A nurse is caring for a client who has hypernatremia and is receiving intravenous (IV) hypotonic fluid replacement. Which of the following manifestations should the nurse understand is an indication of an adverse effect from the administration of hypotonic fluids?

The client has developed confusion.

The client's serum sodium is 140 mEq/L (135 to 145 mEq/L).

The client has a positive Chvostek's sign.

The client's blood urea nitrogen (BUN) level is 18 mg/dL (10 to 20 mg/dL).

Answer and Explanation

The Correct Answer is A

A. The client has developed confusion: Hypotonic fluids can cause a rapid shift of water into cells, potentially leading to cerebral edema. This can manifest as confusion or altered mental status, which is a serious adverse effect requiring immediate attention.

B. The client's serum sodium is 140 mEq/L (135 to 145 mEq/L): A serum sodium level within the normal range indicates that the hypotonic fluid therapy is likely effective in correcting hypernatremia, and does not suggest an adverse effect.

C. The client has a positive Chvostek's sign: A positive Chvostek's sign is indicative of hypocalcemia rather than an adverse effect of hypotonic fluid administration. This sign is related to low calcium levels and is not a direct result of hypotonic fluid therapy.

D. The client's blood urea nitrogen (BUN) level is 18 mg/dL (10 to 20 mg/dL): This BUN level is within normal limits and does not suggest an adverse effect of hypotonic fluid therapy. BUN levels can be affected by various factors, but this value alone is not indicative of an adverse reaction.

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Correct Answer is C

Explanation

In cases of acute bacterial sinusitis that last longer than 10 days, worsen after initial improvement, or present with severe symptoms (such as fever and significant facial pain), oral antibiotics are generally indicated. First-line options typically include amoxicillin-clavulanate.

Other options listed, such as nasal saline irrigation, oral decongestants, or intranasal corticosteroids, may help alleviate symptoms but would not address the bacterial infection, making antibiotics the most appropriate primary treatment in this case.

A. Apply positive pressure ventilation and provide supportive care with pain management. B. Perform needle decompression of the pleural space followed by chest tube insertion. C. Administer intravenous antibiotics and arrange for an elective surgical repair. D. Provide high-flow oxygen and intubate the patient for mechanical ventilation.

Correct Answer is B

Explanation

A. Apply positive pressure ventilation and provide supportive care with pain management: While supportive care is important, positive pressure ventilation may not be sufficient to address the underlying issue, which is likely a pneumothorax or hemothorax.
B. Perform needle decompression of the pleural space followed by chest tube insertion: This is the most appropriate initial management for a patient with paradoxical chest wall movement, which is a sign of flail chest and likely pneumothorax. Needle decompression can relieve pressure in the pleural space, and chest tube insertion can help drain any fluid or air that has accumulated.
C. Administer intravenous antibiotics and arrange for an elective surgical repair: While infection may be a concern, it is not the most immediate priority in this case. The patient's respiratory distress needs to be addressed first.
D. Provide high-flow oxygen and intubate the patient for mechanical ventilation: While oxygen therapy may be necessary, intubation should be considered as a last resort if other measures fail to improve oxygenation. In this case, needle decompression and chest tube insertion are more likely to be effective in improving respiratory function.

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A nurse is caring for a client who has hypernatremia and is receiving intravenous (IV) hypotonic fluid replacement. Which of the following manifestations should the nurse understand is an indication of an adverse effect from the administration of hypotonic fluids?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Exhibits Which of the following is the most appropriate treatment for this patient. given the likely diagnosis of acute sinusitis?

Correct Answer is C

Explanation

Exhibits What is the most appropriate initial management for this patient?

Correct Answer is B

Explanation

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