A client was seen in the emergency room with a complaint of severe episodes of vomiting and diarrhea, and complains of feeling lightheaded.
Which laboratory test should the nurse prioritize?

The client is at risk for developing Hyponatremia due to dehydration and hypovolemia. This risk may result in Confusion.

Choice A rationale: Hypernatremia is a condition characterized by high sodium levels in the blood. It typically results from water loss exceeding sodium loss, such as in cases of inadequate water intake, excessive sweating, or osmotic diuresis. Symptoms can include thirst, irritability, confusion, and muscle twitching. However, this client's presentation of dehydration and low blood pressure is more indicative of hyponatremia rather than hypernatremia.

Choice B rationale: Hyperkalemia refers to elevated potassium levels in the blood. This condition can occur due to kidney dysfunction, excessive potassium intake, or certain medications. Symptoms of hyperkalemia include muscle weakness, fatigue, numbness, and irregular heart rhythms. While dehydration can impact electrolyte levels, the client's presentation does not specifically suggest hyperkalemia.

Choice C rationale: Hypercalcemia is a condition where calcium levels in the blood are elevated. It can result from hyperparathyroidism, certain cancers, excessive calcium or vitamin D intake, or prolonged immobilization. Symptoms include nausea, vomiting, constipation, abdominal pain, and confusion. The client's symptoms do not align with hypercalcemia, as dehydration and hypovolemia are not primary causes of elevated calcium levels.

Choice D rationale: Hyponatremia occurs when sodium levels in the blood are abnormally low. This can result from excessive fluid loss, such as through vomiting, diarrhea, sweating, or inadequate sodium intake. Symptoms include headache, nausea, vomiting, confusion, seizures, and coma. Given the client's dehydration, low blood pressure, and symptoms of weakness and dizziness, hyponatremia is the most likely risk.

Options for Response 2:

Choice A rationale: Confusion is a common symptom of hyponatremia due to the brain's response to low sodium levels, which affects neuron function and water balance within brain cells. As sodium levels fall, osmotic imbalances cause cerebral edema, leading to altered mental status, lethargy, and confusion.

Choice B rationale: Seizures can occur in severe cases of hyponatremia when the brain's neurons are significantly impacted by osmotic shifts. However, the client's symptoms do not indicate imminent seizure activity, making confusion the more appropriate choice for this scenario.

Choice C rationale: Nausea and vomiting can be symptoms of hyponatremia but are not specific enough to be the primary concern here. The client's symptoms of confusion and lethargy take precedence due to their more direct impact on overall neurological function.

Choice D rationale: Abdominal cramps can result from various electrolyte imbalances, including hyponatremia. However, this symptom is less critical compared to the neurological implications of hyponatremia, such as confusion.

Choice A rationale

Measuring blood pressure manually is important in assessing the patient's hemodynamic status, but it is not the priority intervention in diabetic ketoacidosis (DKA). The priority is to address dehydration and electrolyte imbalances.

Choice B rationale

Administering intravenous fluids is the priority intervention for a client with DKA. Rapid, deep respirations (Kussmaul breathing) indicate severe metabolic acidosis and dehydration. IV fluids help to correct fluid deficit, improve perfusion, and decrease blood glucose levels.

Choice C rationale

Oxygen therapy may be beneficial if the client is hypoxic, but it is not the priority intervention for DKA. The primary issue is fluid deficit and metabolic acidosis.

Choice D rationale

Administering subcutaneous insulin is essential for managing hyperglycemia in DKA, but it should be done after initiating IV fluids to avoid rapid shifts in electrolyte balance.