A nurse is planning care for a client who has intracellular dehydration. Which intravenous solution should the nurse plan to administer?

A.A serum calcium level of 12.5 mg/dL indicates significant hypercalcemia, which is a common and life-threatening complication of multiple myeloma due to excessive bone resorption. High calcium levels can lead to cardiac dysrhythmias, renal failure, and altered mental status, necessitating immediate clinical intervention. This finding represents an acute physiological instability that takes priority over chronic symptoms like fatigue or pain.

B.Extreme fatigue is a common symptom in multiple myeloma, often resulting from the underlying malignancy, anemia, or the metabolic demands of the disease. While distressing to the client, it does not pose an immediate threat to life when compared to severe electrolyte imbalances. The nurse should address fatigue through energy conservation techniques after ensuring that more critical metabolic parameters are stabilized.

C.A hemoglobin level of 10 g/dL reflects mild anemia, which frequently occurs in multiple myeloma as malignant plasma cells crowd out normal erythropoietic tissue in the bone marrow. Although this requires monitoring and potential future treatment, it is not an emergency situation for most stable adult clients. The nurse must prioritize the hypercalcemia, which has a higher potential for causing rapid systemic collapse and organ damage.

D.Lower back pain is a hallmark manifestation of multiple myeloma caused by lytic bone lesions and pathological fractures within the spinal column. While pain management is a central component of nursing care, it is considered a secondary priority to the management of severe hypercalcemia. Correcting the calcium levels is essential to prevent further physiological deterioration, whereas pain is a subjective symptom that does not immediately jeopardize systemic homeostasis.

A.A urine specific gravity of 1.038 is significantly elevated above the normal physiological range of 1.005 to 1.030. This finding indicates that the urine remains highly concentrated, suggesting that the kidneys are still conserving water due to a continued state of fluid volume deficit. Effective rehydration would result in a lower, more dilute specific gravity as the circulating volume and renal perfusion normalize.

B.A urine output of 25 mL/hour is below the standard clinical threshold of 30 mL/hour, which is the minimum required to ensure adequate organ perfusion and metabolic waste excretion. Persistent oliguria indicates that the compensatory mechanisms for dehydration are still active and that the fluid resuscitation has not yet achieved hemodynamic stability. The nurse should continue to monitor and potentially escalate fluid therapy until output meets or exceeds 30 mL/hour.

C.A mean arterial pressure of 58 mmHg is critically low and insufficient to maintain adequate perfusion to vital organs, particularly the brain and kidneys. Normal mean arterial pressure should be maintained at 65 mmHg or higher to ensure systemic homeostasis. This hypotensive value suggests that the client is still experiencing a significant volume deficit or is potentially progressing toward hypovolemic shock despite the current IV fluid replacement.

D.A heart rate of 88 beats/minute falls within the normal adult reference range of 60 to 100 beats/minute. Dehydration typically causes compensatory tachycardia as the body attempts to maintain cardiac output in the presence of decreased stroke volume. The normalization of the heart rate is a reliable indicator that the intravascular volume has been restored and the sympathetic nervous system's compensatory drive has decreased.