Health Promotion and Maintenance
93. A client, who is 10 weeks' gestation, has been having severe nausea for the past 3 weeks. She tells a nurse that she cannot eat anything. She has been diagnosed with hyperemesis gravidarum and is at risk for developing:
. Respiratory alkalosis without dehydration.
. Metabolic acidosis with dehydration.
. Respiratory acidosis without dehydration.
. Metabolic alkalosis with dehydration.
Test-Taking Tip
Hyperemesis results in metabolic acidosis. Eliminate the options with respiratory acidosis and alkalosis.
Content Area: Maternity, Antepartum; Integrated Process: Nursing Process, Analysis; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Physiological Adaptation/Fluid and Electrolyte Imbalances
Health Promotion and Maintenance
.
Answer 1 is incorrect because hyperemesis leads to metabolic acidosis, not respiratory alkalosis. Hyperemesis also includes dehydration. Answer 2 is correct because hyperemesis leads to metabolic acidosis and dehydration. Answer 3 is incorrect because hyperemesis leads to metabolic acidosis, not respiratory acidosis. Hyperemesis also includes dehydration. Answer 4 is incorrect because, if the client has prolonged vomiting, it can lead to metabolic alkalosis. This client has only nausea and dehydration for a 3-day period.