The physician orders 1.5 liters of Lactated Ringers solution to be administered intravenously to a client over the next 12 hours.

Calculate the rate of flow if the intravenous (IV) tubing delivers 20 drops per milliliter (gtts/mL). Round to the nearest whole number.

Write the numerical value only.

Choice A rationale

Sodium is the primary cation found in the extracellular fluid and plays a critical role in maintaining osmotic pressure and fluid volume. The normal serum sodium range is 135 to 145 mEq/L. Because water follows sodium, it is the most significant factor in determining the distribution of water between the intracellular and extracellular compartments. It is essential for nerve impulse transmission and muscle contraction, and its concentration is tightly regulated by the kidneys and hormones like aldosterone.

Choice B rationale

Potassium is the most abundant cation in the intracellular fluid, not the extracellular fluid. The normal serum range for potassium is 3.5 to 5.0 mEq/L, which is much lower than the sodium concentration in the blood. While its extracellular concentration is small, it is vital for maintaining the resting membrane potential of cells, particularly in cardiac and skeletal muscle. Small shifts in extracellular potassium can have profound effects on heart rhythm, but it remains predominantly an intracellular electrolyte.

Choice C rationale

Calcium is a vital electrolyte for bone health, blood coagulation, and neuromuscular signaling, but it is not the most abundant in the extracellular fluid. The normal total serum calcium range is approximately 8.5 to 10.5 mg/dL. Most of the body's calcium is stored in the skeletal system rather than circulating in the plasma or interstitial fluid. While its presence in the extracellular fluid is crucial for physiological functions, its molar concentration is significantly lower than that of sodium.

Choice D rationale

Magnesium is the second most abundant intracellular cation after potassium and is involved in hundreds of enzymatic reactions, including protein synthesis and DNA repair. The normal serum magnesium range is 1.3 to 2.1 mEq/L. Although it is present in the extracellular fluid and is necessary for cardiovascular and neuromuscular health, its concentration is relatively low compared to sodium. It does not exert the same level of osmotic pull or represent the majority of the extracellular solute load.

Choice A rationale

Recommending the avoidance of bananas and apples is counterproductive for a client suffering from diarrhea. These specific fruits are actually part of the BRAT diet, which stands for bananas, rice, applesauce, and toast. These foods are low in fiber and help bind the stool, making them beneficial during recovery. Restricting them removes a potential source of potassium and pectin, which help stabilize the gut. Fiber management is essential for maintaining normal electrolyte and fluid balance.

Choice B rationale

Encouraging a clear liquid diet is the primary intervention to prevent dehydration, which is the most severe complication of diarrhea. Clear liquids such as broth, gelatin, and electrolyte replacement drinks provide essential hydration without overtaxing the gastrointestinal tract. This approach allows the bowel to rest while ensuring the client receives necessary fluids. Maintaining hydration is critical because excessive water loss leads to hypotension and electrolyte imbalances, where normal sodium levels are 135 to 145 mEq/L.

Choice C rationale

Offering solid foods like vegetables and beans is inappropriate during an acute episode of diarrhea. These foods are typically high in insoluble fiber and complex carbohydrates, which can increase gas production and stimulate further peristalsis. This mechanical stimulation can worsen the frequency of stools and increase abdominal cramping. The gut requires a period of rest and easily digestible nutrients rather than bulky roughage. Reintroducing these foods should only happen once the stool consistency begins to normalize.

Choice D rationale

Helping the client lie flat in a supine position does not directly treat or prevent complications related to diarrhea. In fact, if the client is experiencing nausea or vomiting alongside diarrhea, lying flat could increase the risk of aspiration. While rest is important, position changes do not address the physiological need for fluid replacement or bowel rest. Nursing care should focus on metabolic stability and skin integrity rather than a specific supine position, which provides no therapeutic benefit.