A nurse is caring for 4 clients. Which prescription by the health care provider would the nurse question and seek further clarification before administering?
A)0)45% sodium chloride solution for a client with severe gastroenteritis who had 12 episodes of diarrhea and vomiting in the past 4 hours
B)IV bolus of 1000 mL 0.9% sodium chloride solution for a client in anaphylaxis due to a food allergy
C)IV bolus of 1000 mL 0.9% sodium chloride solution for a client with diabetic ketoacidosis who has a serum glucose level of 650 mg/dL (36.1 mmol/L)
D)IV mannitol 25% solution for a client with a closed head injury who is exhibiting signs of increased intracranial pressure

Question

A nurse is caring for 4 clients.  Which prescription by the health care provider would the nurse question and seek further clarification before administering?
A)0)45% sodium chloride solution for a client with severe gastroenteritis who had 12 episodes of diarrhea and vomiting in the past 4 hours
B)IV bolus of 1000 mL 0.9% sodium chloride solution for a client in anaphylaxis due to a food allergy
C)IV bolus of 1000 mL 0.9% sodium chloride solution for a client with diabetic ketoacidosis who has a serum glucose level of 650 mg/dL (36.1 mmol/L)
D)IV mannitol 25% solution for a client with a closed head injury who is exhibiting signs of increased intracranial pressure

Quizplus · Accepted Answer

The nurse should question the administration of a hypotonic IV solution (ie, 0.45% sodium chloride) to replace gastrointestinal tract fluid losses as this would create a concentration gradient and shift fluid out of the intravascular compartment into the interstitial tissue and cells, worsening the client's fluid volume deficit. Isotonic IV solutions (eg, 0.9% sodium chloride, lactated Ringer's) have the same osmolality as plasma and are administered to expand intravascular fluid volume. These solutions replace fluid losses commonly associated with vomiting and diarrhea, burns, and traumatic injury. (Option B) Anaphylaxis causes increased capillary permeability, leaking intravascular fluid into free spaces; this places the client at risk for hypotension. Therefore, isotonic solutions should be given to such clients. (Option C) Extreme hyperglycemia in a client with diabetic ketoacidosis results in osmotic diuresis and dehydration. The immediate initial treatment is IV fluid resuscitation with isotonic 0.9% sodium chloride to replace fluid losses, stabilize vital signs, reestablish urine output, and dilute the serum glucose concentration before initiating insulin therapy. (Option D) A client with head trauma is at risk for increased intracranial pressure due to inflammation and cerebral edema. IV mannitol is an osmotic diuretic that reduces cerebral edema by pulling water from the cerebral cells into the vasculature. Educational objective: Isotonic IV solutions, which have the same osmolality as plasma, are administered to expand intravascular fluid volume and replace the fluid losses commonly associated with vomiting and diarrhea, burns, and traumatic injury.

A Nurse Is Caring for 4 Clients