Test-Taking Tip

The variables to look at for inclusion are: dextrose, NS, KCl, and at a moderate rate. Consider the effect the solution will have on the laboratory values.

Content Area: Adult Health, Fluid and Electrolyte Imbalances; Integrated Process: Nursing Process, Implementation; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Pharmacological and Parenteral Therapies/Parenteral/Intravenous Therapies

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Pre-Test 1 and 2: Introduction to Special Questions Based on Official NCLEX-RN[®]

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Answer 1 is incorrect because when the sugar of D₁₀W is metabolized, free water remains. At a rate of 150 mL/hr, this would further decrease the serum sodium. Answer 2 is incorrect because, although the fluid rate and potassium in this order are reasonable, the ¼ normal saline (NS) contains relatively more free water than normal saline does, which would decrease the serum sodium further. Clients who are NPO generally need an energy source order as dextrose. Answer 3 is incorrect because the rate is a little slow for normal fluid balance, but could be acceptable if the client was in fluid overload. A client needs potassium, which is not present in this IV. ¼ NS would dilute the serum sodium further. Answer 4 is correct because the client needs potassium, which cannot be replaced with enteral feedings. Fluids are needed when NPO, but the low serum sodium should not be further diluted with rapid administration of hypotonic solutions; thus, normal saline is appropriate. Even though the blood sugar is slightly elevated, it is appropriate to give clients who are NPO some energy source. Dextrose 5% contains only 17 calories/100 mL.

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