A nurse assesses a client with diabetes mellitus who is admitted with an acid–base imbalance. The client’s arterial blood gas values are pH 7.36, PaO2 98 mm Hg, PaCO2 33 mm Hg, and HCO3 18 mEq/L (18 mmol/L). Which sign or symptom does the nurse identify as an example of the client’s compensatory mechanisms?

Correct Answer: A

Rationale: The correct answer is A: Increased rate and depth of respirations. In this case, the client has metabolic acidosis indicated by a low pH and low HCO3 levels. The PaCO2 is low, which is not expected in metabolic acidosis. Therefore, the respiratory system is compensating by decreasing PaCO2 through increased rate and depth of respirations to help normalize the pH. Increased urinary output (choice B) and increased thirst and hunger (choice C) are not directly related to compensatory mechanisms for acid-base imbalances. Increased release of acids from the kidneys (choice D) would exacerbate the acidosis rather than compensate for it.

Correct Answer: B

Rationale: The correct answer is B: speech therapist. Speech therapists specialize in evaluating and treating swallowing difficulties (dysphagia) after a stroke. They can provide techniques and exercises to improve swallowing function. Physical therapists focus on mobility and strength, social workers address psychosocial needs, and respiratory therapists manage breathing-related issues. However, in this case, the primary concern is swallowing dysfunction, making the speech therapist the most appropriate referral.

Correct Answer: A

Rationale: The correct answer is A because the patient's medical record should accompany them to the long-term care facility to ensure continuity of care. This is essential for healthcare providers at the new facility to have access to the patient's medical history, diagnoses, treatments, and medications. Choice B is incorrect because leaving the record in the hospital could lead to delays in treatment and jeopardize patient safety. Choice C is incorrect as shredding the record would violate patient privacy laws and hinder the patient's care continuity. Choice D is incorrect because only the original record should go with the patient to ensure accuracy and completeness.

Correct Answer: C

Rationale: The correct answer is C: patient's record. The patient's record is a legal document that provides an accurate and detailed account of the care provided, actions taken, and assessments made by the nurse. It serves as concrete evidence to defend against allegations of nursing negligence. Testimony of other nurses (A) may be biased or inconsistent. Testimony of expert witnesses (B) may not always be available or reliable. Patients' families (D) are not directly involved in the care provided and may not have accurate information. The patient's record is the most reliable and objective source of evidence to refute claims of nursing negligence.

Correct Answer: A

Rationale: The correct answer is A: patient sex. In electronic medical records, patient sex is crucial for accurate identification and treatment. It helps in determining appropriate medical interventions and understanding potential health risks based on gender. Patient admission date (B) is important for administrative purposes but not part of the minimum data set. Patient physical assessment (C) may be important clinically but not mandatory in all electronic medical records. Patient insurance (D) may be relevant for billing purposes but is not part of the minimum data set. Therefore, the correct answer is patient sex as it is essential for providing personalized and effective healthcare.