Fluids and electrolyte balance

A 72-year-old client on NG suctioning has sodium of 126 mEq/L. They are restless and complaining of a headache. What’s your priority action?

• Administer 3% NaCl IV as ordered

• Place the client in Trendelenburg

• Encourage free water intake

• Restrict fluids and monitor neuro status

Answer explanation

Severe symptomatic hyponatremia requires hypertonic saline to correct sodium and reduce risk of seizures.

A post-op client is on furosemide. They complain of muscle weakness and an irregular heartbeat. Labs: K⁺ 2.8 mEq/L. What intervention should the nurse anticipate?

• Administer IV potassium bolus over 5 minutes

• Give oral potassium supplement and monitor ECG

• Restrict dietary potassium

• Stop fluids immediately

Answer explanation

Oral or slow IV K⁺ replacement is appropriate; bolus IV K⁺ is dangerous (risk of arrhythmias).

A client with hypoparathyroidism develops tingling around the mouth and a positive Trousseau’s sign. What is the most urgent nursing action?

• Administer IV calcium gluconate
  

• Encourage weight-bearing exercise

• Increase fluid intake

• Place client on fluid restriction

Answer explanation

Symptomatic hypocalcemia can cause laryngospasm and seizures—IV calcium is priority.

What is the primary risk of administering fluids too rapidly?

• Dehydration

• Hypothermia

• Fluid overload

• Electrolyte imbalance

A client presents with sodium 155 mEq/L, dry mucous membranes, and confusion. Which fluid would you expect to administer?

• 0.9% NS
  

• D5W or 0.45% NS

• 3% NS

• Lactated Ringer’s bolus

Answer explanation

Hypotonic solutions (D5W, 0.45% NS) correct hypernatremia by diluting serum sodium.

A client with CKD has potassium 6.8 mEq/L and peaked T waves on ECG. What is the priority treatment?

• Give IV calcium gluconate
  

• Encourage potassium-rich foods

• Administer hypotonic fluids

• Stop dialysis

Answer explanation

IV calcium stabilizes cardiac membranes, preventing arrhythmias. Other measures (insulin/glucose, dialysis) follow.

While planning care for elderly individuals, the nurse remembers the elderly are at a higher risk for developing dehydration because they have a(n):

• Higher total body water volume

• Decreased muscle mass

• Increase in thirst

• Increased tendency towards developing edema

Electrolytes are the same as ____ in the body.

• electrical movement

• salts

• carbohydrates

• sweat

Loop diuretics like furosemide increase excretion of _____ and _____, which can lead to muscle weakness and arrhythmias.

A U wave on the ECG is a classic sign of _____.