A nurse working on a surgical unit is developing a care plan for a client who has paraplegia. The client has an area of nonblanchable erythema over his ischium. Which of the following interventions should the nurse include in the care plan?

Choice A reason: Hypernatremia is unlikely with 0.45% sodium chloride, a hypotonic solution that dilutes serum sodium. Over-infusion risks hyponatremia, not high sodium levels. Monitoring for hypernatremia is inappropriate, as the solution’s low sodium content does not contribute to elevated sodium in fluid therapy.
Choice B reason: Assessing for fluid overload is essential, as 0.45% sodium chloride, being hypotonic, can cause water to shift into cells, risking pulmonary or cerebral edema. This is critical in clients with renal or cardiac issues, where monitoring for dyspnea or swelling ensures safe fluid administration.
Choice C reason: Hypoglycemia is not directly linked to 0.45% sodium chloride, which affects fluid and electrolytes, not glucose. Fluid shifts may indirectly stress metabolism, but hypoglycemia relates to fasting or insulin issues, making this an inappropriate focus for monitoring in this fluid therapy context.
Choice D reason: Dehydration is unlikely, as 0.45% sodium chloride provides free water, promoting hydration. It corrects hypernatremia or replaces fluid losses. Evaluating for dehydration is unnecessary unless infusion is inadequate or losses persist, which is not indicated in the context of this hypotonic solution.

Choice A reason: Using three-pronged grounded plugs ensures proper grounding, reducing the risk of electrical fires by safely dissipating excess current. This prevents shocks and short circuits, aligning with National Fire Protection Association (NFPA) standards. Grounded plugs are essential for safe appliance use, making this a critical recommendation for fire prevention education.
Choice B reason: Checking for a tingling sensation around a cord is not a reliable or safe method for fire prevention. Tingling may indicate electrical faults, but proactive measures like inspecting cords for fraying or overheating are more effective. This approach is reactive and risky, as it does not prevent fires, making it inappropriate.
Choice C reason: Covering extension cords with a rug traps heat and increases wear, raising the risk of electrical fires. Cords should be exposed to air and placed to avoid damage or tripping hazards. This practice violates safety guidelines, as it conceals potential issues, making it an incorrect recommendation for fire prevention.
Choice D reason: Removing a plug by pulling the cord can damage insulation or wiring, increasing fire risk due to exposed conductors or short circuits. Plugs should be grasped firmly at the base to remove safely. This action is unsafe and contradicts electrical safety standards, making it an incorrect teaching point.