The nurse is caring for a patient diagnosed with renal failure. Which compensation does the nurse expect for the acid-base disturbance found in patients with renal failure?
1. The patient breathes rapidly to eliminate carbon dioxide.
2. The patient will retain bicarbonate in excess of normal.
3. The pH will decrease from the present value.
4. The patient's oxygen saturation level will improve.
1
Rationale 1: In metabolic acidosis, compensation is accomplished through increased ventilation or "blowing off" CO2. This raises the pH by eliminating the volatile respiratory acid and compensates for the acidosis.
Rationale 2: Because compensation must be performed by the system other than the affected system, the patient cannot retain bicarbonate; the manifestation of metabolic acidosis of renal failure is a lower than normal bicarbonate value.
Rationale 3: Metabolic acidosis of renal failure causes a low pH; this is the manifestation of the disease process, not the compensation.
Rationale 4: Oxygenation disturbance is not part of the acid-base status of the patient with renal failure.
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