Correct Answer: D

Rationale: 60 mL of urine in a 2-hour period is not very concerning for a nurse, as it is within the normal range of urine output. The average urine output for an adult is about 1 to 2 L per day, or 40 to 80 mL per hour. 720 mL of urine in a 24-hour period is slightly below the normal range, but not alarming. It may indicate mild dehydration or reduced fluid intake, but it is not a sign of fluid volume excess or kidney failure. 600 mL of urine in a 10-hour period is also within the normal range of urine output, and does not indicate any problem with fluid balance or renal function. 100 mL of urine in a 5-hour period is the most concerning for a nurse, as it indicates oliguria, or abnormally low urine output. Oliguria is defined as urine output less than 400 mL per day, or less than 20 mL per hour. It may be caused by acute or chronic kidney injury, urinary obstruction, shock, dehydration, or fluid volume excess. Oliguria can lead to fluid overload, electrolyte imbalance, acidosis, and uremia, and requires immediate medical attention.

Correct Answer: B

Rationale: Potassium (K+) imbalance can cause cardiac and neuromuscular symptoms, such as arrhythmias, palpitations, muscle weakness, or paralysis, but not abdominal pain, urinary retention, or confusion.

Correct Answer: D

Rationale: Stroke is not a cause of hyponatremia, but rather a possible complication of it. Hyponatremia is a condition where the sodium level in the blood is too low, which can affect the brain function and cause symptoms such as confusion, seizures, or coma. Stroke is a condition where the blood supply to a part of the brain is interrupted, which can cause brain damage and neurological deficits. Dehydration is not a cause of hyponatremia, but rather a cause of hypernatremia. Dehydration is a condition where the body loses more fluids than it takes in, which can affect the blood volume and the electrolyte balance. Dehydration can cause hypernatremia, which is a condition where the sodium level in the blood is too high, which can also affect the brain function and cause symptoms such as thirst, dry mouth, or lethargy. Increased secretion of aldosterone is not a cause of hyponatremia, but rather a cause of hypokalemia. Aldosterone is a hormone that regulates the sodium and potassium levels in the body by increasing the reabsorption of sodium and the excretion of potassium in the kidneys. Increased secretion of aldosterone can cause hypokalemia, which is a condition where the potassium level in the blood is too low, which can affect the muscle and nerve function and cause symptoms such as weakness, cramps, or arrhythmias. Congestive heart failure (CHF) is a cause of hyponatremia, as it is a condition where the heart is unable to pump enough blood to meet the body's needs. This can lead to fluid retention and edema, which can dilute the sodium level in the blood and cause hyponatremia. CHF can also stimulate the release of antidiuretic hormone (ADH), which increases the reabsorption of water in the kidneys and further lowers the sodium level in the blood.

Correct Answer: A

Rationale: This is correct because metabolic alkalosis is characterized by a high pH and a high HCO3-. The client's pH and HCO3- are both high, indicating a metabolic disorder. The condition is uncompensated because the PaCO2 is normal, meaning the respiratory system is not compensating for the metabolic alkalosis. This is incorrect because metabolic acidosis is characterized by a low pH and a low HCO3-. The client's pH and HCO3- are both high, indicating alkalosis, not acidosis. This is incorrect because respiratory alkalosis is characterized by a high pH and a low PaCO2. The client's pH is high, but PaCO2 is normal, indicating a metabolic problem, not a respiratory one. This is incorrect because respiratory acidosis is characterized by a low pH and a high PaCO2. The client's pH is high, and PaCO2 is normal, indicating a metabolic problem, not a respiratory one.

Correct Answer: C

Rationale: Metabolic alkalosis is a condition where the pH and the HCO3- are both elevated, indicating a loss of acids or a gain of bases in the body. This is not the case for this patient, as his HCO3- is within the normal range of 22 to 26 mEq/L. Respiratory acidosis is a condition where the pH and the PaCO2 are both low, indicating a retention of carbon dioxide in the lungs due to hypoventilation. This is not the case for this patient, as his pH is high and his PaCO2 is low. Respiratory alkalosis is a condition where the pH and the PaCO2 are both high, indicating a loss of carbon dioxide in the lungs due to hyperventilation. This is the case for this patient, as his pH is above the normal range of 7.35 to 7.45 and his PaCO2 is below the normal range of 35 to 45 mm Hg. This condition is uncompensated, as his HCO3- is within the normal range and has not changed to counteract the pH imbalance. Metabolic acidosis is a condition where the pH and the HCO3- are both low, indicating a gain of acids or a loss of bases in the body. This is not the case for this patient, as his pH is high and his HCO3- is within the normal range.