A client is to receive mannitol IV for increased intracranial pressure. Which outcome may result from the use of mannitol?

Rationale:
A. Rib pain with deep inspiration: Rib pain suggests possible rib fracture or contusion, which can be painful but is not immediately life threatening unless accompanied by respiratory compromise or pneumothorax. It requires monitoring but not urgent life-saving action.

B. Diminished bilateral breath sounds: Decreased breath sounds on both sides may indicate a severe chest injury such as pneumothorax, hemothorax, or respiratory failure. This finding threatens oxygenation and ventilation, requiring immediate airway management and possibly chest tube insertion.

C. Generalized abdominal tenderness: While abdominal tenderness raises concern for internal bleeding or organ injury, it does not immediately impair ventilation or perfusion. It is serious but not as acutely life threatening as compromised breath sounds.

D. Nausea with projectile vomiting: Projectile vomiting may suggest increased intracranial pressure from head trauma, but the airway and breathing take priority. Airway obstruction or hypoxia from inadequate ventilation remains the most immediate life-threatening condition.

A. Notifying the rapid response team is essential in cases of sudden hemodynamic instability, but immediate actions to stop potential causes of hypotension must be taken first. Delaying this step could worsen shock or compromise perfusion.

B. Discontinuing the nitroprusside infusion is the first priority because the client is experiencing hypotension, which may be exacerbated by ongoing vasodilation from the medication. Rapid intervention to stop the source of hypotension is critical to prevent further cardiovascular collapse and maintain organ perfusion.

C. Increasing the saline infusion rate may help restore intravascular volume, but it does not address the immediate cause of hypotension from the vasodilator. Volume expansion alone may be insufficient if nitroprusside continues to lower blood pressure.

D. Placing the client with head flat and feet elevated can temporarily improve venous return and perfusion, but this is a supportive measure and does not treat the underlying cause of sudden hypotension. Immediate discontinuation of the vasodilator takes precedence.