A nurse receives a telephone prescription from a provider for a client who is experiencing pain. Which of the following responses should the nurse make?

Rationale

A. Decreased serum potassium: Dehydration can lead to electrolyte imbalances, including hypokalemia. Muscle cramps and constipation are common signs of low potassium levels, as potassium is essential for normal muscle and nerve function. Monitoring electrolytes helps guide appropriate replacement therapy.

B. Decreased BUN: Dehydration typically causes an elevation in BUN due to hemoconcentration and reduced renal perfusion. A decreased BUN would not be expected in fluid volume deficit.

C. Decreased hematocrit (Hct): Hematocrit usually increases during dehydration because of reduced plasma volume, leading to hemoconcentration. A decreased Hct would suggest anemia or fluid overload, not dehydration.

D. Decreased specific gravity: Specific gravity of urine increases with dehydration as the kidneys concentrate urine to conserve water. A decreased specific gravity indicates diluted urine, which is not consistent with fluid deficit.

Rationale

A. Restlessness: Restlessness can be an early sign of hypovolemia due to blood loss. Reduced circulating volume leads to decreased oxygen delivery to tissues, including the brain, causing anxiety, agitation, or confusion. Monitoring for restlessness helps identify active bleeding before more overt signs appear.

B. Brisk capillary refill: Brisk capillary refill indicates good peripheral perfusion and adequate circulating volume. In the context of active bleeding, capillary refill would more likely be delayed due to hypovolemia.

C. Bounding pulses: Bounding pulses are associated with fluid volume excess rather than blood loss. In active bleeding, pulses are more likely to be weak, thready, and rapid as the body attempts to compensate for decreased blood volume.

D. Warm skin: Warm, dry skin generally reflects stable perfusion. Active bleeding often causes cool, clammy skin as vasoconstriction occurs to maintain blood flow to vital organs. Skin assessment provides important clues about hemodynamic status.