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When caring for a client with metabolic alkalosis, placing the client on continuous cardiac monitoring is an essential action because metabolic alkalosis can lead to electrolyte imbalances, particularly hypokalemia, which can affect cardiac function. Monitoring the heart's electrical activity allows the healthcare team to quickly identify any arrhythmias or changes in cardiac rhythm that may arise due to these imbalances.

While other actions may seem relevant, they do not address the immediate safety concerns for the client with metabolic alkalosis as effectively. Administering sodium bicarbonate would not be appropriate, as it may further increase alkalinity. Having the client breathe into a paper bag is generally a method used for respiratory alkalosis, not metabolic alkalosis. Obtaining a prescription for insulin may not be relevant unless the client has concurrent conditions that warrant its use, such as hyperglycemia, which is typically unrelated to the management of metabolic alkalosis itself. Continuous cardiac monitoring directly supports the client's safety and well-being during episodes of metabolic alkalosis, making it a critical step in their care.