A nurse is caring for a client who has dehydration and is receiving dextrose 5% in water (D5W) intravenously. The nurse should monitor the client for which of the following complications of this type of solution?

Choice A reason: Hyperglycemia. This is incorrect because dextrose 5% in water (D5W) is not likely to cause hyperglycemia in a dehydrated client. D5W is a hypotonic solution that provides free water and glucose to the body. The glucose is rapidly metabolized by the cells, leaving only water in the intravascular space. This water then moves into the intracellular and interstitial compartments, rehydrating the tissues. Therefore, D5W does not increase the blood glucose level significantly in a dehydrated client.

Choice B reason:

Hyperkalemia. This is incorrect because dextrose 5% in water (D5W) does not contain any potassium or other electrolytes. Hyperkalemia is a condition of high potassium level in the blood, which can be caused by renal failure, acidosis, tissue injury, or excessive intake of potassium-rich foods or supplements. D5W does not affect the potassium level in the blood.

Choice C reason:

Fluid overload. This is correct because dextrose 5% in water (D5W) can cause fluid overload in a client who has impaired fluid regulation mechanisms, such as heart failure, kidney disease, or liver disease. Fluid overload is a condition of excess fluid volume in the body, which can lead to edema, hypertension, dyspnea, crackles, jugular venous distension, and pulmonary congestion. D5W can cause fluid overload by expanding the intravascular volume and shifting water into the interstitial and intracellular spaces.

Choice D reason:

Metabolic acidosis. This is incorrect because dextrose 5% in water (D5W) does not cause metabolic acidosis in a dehydrated client. Metabolic acidosis is a condition of low pH and low bicarbonate level in the blood, which can be caused by diabetic ketoacidosis, lactic acidosis, renal failure, diarrhea, or ingestion of toxic substances. D5W does not affect the pH or bicarbonate level in the blood.

Choice A reason:

Assess the client's blood pressure and pulse frequently. This is correct because a client who has hypovolemia due to third-space shifting has lost fluid from the intravascular space to the interstitial space, resulting in decreased blood volume and pressure. The nurse should monitor the client's vital signs to assess the response to fluid replacement and detect any signs of fluid overload or electrolyte imbalance.

Choice B reason:

Monitor the client's serum electrolyte levels. This is correct because lactated Ringer's solution contains sodium, chloride, potassium, calcium, and lactate, which are important electrolytes for maintaining fluid balance, acid-base balance, nerve conduction, muscle contraction, and cellular function. The nurse should monitor the client's serum electrolyte levels to ensure they are within normal range and to identify any abnormalities that may require intervention.

Choice C reason:

Warm the solution to body temperature before infusion. This is incorrect because warming the solution is not necessary and may cause hemolysis (destruction of red blood cells) or bacterial growth. The nurse should infuse the solution at room temperature or use a fluid warmer device if indicated.

Choice D reason:

Use a filter needle when drawing the solution from the bag. This is incorrect because using a filter needle is not required when drawing the solution from the bag. A filter needle is used to remove particles or air bubbles from a vial or ampule before injection. The nurse should use a sterile spike to pierce the bag and connect it to the IV tubing.

Choice E reason:

Check the solution for cracks or leaks. This is incorrect because checking the solution for cracks or leaks is not specific to lactated Ringer's solution. The nurse should check any IV fluid for cracks or leaks before administration to prevent contamination or infection. The nurse should also check the expiration date, color, clarity, and label of the solution before use.