A nurse is caring for a client who has metabolic alkalosis. Which of the following actions should the nurse take.

Choice A rationale Metabolic alkalosis involves an elevated pH level above 7.45 and a bicarbonate level exceeding 26 mEq/L. Breathing slowly would lead to the retention of carbon dioxide, which is a physiological compensation mechanism to lower the pH. However, encouraging this can lead to hypoventilation and potential respiratory failure. The nurse should monitor respiratory status but focuses primarily on treating the underlying cause of the electrolyte imbalance to restore homeostasis effectively. Choice B rationale Sodium bicarbonate is an alkalizing agent used to increase the pH of the blood and body fluids. Administering this medication to a client who already has metabolic alkalosis would be contraindicated and dangerous. It would further elevate the bicarbonate levels and increase the pH, worsening the alkalotic state. Treatment usually involves administering isotonic saline or ammonium chloride to facilitate the renal excretion of excess bicarbonate and restore normal acid base balance. Choice C rationale Metabolic alkalosis increases neuromuscular irritability and can lead to tetany or seizures due to a decrease in ionized calcium levels. As the pH rises, more calcium binds to albumin, lowering the amount of physiologically active calcium available to the body. Placing the client on seizure precautions is a critical safety intervention to prevent injury. The nurse must ensure the environment is safe, as electrolyte shifts significantly alter the resting membrane potential of neurons. Choice D rationale Breathing into a paper bag is a specific intervention for respiratory alkalosis, which is often caused by hyperventilation. This action allows the client to rebreath exhaled carbon dioxide, thereby increasing the partial pressure of carbon dioxide in the blood to lower the pH. In metabolic alkalosis, the primary problem is a metabolic excess of base or loss of acid, not a respiratory deficit of carbon dioxide, making this intervention inappropriate for this specific condition.