A nurse is caring for a client who has hypernatremia and is receiving intravenous (IV) hypotonic fluid replacement. Which of the following manifestations should the nurse understand is an indication of an adverse effect from the administration of hypotonic fluids?

The client has developed confusion.

The client's serum sodium is 140 mEq/L (135 to 145 mEq/L).

The client has a positive Chvostek's sign.

The client's blood urea nitrogen (BUN) level is 18 mg/dL (10 to 20 mg/dL).

Answer and Explanation

The Correct Answer is A

A. The client has developed confusion: Hypotonic fluids can cause a rapid shift of water into cells, potentially leading to cerebral edema. This can manifest as confusion or altered mental status, which is a serious adverse effect requiring immediate attention.

B. The client's serum sodium is 140 mEq/L (135 to 145 mEq/L): A serum sodium level within the normal range indicates that the hypotonic fluid therapy is likely effective in correcting hypernatremia, and does not suggest an adverse effect.

C. The client has a positive Chvostek's sign: A positive Chvostek's sign is indicative of hypocalcemia rather than an adverse effect of hypotonic fluid administration. This sign is related to low calcium levels and is not a direct result of hypotonic fluid therapy.

D. The client's blood urea nitrogen (BUN) level is 18 mg/dL (10 to 20 mg/dL): This BUN level is within normal limits and does not suggest an adverse effect of hypotonic fluid therapy. BUN levels can be affected by various factors, but this value alone is not indicative of an adverse reaction.

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Correct Answer is A

Explanation

A. "Diffusion is the movement of molecules from an area of higher concentration to an area of lower concentration.": This statement accurately describes diffusion. Molecules move down their concentration gradient from areas of higher concentration to areas of lower concentration until equilibrium is reached.

B. "Diffusion is the movement of particles between areas of equal concentrations.": Diffusion does not occur between areas of equal concentration as there is no concentration gradient to drive the movement.

C. "Diffusion is the movement of water from an area of higher concentration of water to an area of lower concentration of water.": This describes osmosis, not diffusion. Osmosis specifically refers to the movement of water across a semipermeable membrane.

D. "Diffusion is the movement of particles from an area of lower concentration of particles to an area of higher concentration of particles.": This is incorrect as diffusion occurs from higher to lower concentration, not the reverse.

A. Expiratory wheeze B. Rhonchi C. Pleural friction rub D. Fine rales

Correct Answer is A

Explanation

A. Expiratory wheeze: Wheezing, particularly on expiration, is a characteristic finding during an acute asthma exacerbation. It occurs due to the narrowing of the airways and turbulent airflow.

B. Rhonchi: Rhonchi are low-pitched, rattling sounds often caused by secretions in larger airways, not typically associated with asthma exacerbations.

C. Pleural friction rub: A pleural friction rub is a grating sound heard when the pleurae are inflamed, often seen in conditions like pleuritis, not asthma.

D. Fine rales: Fine rales, or crackles, are associated with fluid in the alveoli, often found in conditions like pneumonia or heart failure, rather than asthma

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A nurse is caring for a client who has hypernatremia and is receiving intravenous (IV) hypotonic fluid replacement. Which of the following manifestations should the nurse understand is an indication of an adverse effect from the administration of hypotonic fluids?

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