A postoperative patient who had surgery for a perforated gastric ulcer has been receiving nasogastric suction for 3 days. The patient now has a serum sodium level of 127 mEq/L (127 mmol/L). Which prescribed therapy should the nurse question?
Administer IV morphine sulfate 4 mg every 2 hours PRN.
Dextrose 5% in 0.9% sodium chloride, continuous infusion.
Infuse 5% dextrose in water at 125 mL/hr.
Neurologic assessment Q2 hours.
The Correct Answer is C
Choice A reason: This statement is false. IV morphine sulfate is a pain medication that can be given as needed to the postoperative patient. It does not affect the serum sodium level.
Choice B reason: This statement is false. Dextrose 5% in 0.9% sodium chloride is a hypertonic solution that can be used to treat hyponatremia, or low serum sodium level. It provides both glucose and sodium to the patient.
Choice C reason: This statement is true. 5% dextrose in water is a hypotonic solution that can cause further dilution of the serum sodium level. It can worsen the hyponatremia and increase the risk of cerebral edema and seizures.
Choice D reason: This statement is false. Neurologic assessment Q2 hours is a necessary intervention for a patient with hyponatremia, as it can monitor for signs of neurologic deterioration such as confusion, lethargy, or coma.
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Related Questions
Correct Answer is D
Explanation
Choice A reason: Performing an in/out catheterization is not a suitable method to measure urine output for a 10-month old client with dehydration. An in/out catheterization is a procedure where a catheter is inserted into the bladder through the urethra, and the urine is drained and measured. This method is invasive, painful, and carries the risk of infection and trauma. It is usually reserved for clients who have urinary retention or obstruction, or who need a sterile urine sample.
Choice B reason: Inserting a Foley catheter is also not an appropriate method to measure urine output for a 10-month old client with dehydration. A Foley catheter is a type of catheter that stays in the bladder and drains the urine into a collection bag. This method is also invasive, painful, and carries the risk of infection and trauma. It is usually used for clients who have urinary incontinence, surgery, or long-term bed rest.
Choice C reason: Collecting the client's urine in a cup is not a feasible method to measure urine output for a 10-month old client with dehydration. A cup is not a reliable or accurate device to collect and measure urine, especially for a young child who may not be toilet trained or cooperative. It is also difficult to ensure that all the urine is collected in the cup, and that the cup is not contaminated by other fluids or substances.
Choice D reason: Counting the number of wet diapers is the best method to measure urine output for a 10-month old client with dehydration. This method is non-invasive, simple, and practical. It can provide an estimate of the urine volume and frequency, and indicate the hydration status of the child. The nurse should weigh the diapers before and after use, and record the difference in grams. One gram of weight equals one milliliter of urine. The nurse should also observe the color, odor, and concentration of the urine. The normal urine output for a child is 1 to 2 mL/kg/hour.
Correct Answer is D
Explanation
Choice A reason: This statement is false. Glucose: 88 mg/dL is a normal blood sugar level and does not indicate any problem with fluid or electrolyte balance.
Choice B reason: This statement is false. WBCs: 4,000 is slightly below the normal range, but not significantly low. It may indicate a mild infection or inflammation, but not a serious fluid or electrolyte imbalance.
Choice C reason: This statement is false. K+: 3.4 mEq/L is slightly below the normal range, but not dangerously low. It may indicate a mild potassium deficiency, which can cause muscle weakness, but not restlessness or agitation.
Choice D reason: This statement is true. Na+: 154 mEq/L is above the normal range and indicates hypernatremia, or high blood sodium level. This can cause dehydration, confusion, restlessness, agitation, and seizures. It is a medical emergency that requires immediate treatment. Continuous tube feedings can increase the risk of hypernatremia if the formula is too concentrated or the fluid intake is inadequate.
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