A nurse is preparing to administer lactated Ringer's (LR) solution to a client who has hypovolemia due to third-space shifting. Which of the following actions should the nurse take? (Select all that apply.)

Assess the client's blood pressure and pulse frequently.

Monitor the client's serum electrolyte levels.

Warm the solution to body temperature before infusion.

Use a filter needle when drawing the solution from the bag.

Check the solution for cracks or leaks.

Answer and Explanation

Correct Answer : A,B

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.

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Correct Answer is C

Explanation

Choice A reason:

This is incorrect because dextrose 5% in normal saline is a hypertonic solution that will increase the blood sugar level, not lower it. Patients with Addison's crisis have low cortisol levels, which can impair glucose metabolism and cause hypoglycemia, so they need glucose supplementation.

Choice B reason:

This is partially correct because dextrose 5% in normal saline will provide some nutrition with glucose, but this is not the main reason for using this solution in Addison's crisis. Patients with Addison's crisis have low aldosterone levels, which can cause hyponatremia and hypovolemia, so they need sodium and fluid replacement.

Choice C reason:

This is correct because dextrose 5% in normal saline will correct the low sodium level caused by aldosterone deficiency in Addison's crisis. Sodium is essential for maintaining blood pressure, fluid balance, and nerve and muscle function. Dextrose 5% in normal saline will also increase the blood volume and prevent dehydration and shock.

Choice D reason:

This is partially correct because dextrose 5% in normal saline will increase the blood volume, but this is not the only solution that can do that. Other isotonic or hypertonic solutions can also expand the intravascular space. Dextrose 5% in normal saline is preferred in Addison's crisis because it also provides glucose and sodium, which are both deficient in this condition.

A. Decreased serum osmolarity. B. Increased urine specific gravity. C. Decreased serum bicarbonate level. D. Increased serum potassium level.

Correct Answer is A

Explanation

Choice A reason:

Decreased serum osmolarity. This is the correct answer because the goal of therapy for diabetic ketoacidosis (DKA) is to restore fluid and electrolyte balance, correct acidosis, and lower blood glucose levels. 0.45% sodium chloride (1/2 normal saline) is a hypotonic solution that helps to rehydrate the intracellular and extracellular compartments and reduce the serum osmolarity, which is elevated in DKA due to hyperglycemia and dehydration.

Choice B reason:

Increased urine specific gravity. This is incorrect because urine specific gravity reflects the concentration of solutes in the urine. In DKA, urine specific gravity is usually high due to osmotic diuresis caused by hyperglycemia and ketonuria. Effective therapy for DKA should lower the urine specific gravity as the blood glucose level and hydration status improve.

Choice C reason:

Decreased serum bicarbonate level. This is incorrect because serum bicarbonate level reflects the metabolic component of acid-base balance. In DKA, serum bicarbonate level is low due to increased production of ketoacids that consume bicarbonate as a buffer. Effective therapy for DKA should increase the serum bicarbonate level as the acidosis is corrected by insulin and fluid administration.

Choice D reason:

Increased serum potassium level. This is incorrect because serum potassium level is affected by several factors in DKA, such as insulin deficiency, acidosis, osmotic diuresis, and fluid therapy. In DKA, serum potassium level may be normal or high initially due to the shift of potassium from the intracellular to the extracellular space, but the total body potassium is depleted. Effective therapy for DKA should normalize the serum potassium level by replacing potassium losses and correcting the factors that cause potassium shift.

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A nurse is preparing to administer lactated Ringer's (LR) solution to a client who has hypovolemia due to third-space shifting. Which of the following actions should the nurse take? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

A client who has Addison's crisis is receiving dextrose 5% in normal saline intravenously. The client asks the nurse why this type of solution is used. Which of the following responses should the nurse give?

Correct Answer is C

Explanation

A nurse is reviewing the laboratory results of a client who has diabetic ketoacidosis (DKA) and is receiving 0.45% sodium chloride (1/2 normal saline) intravenously. Which of the following findings indicates that the therapy is effective?

Correct Answer is A

Explanation

A nurse is teaching a client who has diabetes mellitus about fluid and electrolyte balance. The nurse should instruct the client to increase fluid intake before, during, and after active exercise for which of the following reasons?

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?

A nurse is preparing to administer lactated Ringer's (LR) solution to a client who has hypovolemia due to third-space shifting. Which of the following actions should the nurse take? (Select all that apply.)