A nurse is monitoring a client who was admited with a severe burn injury and is receiving IV fluid resuscitation therapy. The nurse should identify a decrease in which of the following findings as an indication of adequate fluid replacement?

Choice A Reason: Albumin 25% is not a medication that the nurse should plan to administer for a client who is experiencing Cushing's triad following a subdural hematoma. Albumin 25% is a colloid solution that increases the oncotic pressure and draws fluid from the interstitial space into the intravascular space, which can worsen the intracranial pressure by increasing the cerebral blood flow and edema.

Choice B Reason: Dextran 70 is not a medication that the nurse should plan to administer for a client who is experiencing Cushing's triad following a subdural hematoma. Dextran 70 is a plasma expander that increases the blood volume and viscosity, which can also worsen the intracranial pressure by increasing the cerebral blood flow and edema.

Choice C Reason: Mannitol 25% is a medication that the nurse should plan to administer for a client who is experiencing Cushing's triad following a subdural hematoma. Mannitol 25% is an osmotic diuretic that reduces the intracranial pressure by creating an osmotic gradient and drawing fluid from the brain tissue into the blood vessels, which can then be excreted by the kidneys. The nurse should monitor the urine output, serum osmolality, and electrolytes when administering mannitol 25%.

Choice D Reason: Hydroxyethyl starch is not a medication that the nurse should plan to administer for a client who is experiencing Cushing's triad following a subdural hematoma. Hydroxyethyl starch is another plasma expander that has similar effects as dextran 70, and can also increase the risk of coagulopathy and renal failure.

Choice A Reason: This is incorrect because hypervolemia is a condition of excess fluid volume in the body. A client who has an extensive burn injury is more likely to have hypovolemia, which is a condition of low fluid volume, due to fluid loss from the damaged skin and capillaries.

Choice B Reason: This is incorrect because metabolic alkalosis is a condition of high blood pH and high bicarbonate level. A client who has an extensive burn injury is more likely to have metabolic acidosis, which is a condition of low blood pH and low bicarbonate level, due to increased production of lactic acid and ketones from tissue hypoxia and breakdown.

Choice C Reason: This is correct because low hemoglobin is a common laboratory finding in a client who has an extensive burn injury. Hemoglobin is the protein in red blood cells that carries oxygen. A client who has an extensive burn injury may have low hemoglobin due to hemolysis, which is the destruction of red blood cells, or hemorrhage, which is the loss of blood.

Choice D Reason: This is incorrect because hyperkalemia is a condition of high blood potassium level. A client who has an extensive burn injury may have hyperkalemia in the early phase of injury, due to cell damage and potassium release, but it is usually transient and followed by hypokalemia, which is a condition of low blood potassium level, due to fluid loss and potassium depletion.