13. The nurse is caring for the client diagnosed with chronic kidney disease (CKD) who is experiencing metabolic acidosis. Which statement best describes the scientific rationale for metabolic acidosis in this client?

1. There is increased excretion of phosphates and organic acids, which leads to an increase in arterial blood pH.

2. A shortened life span of red blood cells because of damage secondary to dialysis treatments in turn leads to metabolic acidosis.

3. The kidney cannot excrete increased levels of acid because it cannot excrete ammonia or cannot reabsorb sodium bicarbonate.

4. An increase in nausea and vomiting causes a loss of hydrochloric acid and the respiratory system cannot compensate adequately.

14.The nurse in the dialysis center is initiating the morning dialysis run. Which client should the nurse assess first?

1. The client who has hemoglobin of 9.8 g/dL and hematocrit of 30%.

2. The client who does not have a palpable thrill or auscultated bruit.

3. The client who is complaining of being exhausted and is sleeping.

4. The client who did not take antihypertensive medication this morning.

15. The male client diagnosed with CKD has received the initial dose of erythropoietin, a biologic response modifier, one (1) week ago. Which complaint by the client indicates the need to notify the health-care provider?

1. The client complains of flu-like symptoms.

2. The client complains of being tired all the time.

3. The client reports an elevation in his blood pressure.

4. The client reports discomfort in his legs and back.