The nurse reviews prescriptions for assigned adult clients. Which prescription should the nurse question?

Question

The nurse reviews prescriptions for assigned adult clients.  Which prescription should the nurse question?

Quizplus · Accepted Answer

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is associated with increased water reabsorption and excessive intra- and extracellular fluid, which result in hypervolemia from fluid retention and dilutional hyponatremia. In the setting of SIADH, the nurse should question a prescription for a hypotonic solution (eg, 0.45% NaCl; or dextrose water) as it would worsen the fluid and electrolyte imbalance. A prescription for fluid restriction and a hypertonic IV solution (eg, 3% NaCl) administered in small quantities would be appropriate to shift fluid back into the vascular compartment and correct hyponatremia. (Option B) Isotonic fluids (eg, normal saline) are appropriate for clients with volume deficit such as those with gastrointestinal bleeding. (Option C) Septic shock involves an inflammatory response to pathogens that leads to massive vasodilation and increased capillary permeability, resulting in intravascular hypovolemia and severe hypotension. An isotonic solution (eg, 0.9% NaCl) bolus is prescribed to expand intravascular volume and increase blood pressure. (Option D) A burn injury causes tissue damage and increased capillary permeability; this leads to fluid and electrolyte losses related to evaporation and intravascular fluid shifts into the interstitial tissue, which result in hypovolemia, hemoconcentration (eg, hematocrit >53% [0.53]), and hypotension. An isotonic solution (eg, lactated Ringer's) is prescribed to replace fluid and electrolyte losses. Educational objective: Syndrome of inappropriate antidiuretic hormone secretion is associated with hypervolemia and dilutional hyponatremia. Fluid restriction and hypertonic IV solutions (eg, 3% saline) are prescribed to correct hyponatremia.

The Nurse Reviews Prescriptions for Assigned Adult Clients