatitis A. 2. Correct:This is a correct statement about immune globulin for Hepatitis A, indicating that teaching has been effective. 3. Correct:This is a correct statement about immune globulin for Hepatitis A, indicating that teaching has been effective. 5. Correct: This is a correct statement about immune globulin for Hepatitis A, indicating that teaching has been effective.

A client is being treated for fluid volume deficit with D5W, oral hydration, and management of viral symptoms. Which client data would indicate to the nurse that further treatment is needed? SATA 1. BP 120/70 lying; 98/68 standing 2. Bounding pulses 3. One day weight gain of 5 kg 4. Urine specific gravity of 1.010 5. Serum sodium 145 mEq (145 mmol/L)

1., 2., & 3. Correct: The systolic BP has dropped more than 20 mm Hg from lying to standing. This is considered orthostatic hypotension and indicates that the client is still in a fluid volume deficit. A bounding pulse is an indication of fluid volume excess. We have given the client too much fluid. This weight gain for one day is way too much. This indicates that we have put the client into fluid volume excess, which is a problem. 4. Incorrect: With fluid volume deficit, the specific gravity can be expected to be abnormally high. This urine specific gravity is normal. That means treatment has been successful. 5. Incorrect: This is a normal sodium level. Treatment is working.

Which clinical manifestations would validate to the nurse that a client has developed an electrolyte imbalance due to malabsorption from celiac disease? SATA 1. Anorexia 2. Arrhythmia 3. Doll's eyes 4. Paralysis 5. Seizure

1., 2., & 5. Correct: Low magnesium is typically due to decreased absorption of magnesium in the gut or increased excretion of magnesium in the urine. Conditions that increase the risk of magnesium deficiency include gastrointestinal (GI) diseases, such as Celiac disease, advanced age, type 2 diabetes, use of loop diuretics, and alcohol dependence. Early signs of low magnesium include nausea, vomiting, weakness, and decreased appetite. As magnesium deficiency worsens, symptoms may include numbness, tingling, muscle cramps, seizures, muscle spasticity, personality changes, dysrhythmias, tremors, hyperactive deep-tendon reflexes, hyperreactivity to sensory stimuli, positive Chvostek and Trousseau signs, tetany, and nystagmus. 3. Incorrect: Typically the doll's eyes reflex is elicited by turning the head of the unconscious patient while observing the eyes. The eyes will normally move as if the patient is fixating on a stationary object. If there is a negative doll's eyes reflex then the eyes remain stationary with respect to the head. 4. Incorrect: A low magnesium level goes muscle to become hyperactive.

The Emergency department nurse is caring for a client who has sustained a high-voltage electrical injury. Which intervention should the nurse initiate? SATA 1. Initiate continuous cardiac monitoring. 2. Identify entrance and exit wounds. 3. Give analgesic by mouth as needed. 4. Keep burned limbs below the level of the heart. 5. Cover burned areas with clean sheets.

1., 2., & 5. Correct: These are correct interventions for the nurse to initiate when caring for a client who has sustained a high-voltage electrical injury. Remember, electricity kills vessels, nerves, and organs. Electricity can damage the heart muscle, so the client is at risk for dysrhythmias within 24 hours following an electrical burn. Put the client on continuous cardiac monitoring during this time. Electrical burns have two wounds: an entrance burn wound that is generally small and an exit burn wound that is much larger. The electricity goes throughout the body causing damage, and then exits the body. So look for 2 burn wounds. In the emergent phase of care, the nurse needs to protect the wound from contaminants. Cover burned areas with dry dressings or a clean sheet. 3. Incorrect: Analgesics by mouth will not be as effective as IV analgesics during the emergent phase. 4. Incorrect: The burned limb should be elevated above the level of the heart to decrease peripheral edema.

