A nurse is caring for a client who has dehydration due to vomiting and diarrhea. The client's blood pressure is 90/60 mm Hg, pulse is 110/min, and respirations are 22/min. The nurse should anticipate a prescription for which of the following types of IV fluids?

Dextrose 5% in water (D5W)

Lactated Ringer's (LR)

Dextrose 5% in 0.45% sodium chloride (D5W/0.45% NaCl)

Dextrose 5% in lactated Ringer's (D5LR)

Answer and Explanation

The Correct Answer is B

Choice A reason:

Dextrose 5% in water (D5W) is a hypotonic solution that provides free water and calories, but no electrolytes. It is used to treat hypernatremia and cellular dehydration, but it can cause fluid shifts from the intravascular to the intracellular space, leading to cerebral edema and decreased blood pressure. This is not appropriate for a client who has dehydration due to vomiting and diarrhea, as they need to restore their intravascular volume and electrolyte balance.

Choice B reason:

Lactated Ringer's (LR) is an isotonic solution that contains sodium, chloride, potassium, calcium, and lactate. It is used to treat fluid loss from burns, trauma, surgery, or sepsis. It also helps to correct metabolic acidosis by providing bicarbonate precursors. This is the best choice for a client who has dehydration due to vomiting and diarrhea, as they need to replace their fluid and electrolyte losses and maintain their acid-base balance.

Choice C reason:

Dextrose 5% in 0.45% sodium chloride (D5W/0.45% NaCl) is a hypertonic solution that provides free water, calories, and sodium. It is used to treat hypovolemia and hyponatremia, but it can cause fluid shifts from the intracellular to the intravascular space, leading to cellular dehydration and increased blood pressure. This is not appropriate for a client who has dehydration due to vomiting and diarrhea, as they already have low blood pressure and cellular dehydration.

Choice D reason:

Dextrose 5% in lactated Ringer's (D5LR) is a hypertonic solution that provides free water, calories, sodium, chloride, potassium, calcium, and lactate. It is used to treat hypovolemia and metabolic acidosis, but it can cause fluid shifts from the intracellular to the intravascular space, leading to cellular dehydration and increased blood pressure. This is not appropriate for a client who has dehydration due to vomiting and diarrhea, as they already have low blood pressure and cellular dehydration.

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Correct Answer is C

Explanation

Choice A reason: This is incorrect because 0.9% sodium chloride (normal saline) is an isotonic solution, not a hypotonic one. Isotonic solutions have the same concentration of solutes as blood plasma and do not cause fluid movement across the cell membrane.

Choice B reason:

This is incorrect because 0.9% sodium chloride (normal saline) is an isotonic solution, not a hypertonic one. Hypertonic solutions have a higher concentration of solutes than blood plasma and cause fluid to move out of the cells and into the vascular space.

Choice C reason:

This is correct because 0.9% sodium chloride (normal saline) is an isotonic solution that will expand the vascular space by adding fluid without changing the concentration of solutes. This is useful for patients with hyponatremia (low sodium level in the blood) who need to restore their fluid and electrolyte balance.

Choice D reason:

This is incorrect because 0.9% sodium chloride (normal saline) is an isotonic solution that will expand the vascular space by adding fluid without changing the concentration of solutes. It will not have no effect on fluid movement, as it will increase the intravascular volume.

A. Kussmaul respirations. B. Bradypnea. C. Muscle spasms. D. Numbness and tingling of extremities.

Correct Answer is A

Explanation

Choice A reason:

Kussmaul respirations are a type of deep, rapid breathing that occurs in response to metabolic acidosis. The body tries to compensate for the excess acid by blowing off carbon dioxide through the lungs. Kussmaul respirations are a common manifestation of diabetic ketoacidosis (DKA), which is a severe form of metabolic acidosis caused by the accumulation of ketones in the blood. The nurse should monitor the client's respiratory rate, depth, and pattern, as well as the arterial blood gas results, to assess the severity of metabolic acidosis and the effectiveness of treatment.

Choice B reason:

Bradypnea is a condition of abnormally slow breathing, usually less than 12 breaths per minute. Bradypnea can result from respiratory acidosis, which is a condition of excess carbon dioxide in the blood due to hypoventilation or impaired gas exchange. Bradypnea is not a manifestation of metabolic acidosis, which is a condition of excess acid in the blood due to increased production or decreased elimination of hydrogen ions. Therefore, choice B is incorrect.

Choice C reason:

Muscle spasms are involuntary contractions of the skeletal muscles that can cause pain and discomfort. Muscle spasms can result from hypocalcemia, which is a condition of low calcium levels in the blood. Hypocalcemia can occur in metabolic acidosis due to the binding of calcium with excess hydrogen ions, reducing the availability of free calcium for muscle contraction. However, muscle spasms are not a specific or common manifestation of metabolic acidosis, and they can have other causes such as dehydration, electrolyte imbalance, or muscle injury. Therefore, choice C is incorrect.

Choice D reason:

Numbness and tingling of extremities are sensations of reduced or abnormal feeling in the arms or legs. Numbness and tingling can result from hypokalemia, which is a condition of low potassium levels in the blood. Hypokalemia can occur in metabolic acidosis due to the movement of potassium from the intracellular to the extracellular space in exchange for hydrogen ions, which are then excreted by the kidneys. However, numbness and tingling are not specific or common manifestations of metabolic acidosis, and they can have other causes such as nerve compression, peripheral neuropathy, or hyperventilation. Therefore, choice D is incorrect.

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A nurse is caring for a client who has dehydration due to vomiting and diarrhea. The client's blood pressure is 90/60 mm Hg, pulse is 110/min, and respirations are 22/min. The nurse should anticipate a prescription for which of the following types of IV fluids?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is preparing to hang a bag of 0.9% sodium chloride (normal saline) for a patient who has hyponatremia. The nurse knows that this type of solution is:

Correct Answer is C

Explanation

A nurse is caring for a client who has metabolic acidosis due to diabetic ketoacidosis (DKA) Which of the following manifestations should the nurse monitor?

Correct Answer is A

Explanation

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