A nurse is planning care for a client who has hypernatremia. Which of the following interventions should the nurse include in the plan?

• Choice A reason:

• Administering hypotonic IV fluids is an appropriate intervention for a client who has hypernatremia. Hypotonic fluids have a lower concentration of solutes than the blood, so they can help dilute the excess sodium and rehydrate the cells.

• Choice B reason:

• Monitoring blood glucose levels is not directly related to hypernatremia, although it may be indicated for other reasons, such as diabetes. Hypernatremia can be caused by uncontrolled diabetes, but it is not a consequence of high blood glucose levels.

• Choice C reason:

• Providing oral care every 4 hours is a supportive measure for a client who has hypernatremia, but it is not a specific intervention to correct the electrolyte imbalance. Oral care can help relieve thirst and dry mouth, which are common symptoms of hypernatremia, but it does not address the underlying cause of fluid loss or sodium gain.

• Choice D reason:

• Increasing dietary intake of potassium is not helpful for a client who has hypernatremia. Potassium is another electrolyte that plays a role in fluid balance and nerve function, but it is not affected by hypernatremia. In fact, increasing potassium intake may worsen the condition by causing further dehydration or hyperkalemia (high potassium levels)

Choice A reason:

Increased skin turgor is not a sign of fluid volume deficit, but rather a sign of normal hydration. Skin turgor is the elasticity of the skin that allows it to return to its original shape after being pinched. Fluid volume deficit causes decreased skin turgor, which means the skin stays tented or takes longer to flatten after being pinched.

Choice B reason:

Hypertension is not a sign of fluid volume deficit, but rather a sign of fluid volume excess. Fluid volume deficit causes hypotension, which means low blood pressure. Fluid volume excess causes hypertension, which means high blood pressure. This is because fluid volume affects the amount of blood in the vessels and the pressure it exerts on the vessel walls.

Choice C reason:

Tachycardia is a sign of fluid volume deficit. Tachycardia means fast heart rate, usually more than 100 beats per minute. Fluid volume deficit causes tachycardia because the heart has to pump faster and harder to compensate for the low blood volume and maintain adequate blood flow to the vital organs.

Choice D reason:

Crackles in the lungs are not a sign of fluid volume deficit, but rather a sign of fluid volume excess or pulmonary edema. Crackles are abnormal lung sounds that indicate fluid accumulation in the alveoli or air sacs of the lungs. Fluid volume deficit does not cause fluid accumulation in the lungs, but rather dehydration of the lung tissues. Some additional information: Fluid volume deficit, also known as dehydration, is a condition where the body loses more fluids than it takes in. This can result from excessive vomiting, diarrhea, sweating, burns, hemorrhage, or diuretic use. Fluid volume excess, also known as overhydration or hypervolemia, is a condition where the body retains more fluids than it needs. This can result from excessive fluid intake, kidney failure, heart failure, liver cirrhosis, or steroid use. Fluid balance is essential for maintaining homeostasis and normal functioning of the body systems. Fluid balance is regulated by various mechanisms such as thirst, urine output, hormones, and electrolytes.