A patient is receiving a 3% saline continuous IV infusion for hyponatremia. Which assessment data represents an adverse outcome (side effect) of this infusion?
There are crackles throughout both lung fields.
The patient's radial pulse is 105 beats/min.
There is sediment and blood in the patient's urine
The blood pressure increases from 66/50 to 122/74 mm
The Correct Answer is A
A 3% saline solution is a hypertonic solution used to increase serum sodium levels in cases of severe hyponatremia. However, it can lead to fluid overload and pulmonary edema. The presence of crackles throughout both lung fields indicates the accumulation of fluid in the lungs, which is a serious adverse outcome.
The patient's radial pulse rate of 105 beats/min is within a normal range and does not directly indicate an adverse effect of the saline infusion.
The presence of sediment and blood in the patient's urine may be unrelated to the 3% saline infusion and could indicate other issues such as urinary tract infection or kidney injury.
An increase in blood pressure from 66/50 to 122/74 mmHg is an expected effect of a hypertonic solution like 3% saline, as it can cause an increase in intravascular volume. While the increase in blood pressure is significant, it does not represent an adverse outcome specific to the infusion itself.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["1.4"]
Explanation
We know that 7,000 units is equivalent to 5,000 units per ml. So, we can set up the proportion:
7,000 units / 5,000 units per ml = x ml / 1 ml x = 7,000 / 5,000
x = 1.4
Therefore, the nurse should administer 1.4 milliliters (ml) of heparin.
Correct Answer is C
Explanation
The patient bending over the sink while brushing teeth requires intervention by the nurse. After hip arthroplasty using the posterior approach, the patient should avoid bending at the hip greater than 90 degrees to prevent dislocation of the prosthesis. The nurse should instruct the patient to bend at the knees instead of the hips while brushing teeth or doing any other activity that requires bending. The other actions mentioned in the options are appropriate for a patient after hip arthroplasty.
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