The nurse is caring for a client admitted to the unit with heart failure. Opon entering the room, the nurse notes that the client is agitated, gasping for air, and attempting to sit up. The client states "I can't get my breath". What actions should the nurse take? SATA 1. Elevate the head of the bed to sitting position 2. Elevate client's legs on two pillows 3. Initiate oxygen at 2 liters per nasal cannula 4. Initiate IV of lactated ringers 5. Administer morphine 2 mg IV

1., 3., & 5. Correct: What are you worried about? The client has heart failure and is now agitated, gasping for air and trying to sit up. The client is in acute distress, likely from pulmonary edema. The first thing the nurse should do is to sit the client up. This allows for better chest expansion, thereby improving pulmonary capacity. Oxygen increases available oxygen for myocardial uptake to combat effects of hypoxia. Morphine decreases vascular resistance and venous return, reducing myocardial workload, especially when pulmonary congestion is present. Allays anxiety and breaks the feedback cycle of anxiety to catecholamine release to anxiety. 2. Incorrect: Do not elevate the legs when the client is in an acute stage of respiratory difficulty. By dangling the legs, blood is pooling in the periphery. This decreases the circulating blood volume so that the heart does not have to work as hard and blood will then go in a forward direction rather than going backward to the lungs. 4. Incorrect: Lactated Ringers is an isotonic solution, which stays in the vascular space. This will make the problem worse.

The nurse is caring for a client 8 hours post colectomy who is receiving 40% humidified oxygen. ABG results are: pH= 7.30, pO2= 91, pCO2= 50, HCO3= 24. Based on this information, which nursing action should the nurse initiate? SATA 1. Reposition the client every 2 hours. 2. Request respiratory therapy to perform postural drainage and percussion. 3. Increase oxygen percentage. 4. Initiate incentive spirometry. 5. Assess mental status.

1., 4., & 5. Correct: If you had just a colectomy, would you be taking nice deep breaths? No. So what would you be retaining? CO2, which makes your pCO2 go up and your pH go down. These interventions will help improve gas exchange. 2. Incorrect: Requesting postural drainage and percussion form respiratory therapy would not be the best nursing action to address the problem of retaining CO2. 3. Incorrect: How is oxygen going to help this client? It's not until they get rid of what? CO2. And the only way to rid of the CO2 is coughing and deep breathing

A client is admitted for treatment of fluid volume deficit. The nurse reviews the admitting lab work and the primary healthcare provider's prescriptions. Which prescription would be of concern to the nurse? 1. Diet 2. Furosemide 3. IV infusion 4. Potassium Chloride (KCL)

2. Correct: The client is in a fluid volume deficit. Furosemide is a loop diuretic which can be prescribed to get rid of excess fluid in the vascular space. Giving this medication will worsen the fluid volume deficit. 1. Incorrect: This client needs sodium so can be on a regular diet. Sodium will help retain fluid. 3. Incorrect: The IV prescription is for normal saline, which is an isotonic solution. What will this fluid do? Stay in the vascular space, thus helping to correct the fluid volume deficit. 4. Incorrect: A potassium supplement is needed because the client's potassium is low.

A nurse is caring for a client who had a cholecystectomy 4 hours ago. What interpretation should the nurse make based on the results of the client's arterial blood gases (ABGs)? SATA 1. Metabolic acidosis 2. Respiratory acidosis 3. Metabolic alkalosis 4. Respiratory alkalosis 5. Uncompensated 6. Partially compensated 7. Fully compensated

2., & 5. Correct: The pH is 7.31 (normal 7.35-7.45) which means acidosis. The paCO2 of 49 (normal 35-45) indicates a respiratory problem. The arterial blood gas results indicate that the client is in respiratory acidosis. The HCO3 is normal. This means that the client is in uncompensated respiratory acidosis. 1. Incorrect: This is a respiratory problem. The bicarb is within normal limits, eliminating a metabolic problem. 3. Incorrect: The pH is low which indicates acidosis. The bicarb is within normal limits, eliminating a metabolic problem. 4. Incorrect: The pH is low, which indicates acidosis. 6. Incorrect: Compensation has not begun because the bicarb is normal. To compensate the bicarb would need to decrease to bring the pH down to normal. 7. Incorrect: Fully compensated would occur if the pH is normal with abnormal CO2 and bicarb.

