A client is admitted to the hospital with dehydration and hyponatremia.
The nurse is preparing to start an intravenous (IV) infusion.
Which of the following IV fluids is the most appropriate for this client?
Normal saline (0.9% NaCl).
Half normal saline (0.45% NaCl).
Lactated Ringer’s.
D5W (5% dextrose in water).
The Correct Answer is A
Choice A rationale:
Normal saline (0.9% NaCl).
Rationale: Normal saline is the most appropriate choice for a client with dehydration and hyponatremia.
It provides a balanced solution with sodium and chloride, which can help correct hyponatremia and rehydrate the client.
It is an isotonic solution and is commonly used for fluid resuscitation.
Choice B rationale:
Half normal saline (0.45% NaCl).
Rationale: Half normal saline is also an isotonic solution, but it contains less sodium than normal saline.
In a case of hyponatremia, it's better to use a solution with a higher sodium concentration, making choice A (normal saline) more appropriate.
Choice C rationale:
Lactated Ringer’s.
Rationale: Lactated Ringer's is another isotonic solution, but it may not be the best choice for a client with hyponatremia.
It contains lactate, which can be metabolized to bicarbonate, potentially worsening the client's hyponatremia.
Therefore, it's not the most appropriate option in this case.
Choice D rationale:
D5W (5% dextrose in water).
Rationale: D5W is a hypotonic solution and should not be used for rehydration in a client with hyponatremia.
It can exacerbate the electrolyte imbalance and is not suitable for addressing dehydration.
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Correct Answer is C
Explanation
Approximately 100 mL/hour.
To calculate the total hourly fluid replacement rate, we can use the Holliday-Segar method, which is commonly used in pediatrics.
According to this method, a child's daily maintenance fluid requirement is calculated as follows: For the first 10 kg of body weight: 100 mL/kg/day.
For the next 10 kg of body weight: 50 mL/kg/day.
For each additional kg of body weight: 20 mL/kg/day.
In this case, the child weighs 14 kg.
So, we calculate as follows: For the first 10 kg: 10 kg x 100 mL/kg/day = 1000 mL/day.
For the next 4 kg (14 kg - 10 kg): 4 kg x 50 mL/kg/day = 200 mL/day.
Now, add these two together: 1000 mL/day + 200 mL/day = 1200 mL/day.
To find the hourly rate, we divide the daily requirement by 24 (hours in a day): 1200 mL/day ÷ 24 hours/day = 50 mL/hour.
So, the child's total hourly fluid replacement rate should be approximately 50 mL/hour.
However, this is an approximate rate.
To be more conservative in the case of severe dehydration, it's common to round this up to approximately 100 mL/hour to ensure that the child receives adequate fluids to rehydrate.
Choice A rationale:
Approximately 58 mL/hour is not The correct answer.
This calculation does not match the standard Holliday-Segar method used in pediatrics for fluid replacement.
Choice B rationale:
Approximately 140 mL/hour is not The correct answer.
This calculation significantly exceeds the recommended hourly fluid replacement rate for a child of this weight, which could potentially lead to overhydration.
Choice D rationale:
Approximately 82 mL/hour is not The correct answer.
This calculation does not align with the standard method for calculating fluid replacement in pediatric patients.
Correct Answer is C
Explanation
“I understand that my child’s hydration status will be continuously assessed.”.
Choice A rationale:
While a child's age and weight may play a role in determining fluid replacement, this statement doesn't encompass the entire concept of managing dehydration.
Monitoring hydration status involves assessing clinical signs and symptoms, as well as ongoing evaluation.
Choice B rationale:
Electrolyte solutions and supplements are indeed part of the treatment for dehydration.
However, this statement doesn't reflect the comprehensive understanding of managing a dehydrated child, including continuous assessment of hydration status.
Choice C rationale:
This statement indicates a correct understanding.
Continuous assessment of a child's hydration status is essential in managing dehydration.
It allows healthcare providers to monitor the child's response to treatment and make necessary adjustments.
Choice D rationale:
Collaboration within the healthcare team is important, but this statement doesn't specifically address the understanding of fluid replacement and dehydration management.
The correct response is choice C because it highlights the critical aspect of continuous assessment, which is essential to ensure that the child's hydration status is being monitored effectively during treatment.
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