A nurse is planning care for a client who has hyponatremia and is receiving IV fluid therapy with 3% sodium chloride solution. Which of the following interventions should the nurse include in the plan? (Select all that apply.)

Administer the solution via a central line.

Monitor serum sodium levels every 4 hours.

Titrate the infusion rate according to urine output.

Assess for signs of fluid overload.

Keep an accurate intake and output record.

Answer and Explanation

Correct Answer : A,B,D,E

Choice A reason:

Administer the solution via a central line. This is correct because 3% sodium chloride solution is a hypertonic solution that can cause phlebitis and tissue damage if infused peripherally. A central line can deliver the solution more safely and effectively.

Choice B reason:

Monitor serum sodium levels every 4 hours. This is correct because serum sodium levels can indicate the effectiveness of the therapy and the risk of complications such as hypernatremia or cerebral edema. The normal range of serum sodium is 135 to 145 mEq/L.

Choice C reason:

Titrate the infusion rate according to urine output. This is incorrect because the infusion rate of 3% sodium chloride solution should be titrated according to serum sodium levels, not urine output. Urine output can be affected by other factors such as renal function, fluid intake, and diuretics.

Choice D reason:

Assess for signs of fluid overload. This is correct because 3% sodium chloride solution can cause fluid shifts from the intracellular and interstitial spaces to the intravascular space, leading to fluid overload. Signs of fluid overload include cough, dyspnea, crackles, tachypnea, tachycardia, elevated blood pressure, bounding pulse, elevated central venous pressure (CVP), weight gain, edema, neck and hand vein distention, altered level of consciousness, and decreased hematocrit.

Choice E reason:

Keep an accurate intake and output record. This is correct because intake and output records can help monitor the fluid balance and identify any excesses or deficits. Intake includes oral fluids, intravenous fluids, tube feedings, and blood products. Output includes urine, stool, vomitus, drainage, and insensible losses.

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Correct Answer is C

Explanation

Choice A reason: Sodium. Sodium is not affected by serum phosphate level in chronic kidney disease (CKD) patients. Sodium level is mainly regulated by the renin-angiotensin-aldosterone system and the antidiuretic hormone. Sodium level can be altered by fluid intake, fluid loss, diuretics, or salt restriction, but not by phosphate level.

Choice B reason:

Magnesium. Magnesium is also not affected by serum phosphate level in CKD patients. Magnesium level is mainly influenced by dietary intake, intestinal absorption, renal excretion, and exchange with bone and soft tissues. Magnesium level can be altered by malnutrition, malabsorption, diarrhea, vomiting, diuretics, or alcoholism, but not by phosphate level.

Choice C reason:

Calcium. Calcium is the correct answer because calcium and phosphate have an inverse relationship in the body. When serum phosphate level is elevated, as in CKD patients, serum calcium level tends to decrease. This is because high phosphate level binds to calcium and forms insoluble complexes that are deposited in soft tissues and bones. This reduces the amount of free calcium in the blood and triggers the secretion of parathyroid hormone (PTH), which further lowers the calcium level by increasing its excretion in the urine.

Choice D reason:

Bicarbonate. Bicarbonate is not directly affected by serum phosphate level in CKD patients. Bicarbonate level is mainly determined by the acid-base balance in the body. Bicarbonate level can be altered by metabolic acidosis or alkalosis, respiratory acidosis or alkalosis, renal failure, or diarrhea, but not by phosphate level.

A. Crystalloid. B. Colloid. C. Hypertonic. D. Hypotonic.

Correct Answer is B

Explanation

Choice A reason:

Crystalloid solutions are fluids that contain electrolytes and can diffuse across semipermeable membranes. They are used to treat dehydration, electrolyte imbalances, and hypovolemia. However, they are not as effective as colloids in expanding the intravascular volume and maintaining the blood pressure. Therefore, choice A is incorrect.

Choice B reason:

Colloid solutions are fluids that contain large molecules such as proteins, starches, or gelatin that cannot cross the capillary membrane. They exert an osmotic pressure that draws fluid from the interstitial and intracellular spaces into the intravascular space. They are used to treat hypovolemic shock, burns, and hemorrhage. Albumin is a type of colloid solution that is derived from human plasma and contains 5% or 25% protein. It increases the plasma volume and the blood pressure by increasing the oncotic pressure. Therefore, choice B is correct.

Choice C reason:

Hypertonic solutions are fluids that have a higher osmolarity than the blood plasma. They draw water out of the cells and into the intravascular space. They are used to treat hyponatremia, cerebral edema, and severe dehydration. However, they can cause fluid overload, hypertension, and cellular dehydration if given in excess. Therefore, choice C is incorrect.

Choice D reason:

Hypotonic solutions are fluids that have a lower osmolarity than the blood plasma. They provide free water and electrolytes to the cells and the interstitial space. They are used to treat hypernatremia, cellular dehydration, and fluid loss due to burns or diuresis. However, they can cause fluid shifts from the intravascular space to the interstitial and intracellular spaces, resulting in hypovolemia, hypotension, and edema. Therefore, choice D is incorrect.

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A nurse is planning care for a client who has hyponatremia and is receiving IV fluid therapy with 3% sodium chloride solution. Which of the following interventions should the nurse include in the plan? (Select all that apply.)

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