Based on the results of the arterial blood gases (ABGs), what imbalance does the nurse understand the client to be exhibiting? SATA 1. Metabolic acidosis 2. Respiratory acidosis 3. Metabolic alkalosis 4. Respiratory alkalosis 5. Uncompensated 6. Partially compensated 7. Fully compensated

2., & 7. Correct: The pH is 7.36 normal (normal 7.35-7.45). But the paCO2 of 55 (normal 35-45) indicates a acidosis. The HCO3 is also abnormal at 32 (normal 22-26), indicating alkalosis. Since both chemicals are abnormal, but the pH is normal, compensation must have occurred. A perfect pH is 7.4. A pH of 7.36 is on the acid side of normal. So the original problem was acidosis. Which chemical abnormality matches acidosis? The CO2 is acid. This means that the client is in fully compensated respiratory acidosis. 1. Incorrect: This is a respiratory problem. The bicarb is is high, which is alkalosis. The kidneys are compensating 3. Incorrect: The pH is on the acid side of normal. The bicarb is high. They don't match. 4. Incorrect: The pH is low normal, which indicates acidosis. 6. Incorrect: Compensation is complete because the pH is normal. 7. Incorrect: Fully compensated has occurred because the pH is normal with abnormal CO2 and bicarb.

A new nurse asks the charge nurse for assistance in interpreting arterial blood gases (ABGs) for a client. What acid/base imbalance should the charge nurse tell the new nurse these ABGs indicate in the client? SATA 1. Metabolic Acidosis 2. Respiratory Alkalosis 3. Metabolic Alkalosis 4. Respiratory Acidosis 5. Uncompensated 6. Partially compensated 7. Fully compensated

3., & 6. Correct: Partially compensated metabolic alkalosis is indicated by these ABGs. The pH is 7.46 (normal 7.35-7.45) which is high, which means alkalosis. The PaCO2 is 47 (normal 35-45) which is high. Greater than 45 is acidosis from too much CO2. The HCO3 is 28 (normal 22-26) which is high. A high bicarb level equals alkalosis. The HCO3 matches the pH as both indicate alkalosis. The initial problem was a kidney problem or metabolic alkalosis. The lungs are trying to compensate by holding on to more acid. So the correct answer is partially compensated metabolic alkalosis. 1. Incorrect: A pH of greater than 7.45 indicates alkalosis rather than acidosis. So this option is incorrect. 2. Incorrect: The PaCO2 would be low rather than high if the problem was respiratory alkalosis. 4. Incorrect: A pH of greater than 7.45 indicates alkalosis rather than acidosis. So this option is incorrect. 5. Incorrect: If the ABGs indicated that compensation had not begun (uncompensated) then the CO2 would be normal. Since it is high, the lungs are attempting to compensate for the metabolic alkalosis retaining more acid (Decrease breathing to hold on to acid). 7. Incorrect: Full compensation does not occur until the pH is normal. The pH is still abnormal here.

An elderly, confused client with dehydration is admitted to the medical unit. Which intervention would be appropriate for the RN to delegate to the unlicensed assistive personnel? 1. Perform a physical assessment. 2. Start an IV of NS with KCL 20 mEq at 50 mL/hr. 3. Insert a urinary catheter. 4. Weigh the client.

4. Correct: The UAP can weigh clients. 1. Incorrect: This is a new client admit. The RN should perform the physical assessment. 2. Incorrect: The RN should start an initial IV with a potassium supplement. The LPN can hang maintenance bags with premixed potassium supplements after that. 3. Incorrect: The LPN or RN can insert an indwelling urinary catheter.

