A nurse is caring for a client who has HIV and a CD4-T-cell count of 150/mm³. Which of the following conditions should the nurse monitor the client for?
Hepatitis
Tuberculosis
Gonorrhea
Chlamydia
The Correct Answer is B
A. Hepatitis is a concern for individuals with HIV, but it is not specifically indicated by a low CD4-T-cell count.
B. A CD4-T-cell count of 150/mm³ indicates severe immunosuppression, making the client highly susceptible to opportunistic infections like tuberculosis, which is common in individuals with HIV.
C. While gonorrhea is a risk for sexually active individuals, it is not specifically related to the low CD4-T-cell count.
D. Chlamydia is also a sexually transmitted infection, but similar to gonorrhea, it is not directly linked to the immunocompromised state indicated by the CD4-T-cell count.
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Correct Answer is A
Explanation
A. Respiratory acidosis is indicated by the low pH (7.22) and elevated PaCO2 (68 mm Hg), demonstrating that CO2 is retained due to hypoventilation (as seen with a respiratory rate of 7/min). The bicarbonate level is within normal range, suggesting no metabolic compensation is present.
B. Metabolic acidosis would be indicated by a low pH and low bicarbonate level, which is not the case here since the bicarbonate is normal at 26 mEq/L.
C. Metabolic alkalosis would present with a high pH and high HCO3, which does not match these values.
D. Respiratory alkalosis would show a high pH and low PaCO2, which is contrary to the provided ABG results.
Correct Answer is C
Explanation
A. Mottled skin is more indicative of the progressive or refractory stages of shock, where perfusion to the skin is severely compromised.
B. A heart rate of 160/min indicates tachycardia, which is common in shock but is not the most characteristic finding of the compensatory stage.
C. During the compensatory stage of shock, the body attempts to maintain blood pressure and perfusion, and a blood pressure of 115/68 mmHg suggests that compensatory mechanisms are still functioning adequately.
D. Hypokalemia is not a typical finding in the compensatory stage; rather, the body may exhibit signs of hyperkalemia due to tissue breakdown and acidosis.