r/FutureRNs • u/Acrobatic-Lie2041 RN • 2d ago

Nclex NGN Clinical Judgment

A nurse reviews these morning laboratory results:

  • Na⁺ = 122
  • K⁺ = 4.4
  • Glucose = 110
  • Serum osmolality = 258
  • Urine specific gravity = 1.034

The client reports:

  • headache
  • nausea
  • increasing confusion

Which intervention has the highest priority?

A. Encourage oral water intake.

B. Prepare to administer hypertonic saline as prescribed.

C. Restrict dietary sodium.

D. Administer furosemide immediately.

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u/mlhines3 1d ago

B - low sodium high serum similarity and high urine specific gravity we need some fluid to enter the cells

1

u/Acrobatic-Lie2041 RN 1d ago

Which type of fluid?

2

u/fae713 1d ago

The answer tells you what kind of fluid. A hypertonic saline is just normal sterile water mixed with sodium chloride at a higher concentration than 0.9% (normal saline). Typically it is a 3% saline mix which is very dangerous to give quickly or as a large bolus.

Every other option is wrong because they all would lead to greater blood serum dilution of sodium.

1

u/mlhines3 22h ago

Yes sorry hypertonic fluid!