The home health nurse is visiting a client who had a stoke a several months ago. At today's visit, the client reports nausea, vomiting and anorexia for the last few days. During the assessment, the client becomes unresponsive, without a pulse. What action should the nurse take first? 1. Defibrillate at 200 joules 2. Administer amiodarone IV 150 mg over 10 minutes 3. Infuse 500 mL NS with 40 mEq KCL (40 mmol/L) at 100 mL/hour 4. Begin cardiopulmonary resuscitation

4. Correct: The nurse is in the client's home when the client becomes unresponsive without a pulse. The client has not IV and there is no defibrillatior. So what should the nurse do! Start CPR and have someone activate EMS 1. Incorrect: The client has become unresponsive and does not have a pulse. If the nurse had a defibrillator, defibrillation would be done first. 2. Incorrect: Amiodarone is the first action if the client has a pulse with short runs of V-tach. 3. Incorrect: KCL is probably the cause, but we have to get the heart back in a sinus rhythm.

A nurse educator has completed an educational program on interpreting arterial blood gases (ABGs). The educator recognizes that education was successful when a nurse selects which set of ABGs as compensated respiratory alkalosis? 1. pH - 7.46, PaCO2 - 30, HCO3 - 26 2. pH - 7.45, PaCO2 - 35, HCO3 - 25 3. pH - 7.36, PaCO2 - 43, HCO3 - 24 4. pH - 7.43, PaCO2 - 31, HCO3 - 20

4. Correct: This set of ABGs indicate compensated respiratory alkalosis. The pH is normal, but on the alkalotic side of normal (normal 7.35-7.45; perfect is 7.4). The PaCO2 is low, indicating alkalosis, so it matches the alkalotic pH. The bicarb are low at 20 which indicates acidosis. The bicarb is low to get rid of base. Compensation has occurred. 1. Incorrect: pH - 7.46, PaCO2 - 30, HCO3 - 26. The pH is high. The PaCOs is low. The bicarb is normal. This is uncompensated respiratory alkalsosis. 2. Incorrect: pH - 7.45, PaCO2 - 35, HCO3 - 25. All of these values are normal. No acid base problem here. 3. Incorrect: pH - 7.36, PaCO2 - 43, HCO3 - 24. The pH is normal. The PaCO2 is normal. The bicarb is normal.

The charge nurse is evaluating a new nurse who is performing a linear wound dressing change on a surgical client. Which action by the new nurse requires intervention by the charge nurse? SATA 1. Hand hygiene is done prior to the dressing change. 2. Dressing tape is removed in the direction of the hair growth. 3. The soiled dressing is discarded in a biomedical waste bag. 4. Clean gloves are donned in order to clean the wound. 5. The wound area farthest from the nurse is cleaned first, then the center of the wound, followed by the area closest to the nurse. 6. New sterile dressing is applied to the wound.

4., & 5. Correct: Most dressing changes following surgery are sterile and require that the nurse use standard precautions and wear sterile gloves to clean the incision and apply sterile dressings. Clean gloves can be used to remove the old dressing. Dressings are never touched by ungloved hands. Remember, clean to dirty. The wound center is considered the cleanest area, so that is cleaned first. The area beside the wound farthest from the nurse is considered the next cleanest area. The area closes to the nurse is considered the most contaminated and is cleaned last. The new nurse performed this step correctly. 1. Incorrect: This is a correct procedure for doing a dressing change. 2. Incorrect: This is a correct procedure for doing a dressing change. 3. Incorrect: This is a correct procedure for doing a dressing change. 6. Incorrect: This is a correct procedure for doing a dressing change.

How should the nurse interpret the arterial blood gas (ABG) results of a client admitted with dehydration? SATA 1. Metabolic acidosis 2. Respiratory acidosis 3. Metabolic alkalosis 4. Respiratory alkalosis 5. Uncompensated 6. Partially compensated 7. Fully compensated

