The nurse is caring for a client with a diagnosis of hypervolemia. Which intervention is the priority for the nurse to implement?

Choice A reason: Administering medications that promote fluid retention, like vasopressin, worsens hypervolemia by increasing water reabsorption, exacerbating edema and hypertension. This is contraindicated, as the goal is fluid removal, making this an incorrect intervention for managing excess fluid volume in hypervolemia.

Choice B reason: Administering diuretics is the priority in hypervolemia, promoting renal excretion of excess fluid, reducing edema, pulmonary congestion, and hypertension. Diuretics like furosemide correct fluid overload, preventing complications like heart failure exacerbation, making this the most critical intervention for immediate fluid management.

Choice C reason: Encouraging increased fluid intake worsens hypervolemia by adding to excess fluid, increasing pulmonary edema and heart failure risks. The goal is to remove fluid, not add it, making this inappropriate compared to diuretics, which directly address fluid overload in this condition.

Choice D reason: Monitoring daily weights tracks fluid status but is not an intervention. While useful for assessing treatment response, it does not reduce fluid volume like diuretics, which prevent complications, making weight monitoring a supportive, not primary, action in hypervolemia management.

Choice A reason: Lactated Ringer’s (130 mEq/L sodium) is isotonic but insufficient for severe hyponatremia (120 mEq/L). It may worsen fluid overload without rapidly raising sodium, risking neurological complications like seizures, making it inappropriate for urgent correction compared to hypertonic saline.

Choice B reason: Dextrose 5% in 0.9% sodium chloride (154 mEq/L sodium) is isotonic but inadequate for severe hyponatremia. It raises sodium slowly, risking persistent neurological symptoms. Hypertonic saline (3%) corrects sodium faster, preventing complications like cerebral edema, making this a less effective choice.

Choice C reason: 0.45% sodium chloride (77 mEq/L sodium) is hypotonic, worsening hyponatremia by diluting serum sodium. This exacerbates neurological risks like seizures in a client with 120 mEq/L, making it an incorrect choice for correcting severe hyponatremia compared to hypertonic saline.

Choice D reason: 3% sodium chloride (513 mEq/L sodium) is hypertonic, ideal for correcting severe hyponatremia (120 mEq/L). It raises sodium gradually, preventing seizures or cerebral edema. Careful administration avoids rapid correction risks like osmotic demyelination, making it the appropriate choice for this client’s condition.