A nurse is assigned a client who is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) with a serum sodium level of 118 mEq/L. Which of the following interventions will the nurse anticipate for this client? (Select all that apply)

Choice A reason: TPN contains high dextrose, and abrupt cessation risks hypoglycemia, causing shakiness and diaphoresis due to low blood glucose triggering sympathetic responses. Monitoring for these signs is critical, as TPN-dependent clients rely on continuous glucose, making this the correct choice.

Choice B reason: Fever and chills suggest infection, possibly from a contaminated TPN line, but are not immediate concerns of a non-infusing pump. Hypoglycemia is the primary risk of infusion failure, making this choice less relevant.

Choice C reason: Hypertension and crackles indicate fluid overload, not directly related to TPN infusion failure. TPN cessation causes hypoglycemia, not fluid shifts, making this choice incorrect for the immediate condition to monitor.

Choice D reason: Excessive thirst and urination are symptoms of hyperglycemia, not TPN infusion failure. Stopping TPN risks hypoglycemia due to high dextrose content, not high glucose levels, making this choice incorrect.

Choice A reason: Initiating 3% sodium chloride infusion is appropriate for severe hyponatremia (118 mEq/L) in SIADH, as hypertonic saline corrects low serum sodium by increasing extracellular sodium concentration. This addresses water retention from excess ADH, preventing neurological complications like seizures, making it a key intervention.

Choice B reason: Administering tolvaptan, a vasopressin receptor antagonist, is effective in SIADH, as it promotes water excretion, increasing urine output and correcting hyponatremia. By blocking ADH action, it reduces fluid retention, making it a suitable intervention for severe cases with low sodium levels.

Choice C reason: Administering lactulose is used for hepatic encephalopathy to reduce ammonia, not for SIADH’s hyponatremia. It does not address electrolyte imbalances caused by water retention, making it irrelevant for correcting sodium levels or managing SIADH’s pathophysiology.

Choice D reason: Maintaining seizure precautions is critical in SIADH with severe hyponatremia (118 mEq/L), as low sodium disrupts neuronal membrane stability, increasing seizure risk. Precautions like padded rails and anticonvulsants protect the client, making this a necessary intervention for safety.

Choice E reason: Administering a 3-liter 5% dextrose water bolus is contraindicated in SIADH, as it adds free water, worsening hyponatremia by further diluting serum sodium. Hypertonic saline or fluid restriction is needed, making this an inappropriate and potentially harmful intervention.