Sodium-Na (Hypernatremia, Hyponatremia)
Question 5 of 10 A nurse is caring for a client who had blood drawn for laboratory work. The client's sodium level is 142 mEq/L. Which nursing intervention is most appropriate? Administer diphenhydramine as ordered Contact the provider for an order for vasopressin Increase the IV rate to counteract the effects Document the result and continue to monitor
Andwer :D Document the result and continue to monitor Serum sodium is measured as part of an electrolyte panel. A clients sodium level indicates an appropriate balance between fluid and electrolytes in the body. A normal sodium level is between 135 and 145 mEq/L. This client's results are within normal limits so the nurse should continue to monitor. Increase the IV rate to counteract the effects This is an inappropriate actions because the sodium level is normal. Administer diphenhydramine as ordered This is an inappropriate actions because the sodium level is normal. Contact the provider for an order for vasopressin This is an inappropriate actions because the sodium level is normal.
A nurse is caring for a client who is recovering from surgery. The client has developed a headache, muscle weakness, and mental status changes. The nurse notes that the client's glucose level is 85 mg/dL, sodium is 126 mEq/L, potassium is 4.8 mEq/L and calcium is 8.6 mg/dL. What intervention is most appropriate for the nurse to perform in this situation? Administer 3% sodium chloride solution Give potassium chloride in 5% dextrose Offer the client a drink containing glucose Administer calcium supplements orally
Answe A Administer 3% sodium chloride solution This client is showing signs of hyponatremia, as well as lab values that reflect a low sodium level. A client with hyponatremia can develop symptoms that include skeletal muscle weakness, headache, confusion, hyperactive bowel sounds, nausea, abdominal cramping, increased urinary output, and dry mucous membranes. The nurse would most likely administer a hypertonic solution that contains extra sodium, such as 3% sodium chloride. Give potassium chloride in 5% dextrose This is a treatment for hypokalemia, not hyponatremia. Offer the client a drink containing glucose The client does not have a low blood glucose level. Administer calcium supplements orally The client's calcium level is normal.
A client has developed hyponatremia as a result of syndrome of inappropriate anti-diuretic hormone. Which type of IV fluid would the nurse most likely administer? 0.45% NS D5W 3% Normal saline 0.9% NaCl
Answee C 0.9% NaCl This is not a type of hypertonic solution. D5W D5W is administered for hypernatremia because it is a hypotonic solution. It should not be administered for hyponatremia. 0.45% NS 0.45% NS is a hypotonic solution. A person with hyponatremia needs a hypertonic solution instead. 3% Normal saline When a client has developed hyponatremia, he has a low level of sodium in the bloodstream. The nurse can increase sodium levels in circulation by providing hypertonic IV fluids. In this case, 3% Normal saline is a hypertonic solution can help raise sodium levels. Generally, water restrictions are put in place to aid in correction of hyponatremia.
The nurse is caring for a client who takes a diuretic for heart failure. The nurse is assessing the client and notes confusion, muscle weakness, and diminished deep tendon reflexes. The nurse checks the client's lab values. Which of the following lab values is consistent with this client's symptoms? Na 121 mEq/L Mg 1.6 mg/dL K 7.1 mEq/L Ca 10.8 mg/dL
Answer : a K 7.1 mEq/L Hyperkalemia presents as a weak, irregular pulse, muscle twitching, cramps, and increased GI motility, but not confusion. Ca 10.8 mg/dL Hypercalcemia presents as increased heart rate, hypertension, bounding pulses, skeletal muscle weakness, diminished deep tendon reflexes, and decreased motility. While hypercalcemia can cause confusion, a calcium level of 10.8 mg/dL is considered mild and usually results in no symptoms. Mg 1.6 mg/dL This is a normal magnesium level so it would not cause symptoms. Na 121 mEq/L This client is demonstrating signs and symptoms of hyponatremia. These include a rapid pulse that is thready or bounding depending on fluid status, weak respirations, skeletal muscle weakness, diminished deep tendon reflexes, confusion, headache, and increased GI motility.
A client with hypotension is in the emergency department being evaluated. The client's sodium level has come back at 148 mmol/L. What interventions by the nurse would be most appropriate? Select all that apply. Encourage water intake Perform neurological assessments at least every 4 hours Encourage the client to use incentive spirometry Limit oral intake of sodium Administer hypertonic solution IV as ordered
Answer A,B, D Administer hypertonic solution IV as ordered A hypotonic solution, such as 0.45% Normal Saline (referred to as 1/2 NS) is an example of a fluid that can improve hypernatremia if administered. ✅Perform neurological assessments at least every 4 hours Hypernatremia occurs when there is excess sodium in the bloodstream, with a serum sodium level greater than 145 mmol/L. Symptoms for the client with hypernatremia include mental status changes, skeletal muscle twitching, weakened muscles and decreased deep tendon reflexes. ✅Limit oral intake of sodium This client has a high sodium level, so their sodium intake should be limited to prevent worsening hypernatremia. Encourage the client to use incentive spirometry Incentive spirometry is to exercise the lungs and does not affect serum electrolyte levels. ✅Encourage water intake The goal for the client with hypernatremia is to lower their sodium level slowly. This is done by administering a hypotonic IV solution to increase fluid volume, administer diuretics, limit oral intake of sodium, and encouraging the client to drink water.
