The healthcare provider ordered an IV solution for a dehydrated client with a skull fracture. The nurse knows which IV fluid would be contraindicated?

Normal saline

Dextrose in water 5%

Lactated Ringer's (LR)

Dextrose in normal saline

Answer and Explanation

The Correct Answer is B

Choice A reason: Normal saline is not contraindicated for a dehydrated client with a skull fracture. Normal saline is an isotonic solution that has the same concentration of solutes as the blood plasma. It can help restore fluid balance and prevent cerebral edema.

Choice B reason: Dextrose in water 5% is contraindicated for a dehydrated client with a skull fracture. Dextrose in water 5% is a hypotonic solution that has a lower concentration of solutes than the blood plasma. It can cause fluid to shift from the blood vessels into the brain cells, increasing the intracranial pressure and worsening the skull fracture.

Choice C reason: Lactated Ringer's (LR) is not contraindicated for a dehydrated client with a skull fracture. Lactated Ringer's (LR) is an isotonic solution that has the same concentration of solutes as the blood plasma. It can also provide electrolytes such as sodium, potassium, calcium, and lactate, which can help correct acid-base imbalances.

Choice D reason: Dextrose in normal saline is not contraindicated for a dehydrated client with a skull fracture. Dextrose in normal saline is a hypertonic solution that has a higher concentration of solutes than the blood plasma. It can cause fluid to shift from the brain cells into the blood vessels, reducing the intracranial pressure and cerebral edema.

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Correct Answer is A

Explanation

Choice A reason: This is a correct answer because normal saline is an isotonic solution, which means it has the same osmolarity as the blood plasma. It does not cause any fluid shifts between the intracellular and extracellular compartments, and it can help restore the fluid balance and the blood pressure of the dehydrated client.

Choice B reason: This is not a correct answer because 1/2 normal saline is a hypotonic solution, which means it has a lower osmolarity than the blood plasma. It causes fluid to shift from the extracellular to the intracellular compartment, which can lead to cellular swelling and edema. It is not suitable for rapid infusion, as it can cause hemolysis and hypotension.

Choice C reason: This is not a correct answer because D5W (5% Dextrose in Water) is an isotonic solution when it is in the IV bag, but it becomes hypotonic once it enters the body, as the dextrose is rapidly metabolized and only water remains. It causes fluid to shift from the extracellular to the intracellular compartment, which can lead to cellular swelling and edema. It is not suitable for rapid infusion, as it can cause hemolysis and hypotension.

Choice D reason: This is not a correct answer because D5 1/2 normal saline is a hypertonic solution, which means it has a higher osmolarity than the blood plasma. It causes fluid to shift from the intracellular to the extracellular compartment, which can lead to cellular shrinkage and dehydration. It is not suitable for rapid infusion, as it can cause hypernatremia and fluid overload.

A. I should avoid alcohol and other substances that can harm my liver. B. I should take naproxen and aspirin as needed for pain relief. C. I should report any signs of infection or fever to my doctor. D. I should inject the medication under the skin of my abdomen or thigh.

Correct Answer is B

Explanation

Choice A reason: This is not a statement that indicates a need for further teaching. The client should avoid alcohol and other substances that can harm the liver, as adalimumab can increase the risk of liver toxicity and hepatitis.

Choice B reason: This is a statement that indicates a need for further teaching. The client should not take naproxen and aspirin as needed for pain relief, as these are nonsteroidal anti-inflammatory drugs (NSAIDs) that can increase the risk of bleeding and gastrointestinal ulcers. Adalimumab can also increase the risk of bleeding and ulcers, as it suppresses the immune system and the inflammatory response.

Choice C reason: This is not a statement that indicates a need for further teaching. The client should report any signs of infection or fever to the doctor, as adalimumab can increase the risk of serious infections and sepsis. Adalimumab can also mask the symptoms of infection, such as inflammation and pain.

Choice D reason: This is not a statement that indicates a need for further teaching. The client should inject the medication under the skin of the abdomen or thigh, as this is the recommended route and site for adalimumab administration.

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The healthcare provider ordered an IV solution for a dehydrated client with a skull fracture. The nurse knows which IV fluid would be contraindicated?

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