The nurse is reviewing the arterial blood gas report for a client with chronic kidney disease. Exhibits Which Imbalance should the nurse report to the provider?

Rationale: A. Metabolic alkalosis is characterized by a high pH (>7.45) and elevated HCO₃. In this client, the pH is 7.20 (acidic) and HCO₃ is low at 12 mEq/L, so metabolic alkalosis is not present. B. Respiratory acidosis shows low pH with elevated PaCO₂ and compensatory increase in HCO₃. This client has low PaCO₂ (32 mmHg) and low pH, which is inconsistent with respiratory acidosis. C. Respiratory alkalosis is characterized by high pH (>7.45) and low PaCO₂, with the kidneys compensating by lowering HCO₃. The client’s pH is acidic (7.20), not alkalotic, so this is incorrect. D. Metabolic acidosis is indicated by low pH (7.20) and low HCO₃ (12 mEq/L). The PaCO₂ is 32 mmHg, which is lower than normal, showing respiratory compensation via hyperventilation (Kussmaul respirations). Because the pH remains outside the normal range, the acidosis is partially compensated, not fully compensated. This is typical in chronic kidney disease, where impaired renal function leads to bicarbonate loss and acid retention.