Upon auscultation of a client's heart rate, the nurse notes the rate to have an irregular pattern of 72 bpm. The nurse notifies the health care provider because the client is exhibiting signs of:

Choice A reason: Sodium 138 mEq/L (normal 135-145 mEq/L) is within normal range. Sodium regulates osmotic balance and nerve conduction. Normal levels do not explain tremors, which are often linked to neurological or electrolyte imbalances, like low magnesium. In the context of acute tremors, sodium is not a concern compared to magnesium deficiency.

Choice B reason: Chloride 100 mEq/L (normal 98-106 mEq/L) is normal and does not contribute to tremors. Chloride supports acid-base balance and neuronal inhibition via GABA receptors. Tremors are more likely caused by low magnesium, which affects neuromuscular excitability. Normal chloride levels do not warrant concern in this acute neurological presentation.

Choice C reason: Potassium 4.1 mEq/L (normal 3.5-5.0 mEq/L) is normal and unlikely to cause tremors. Potassium regulates membrane potential and muscle contraction. Tremors are more associated with magnesium deficiency, which increases neuronal excitability. Normal potassium does not explain the neurological symptoms, making it a lower priority than magnesium in this scenario.

Choice D reason: Magnesium 1.0 mEq/L (normal 1.7-2.2 mEq/L) indicates hypomagnesemia, which causes tremors by increasing neuromuscular excitability. Magnesium stabilizes neuronal membranes and regulates calcium channels. Low levels disrupt nerve signaling, leading to tremors and potential seizures. This critical imbalance requires urgent correction, making it the most concerning lab value in this scenario.

Choice A reason: Reporting only the exact intake to the physician’s nurse is incomplete, as fluid status requires balancing intake with output. Intake alone does not indicate hydration or overload, risking misinformed decisions. Comparing intake and output provides a full picture, per fluid balance assessment principles.

Choice B reason: Comparing total intake and output over 24 hours accurately assesses fluid status, as it reveals imbalances like dehydration (output > intake) or retention (intake > output). This guides interventions, ensuring proper fluid management, aligning with physiological monitoring and clinical assessment standards.

Choice C reason: Comparing intake to a normal range is useful but insufficient without output data. Normal intake varies, and fluid status depends on balance. This approach misses output-related issues like oliguria, reducing its accuracy for assessing hydration, per fluid and electrolyte management guidelines.

Choice D reason: Including intake in verbal reports is important but does not directly assess fluid status. Comparison of intake and output is needed to evaluate balance, guiding clinical decisions. Reporting alone risks overlooking imbalances, per nursing documentation and fluid assessment protocols.