A nurse is administering albumin to a client who has hypovolemic shock due to hemorrhage. The nurse understands that albumin is which of the following types of solutions?
Crystalloid.
Colloid.
Hypertonic.
Hypotonic.
The Correct Answer is B
Choice A reason:
Crystalloid solutions are fluids that contain electrolytes and can diffuse across semipermeable membranes. They are used to treat dehydration, electrolyte imbalances, and hypovolemia. However, they are not as effective as colloids in expanding the intravascular volume and maintaining the blood pressure. Therefore, choice A is incorrect.
Choice B reason:
Colloid solutions are fluids that contain large molecules such as proteins, starches, or gelatin that cannot cross the capillary membrane. They exert an osmotic pressure that draws fluid from the interstitial and intracellular spaces into the intravascular space. They are used to treat hypovolemic shock, burns, and hemorrhage. Albumin is a type of colloid solution that is derived from human plasma and contains 5% or 25% protein. It increases the plasma volume and the blood pressure by increasing the oncotic pressure. Therefore, choice B is correct.
Choice C reason:
Hypertonic solutions are fluids that have a higher osmolarity than the blood plasma. They draw water out of the cells and into the intravascular space. They are used to treat hyponatremia, cerebral edema, and severe dehydration. However, they can cause fluid overload, hypertension, and cellular dehydration if given in excess. Therefore, choice C is incorrect.
Choice D reason:
Hypotonic solutions are fluids that have a lower osmolarity than the blood plasma. They provide free water and electrolytes to the cells and the interstitial space. They are used to treat hypernatremia, cellular dehydration, and fluid loss due to burns or diuresis. However, they can cause fluid shifts from the intravascular space to the interstitial and intracellular spaces, resulting in hypovolemia, hypotension, and edema. Therefore, choice D is incorrect.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
No explanation
Correct Answer is ["A","D"]
Explanation
Choice A reason:
Monitoring neurological status is a priority intervention for a client who has overhydration and hyponatremia because these conditions can cause cerebral edema, increased intracranial pressure, and altered mental status. The nurse should assess the client for signs of confusion, lethargy, seizures, and coma, and report any changes to the provider.
Choice B reason:
Administering sodium polystyrene sulfonate is not indicated for a client who has overhydration and hyponatremia. This medication is used to treat hyperkalemia by exchanging sodium ions for potassium ions in the intestine. It has no effect on sodium levels or fluid balance.
Choice C reason:
Providing oral hygiene frequently is a supportive intervention for a client who has overhydration and hyponatremia, but it is not a priority. Oral hygiene can help prevent dry mouth, infections, and discomfort caused by fluid retention and electrolyte imbalance. However, it does not address the underlying causes or complications of the disorder.
Choice D reason:
Restricting sodium intake as prescribed is an essential intervention for a client who has overhydration and hyponatremia. Sodium intake can affect the serum sodium level and the fluid balance in the body. Excessive sodium intake can worsen fluid retention and edema, while inadequate sodium intake can exacerbate hyponatremia. The nurse should follow the provider's orders regarding sodium restriction and educate the client on how to avoid high-sodium foods and beverages.
Choice E reason:
Encouraging foods high in protein is not appropriate for a client who has overhydration and hyponatremia. Protein intake can affect the serum osmolality and the fluid distribution in the body. High-protein foods can increase the osmotic pressure in the blood vessels, drawing more fluid from the interstitial and intracellular spaces. This can worsen overhydration and hyponatremia by diluting the serum sodium level further. The nurse should consult with a dietitian regarding the optimal protein intake for the client.
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