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 D

Explanation

A. Impaired carbon dioxide elimination due to shunting: In ARDS, shunting can impair oxygenation but not directly carbon dioxide elimination. Shunting refers to blood flow through areas of the lung that are not ventilated properly, primarily affecting oxygenation.

B. Decreased pulmonary arterial pressure due to ventilation-perfusion (V/Q) mismatch: ARDS is typically associated with increased, not decreased, pulmonary arterial pressure due to the inflammatory process and reduced lung compliance. V/Q mismatch in ARDS usually results in elevated pulmonary arterial pressure.

C. Hypoxemia due to dead space: ARDS hypoxemia results from impaired gas exchange in damaged alveoli rather than dead space, which is more related to ventilation without perfusion.

D. Decreased pulmonary compliance due to stiffness: ARDS is characterized by decreased pulmonary compliance, which is due to the stiffening of lung tissue from inflammation and edema. This stiffness makes lung expansion more difficult and is a key feature of ARDS.

A. Diarrhea B. Vomiting C. Salicylate intoxication D. Hyperventilation

Correct Answer is A

Explanation

A. Diarrhea: Diarrhea leads to the loss of bicarbonate, an important buffer in the blood, which can contribute to the development of metabolic acidosis as the body loses bicarbonate faster than it can replace it.

B. Vomiting: Vomiting typically leads to metabolic alkalosis due to the loss of stomach acid, which reduces the amount of hydrogen ions in the body.

C. Salicylate intoxication: This condition primarily causes a mixed acid-base disturbance, including metabolic acidosis and respiratory alkalosis, due to its effects on both the metabolic and respiratory systems.

D. Hyperventilation: This condition causes respiratory alkalosis due to excessive loss of carbon dioxide, not metabolic acidosis.

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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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