4. An elderly client, who has had a stroke, is receiving full-strength tube feedings of 75 mL/hr, and an IV of D5 ½NS at 50 mL/hr. The Na+ level is 150. Which action should be taken by a nurse?
4. An elderly client, who has had a stroke, is receiving full-strength tube feedings of 75 mL/hr, and an IV of D5 ½NS at 50 mL/hr. The Na+ level is 150. Which action should be taken by a nurse?
. The IV should be changed to a higher Na+ content such as D5NS.
. The rate of the IV should be slowed.
. Tap water should be given through the feeding tube.
. A diuretic should be given.
Test-Taking Tip
Eliminate the two answers that focus on the IV (Answers 1 and 2). Recognize the effects of tube feedings on fluid and electrolyte levels.
Content Area: Geriatrics, Fluid and Electrolyte Imbalances; Integrated Process: Nursing Process, Implementation; Cognitive Level: Application; Client Need/Subneed: Physiological Integrity/Pharmacological and Parenteral Therapies/Parenteral/Intravenous Therapies
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Answer 1 is incorrect because the serum sodium is high. The client needs relatively more water and less sodium. Answer 2 is incorrect because slowing the IV rate would contribute to dehydration and raise the serum sodium further. Answer 3 is correct because hypernatremia can result from the solute load in tube feedings. Additionally, the IV contains normal saline, which could be removed. The client needs free water to dilute the sodium level down. The enteral route is appropriate for this delivery. Answer 4 is incorrect because a diuretic would contribute to dehydration and raise the serum sodium further.