The nurse is caring for a client with leukemia and notes that the client has poor skin turgor and flat neck and hand veins. The nurse suspects hypernatremia. Which sign/symptom would the nurse expect to note in this client if hypernatremia is present?

Choice A reason: 60 mL of urine in a 2-hour period is not very concerning for a nurse, as it is within the normal range of urine output. The average urine output for an adult is about 1 to 2 L per day, or 40 to 80 mL per hour¹.

Choice B reason: 720 mL of urine in a 24-hour period is slightly below the normal range, but not alarming. It may indicate mild dehydration or reduced fluid intake, but it is not a sign of fluid volume excess or kidney failure¹.

Choice C reason: 600 mL of urine in a 10-hour period is also within the normal range of urine output, and does not indicate any problem with fluid balance or renal function¹.

Choice D reason: 100 mL of urine in a 5-hour period is the most concerning for a nurse, as it indicates oliguria, or abnormally low urine output. Oliguria is defined as urine output less than 400 mL per day, or less than 20 mL per hour². It may be caused by acute or chronic kidney injury, urinary obstruction, shock, dehydration, or fluid volume excess². Oliguria can lead to fluid overload, electrolyte imbalance, acidosis, and uremia, and requires immediate medical attention².

Choice A reason: This is correct because prolonged bed rest can cause hypocalcemia, or low serum calcium level. Calcium is stored in the bones and is released into the blood when the bones are stressed by weight-bearing activities. When a person is on bed rest, the bones are not stimulated and the calcium remains in the bones, leading to a decrease in serum calcium level.

Choice B reason: This is incorrect because too much butter consumption does not affect the serum calcium level directly. Butter is a source of fat and calories, which can affect the cholesterol and triglyceride levels, but not the calcium level. However, too much butter consumption can cause obesity, which can increase the risk of osteoporosis and fractures.

Choice C reason: This is incorrect because hyperparathyroidism can cause hypercalcemia, or high serum calcium level. Hyperparathyroidism is a condition where the parathyroid glands produce too much parathyroid hormone (PTH), which regulates the calcium and phosphorus balance in the body. PTH stimulates the release of calcium from the bones into the blood, leading to an increase in serum calcium level.

Choice D reason: This is incorrect because excessive ingestion of vitamin D can also cause hypercalcemia, or high serum calcium level. Vitamin D is a fat-soluble vitamin that helps the body absorb calcium from the food and supplements. When a person takes too much vitamin D, the calcium absorption is increased and the serum calcium level rises.