The nurse is reviewing new prescriptions provided by the healthcare provider for a client with metabolic acidosis. Which prescription should the nurse question before implementing it for the client?
A) Begin intravenous infusion of 0.9% normal saline.
B) Draw serum potassium levels every 2 hours.
C) Draw arterial blood gas samples every 2 hours.
D) Administer 1 ampule of sodium bicarbonate now.
Answer: D
Administering bicarbonate to correct acidosis increases the risk for hypernatremia, hyperosmolality, and fluid volume excess. This is the order that the nurse should question before providing. Treatment of metabolic acidosis includes correction of fluid balance. An infusion of normal saline would be appropriate for this client. As metabolic acidosis is corrected, potassium shifts back into the intracellular space. This shift can lead to hypokalemia and cardiac dysrhythmias. Serum potassium levels should be carefully monitored during treatment. Arterial blood gases are used to evaluate treatment and guide additional therapies.
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