The nurse is caring for a client with renal failure. Which of the following does the nurse recognize as demonstrating compensation for the acid–base disturbance found in clients with renal failure?
1. The client will breathe more rapidly to eliminate carbon dioxide.
2. The client will retain bicarbonate in excess of normal.
3. The pH will decrease from the present value.
4. The client will demonstrate improved oxygenation.
The client will breathe more rapidly to eliminate carbon dioxide.
Rationale: 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. Because compensation must be performed by the system other than the affected system, the client cannot retain bicarbonate; the manifestation of metabolic acidosis of renal failure is a lower-than-normal bicarbonate value. Metabolic acidosis of renal failure causes a low pH; this is the manifestation of the disease process, not the compensation. Oxygenation disturbance is not part of the acid–base status of the client with renal failure.
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