The health care provider has ordered a hypotonic intravenous (IV) solution to be administered. Which IV bag will the nurse prepare?

0.9% sodium chloride (NS)

0.45% sodium chloride (1/2 NS)

Dextrose 5% in Lactated Ringer's (DSLR)

Lactated Ringer's (LR)

Answer and Explanation

The Correct Answer is B

A.   0.9% sodium chloride, also known as Normal Saline, is an isotonic solution. It has the same concentration of solutes as blood plasma, which means it does not change the cell's fluid volume but rather maintains it. It is not considered hypotonic.

B.   0.45% sodium chloride, commonly known as Half Normal Saline, is a hypotonic solution. It has a lower concentration of sodium chloride compared to the normal saline and is used to provide hydration and to help correct electrolyte imbalances by allowing water to move into the cells.
C.   Dextrose 5% in Lactated Ringer's is not a hypotonic solution. It is actually a type of hypertonic solution. Initially, dextrose 5% is isotonic, but once the dextrose is metabolized, the solution becomes hypotonic due to the electrolyte content of Lactated Ringer’s. However, the classification is generally based on the solution before metabolism, and it is not commonly used as a hypotonic solution.
D.   Lactated Ringer's solution is an isotonic solution. It contains electrolytes in concentrations similar to those found in the body's plasma, and it is used to restore fluids and electrolytes. It does not have a hypotonic effect on cells.

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Correct Answer is D

Explanation

A. Metabolic acidosis is characterized by a primary decrease in bicarbonate (HCO₃⁻) levels, which is not typically a direct result of COPD. However, if a patient with COPD has an additional condition like kidney failure or severe sepsis, they could potentially develop metabolic acidosis. But, this is not the primary concern in COPD.
B. Respiratory alkalosis is caused by hyperventilation, where there is excessive loss of CO₂ leading to an increase in blood pH. This is less common in COPD patients, as they typically have difficulty exhaling CO₂ rather than hyperventilating.
C. Metabolic alkalosis involves an increase in blood pH due to elevated bicarbonate levels or loss of acid. This is not typically associated with COPD, unless there is an unrelated condition causing metabolic alkalosis.
D. COPD is characterized by impaired airflow and reduced ability to expel carbon dioxide (CO₂) effectively. As CO₂ accumulates in the blood, it combines with water to form carbonic acid, which lowers the blood pH, leading to respiratory acidosis.

A. Increase sodium intake. B. Infuse hypotonic IV fluids. C. Administer sodium polystyrene sulfonate. D. Implement a fluid restriction.

Correct Answer is B

Explanation

A. Increasing sodium intake would exacerbate hypernatremia, not correct it. Hypernatremia is characterized by an excess of sodium in the blood, so the goal of treatment is to lower sodium levels, not increase them.
B. Infusing hypotonic IV fluids, such as 0.45% NaCl or D5W (5% dextrose in water), helps to dilute the high sodium concentration in the blood and can assist in correcting hypernatremia. Hypotonic fluids move water into cells and help balance the sodium levels by promoting hydration and lowering the sodium concentration.
C. Sodium polystyrene sulfonate (Kayexalate) is used to treat hyperkalemia (elevated potassium levels), not hypernatremia. It works by exchanging potassium for sodium in the gastrointestinal tract and would not address hypernatremia.
D. Implementing a fluid restriction is generally not the best approach for treating hypernatremia. In fact, fluid restriction could worsen hypernatremia by limiting the client's fluid intake and not addressing the sodium imbalance. The primary goal in hypernatremia is usually to rehydrate the patient with appropriate fluids.

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The health care provider has ordered a hypotonic intravenous (IV) solution to be administered. Which IV bag will the nurse prepare?

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Correct Answer is B

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