4., & 5. Correct: The blood gases confirm respiratory alkalosis. Why? The pH is 7.48 (normal 7.35-7.45). This pH indicates alkalosis since it is high. Which other chemical says alkalosis? The PaCO2 of 30 (normal 35-45) is low which indicates alkalosis. The HCO3 is normal. This means that the client is in uncompensated respiratory alkalosis. 1. Incorrect: The blood gases confirm respiratory alkalosis. The Bicarb is normal, so the problem is not metabolic. 2. Incorrect: The blood gases confirm respiratory alkalosis. The PaCO2 of 30 (normal 35-45) is low which indicates alkalosis. For this client to be in respiratory acidosis, the PaCO2 would be greater than 45. 3. Incorrect: The blood gases confirm respiratory alkalosis. The Bicarb is normal, so the problem is not metabolic. 6. Incorrect: Compensation has not begun because the bicarb is normal. To compensate the bicarb would need to decrease to bring the pH down to normal. 7. Incorrect: Fully compensated would occur if the pH is normal with abnormal CO2 and bicarb.

A nurse is caring for a client that is lethargic and has the following ABGs: pH = 7.32, PaCO2 = 48, HCO3 = 28, O2 = 93%. What medication could contribute to these blood gases? SATA 1. Famotidine 2. Hydrochlorothiazide 3. Hydrocortisone 4. Promethazine 5. Midazolam 6. Oxymorphone

4., 5., & 6. Correct: Yes. These medications typically decrease the respiratory rate, causing respiratory acidosis. 1. Incorrect: Famotidine is a Histamine 2 blocker. It does not affect breathing patterns. 2. Incorrect: Diuretics do not affect breathing patterns. 3. Incorrect: Steroids do not affect breathing patterns.

A client has been admitted with advanced Cirrhosis. The nurse's assessment of the abdominal girth verifies an increase in 5 inches (12.7 cm) and an increase in 6 lbs. (2.72 kg) since yesterday's measurements. The client reports a decreased desire to eat due to gastric reflux and is having steatorrhea. Which interventions would the nurse expect to see in this client's plan of care? SATA 1. Administer pantoprazole 40 mg by mouth every morning. 2. Prepare client for thorocentesis. 3. Infuse Albumin, human 25% 50 mL over 1 hour. 4. Provide a diet of 1500 calories per day. 5. Administer Vitamins A, D, and E in water-soluble form.

1., 3., & 5. Correct: Pantoprazole is a proton pump inhibitor that decreases the amount of acid produced in the stomach. In acute liver failure, Albumin (Human) 25% solution helps to stabilize vascular circulation by moving fluid into the vascular space. Clients who have have fatty stools (steatorrhea) are losing fat-soluble vitamins. They need to receive water-soluble forms of fat-soluble vitamins A, D, and E. 2. Incorrect: This client would need to be prepared for a paracentesis, not a thorocentesis. 4. Incorrect: This client needs 3000 calories per day.

A client arrives in the emergency department in a postictal state after having a seizure for the first time. The nurse notes peripheral edema to the lower extremities. BP 100/68, Resp 18, HR 86. Family reports client has taken "a lot of antacids for indigestion over the past 48 hours. Current health history includes chronic renal failure. What acid/base imbalance does the nurse anticipate for this client? 1. Respiratory acidosis 2. Respiratory alkalosis 3. Metabolic acidosis 4. Metabolic alkalosis

4. Correct: This client's condition indicates metabolic alkalosis. Antacid use won't normally lead to metabolic alkalosis. But if you have weak or failing kidneys and use a nonabsorbable antacid, it can bring on alkalosis. Nonabsorbable antacids contain aluminum hydroxide or magnesium hydroxide. The client has had a seizure for the first time, which is a sign of metabolic alkalosis when combined with the rest of the client's history. 1. Incorrect: This client has no respiratory symptoms. This is not respiratory acidosis. 2. Incorrect: This client has no respiratory symptoms. This is not respiratory alkalosis. 3. Incorrect: This client's condition is related to chronic renal failure.

An adult client has partial and full thickness burns over the anterior trunk, the anterior and posterior aspect the left leg, the anterior aspect of the right leg, and the peritoneal area. Utilizing the rule of nines, what percentage of the body surface area is burned? Round your answer to the nearest whole number.

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