A nurse is caring for a client is being treated for SIADH with 3% hypertonic saline to correct a serum sodium of 129 mEq/L, which was drawn approximately 24 hours ago. A new BMP shows the latest sodium is 147 mEq/L. What is the priority nursing intervention at this time? Notify MD; anticipate additional dosing of hypertonic saline Administer ordered supplemental sodium tablets as scheduled Notify MD; perform detailed neuro assessment Nothing at this time; this is a desired response
Answer C Notify MD; perform detailed neuro assessment Over-correction of serum sodium (more than an increase of 12 mEq/L in 24 hours) is concerning for central pontine myelinolysis, or CPM. This can result in profound neurological complications, and even death. The MD should be notified, as they will most likely discontinue the 3% hypertonic saline due to the risk of developing CPM. Notify MD; anticipate additional dosing of hypertonic saline The MD should be notified, but the nurse should anticipate the hypertonic saline will be STOPPED or at least decreased because the sodium level is increasing too quickly. Nothing at this time; this is a desired response This is inappropriate. The MD needs to be notified because the client is at risk for neurologic injury due to the sodium being overcorrected. Administer ordered supplemental sodium tablets as scheduled This would be inappropriate because it would increase the sodium levels even further. The sodium replacement needs to be slowed or stopped at this time.
The nurse is caring for a client with a sodium level of 125 mEq/L. The client was previously alert, oriented, and ambulatory. The nurse notes that this client can no longer lift his arms and is beginning to demonstrate erratic behavior, such as attempting to climb out of bed. Which of the following medications does the nurse anticipate giving this client? Hydrochlorothiazide Indapamide Haloperidol Mannitol
Answer D Mannitol This client has severe, symptomatic hyponatremia. The nurse will anticipate giving an osmotic diuretic such as mannitol, to rid the body of excess fluid while retaining sodium. Indapamide Indapamide is a thiazide diuretic. This class of diuretics can cause hyponatremia, which means it would be contraindicated for this client. Hydrochlorothiazide Hydrochlorothiazide is a thiazide diuretic. Thiazide diuretics are a common cause of hyponatremia. Since this client's issue is hyponatremia, giving a thiazide diuretic would further lower the sodium level, which would worsen the situation. Haloperidol Haloperidol is an antipsychotic medication. While this client is demonstrating erratic behavior, the nurse would not anticipate giving an antipsychotic. Haloperidol can worsen hyponatremia. Additionally, rather than administering a drug to control this client's behavior, lesser invasive interventions are utilized first, such as obtaining a sitter to keep this client safe.
The nurse is receiving report on a client with severe hypernatremia. The nurse anticipates which of the following findings upon assessment of this client? Select all that apply. Dry mouth Muscle twitching Diarrhea Agitation Seizures
Answer: A,B,D ✅Agitation Agitation, irritability and crankiness are signs of hypernatremia. This occurs because of cellular dehydration in brain cells. ✅Dry mouth Hypernatremia leads to dehydration, so the nurse will anticipate findings related to dehydration upon assessment of this client. Dry mouth, increased skin turgor, thirst, and decreased urine output are a few anticipated findings due to dehydration. ✅Muscle twitching Muscle twitching and cramps are an expected finding in a client with symptomatic hypernatremia. Seizures Seizures are a sign of hyponatremia. This occurs as a result of cerebral edema. Diarrhea Diarrhea usually occurs with hyponatremic clients due to increased GI motility. The client with hypernatremia is more likely to have constipation than diarrhea.
Question 4 of 10 A client presents to the emergency department with suspected heat stroke. Lab values reveal a sodium level of 152 mEq/L. Which of the following orders does the nurse anticipate? Insulin infusion at 2 units/hr 0.45% NS IV at 50 cc/hr 3% NS IV at 250 cc/hr LR IV 1000 bolus
Answer: b 0.45% NS IV at 50 cc/hr This client is hypernatremic. Half normal saline is an appropriate fluid for replacement for this client. The fluid must be replaced slowly to avoid overcorrection of the hypernatremia. LR IV 1000 bolus LR is an appropriate IV fluid replacement for a client with hypernatremia. However, the fluid must be given slowly. A bolus puts the client at risk for overcorrection, leading to hyponatremia and risk of seizures. 3% NS IV at 250 cc/hr A hypernatremic client should not be given 3% NS, because this IV fluid will further increase the client's sodium level. Insulin infusion at 2 units/hr Insulin would not be helpful to manage this client's hypernatremia.
A patient has developed hypernatremia as a result of TPN use. Which of the following signs or symptoms would the nurse see with this situation? Select all that apply. Bloating Dry skin Decreased urine output Thirst Vomiting
Answe ✅Thirst Hypernatremia is a state of excess sodium which can develop as a result of TPN administration. The patient who receives TPN is at risk of electrolyte imbalance like hypernatremia s/s of thirst. ✅Decreased urine output This is one of the s/s of hypernatremia. Bloating This is not symptom of hypernatremia. ✅Dry skin Hypernatremia will also manifest dryness of skin. Vomiting This is not symptom associated with hypernatremia.
