A 48-year-old client is in the surgical intensive care unit after having had three-vessel coronary artery bypass surgery yesterday. She is extubated, awake, alert and talking. She is receiving digitalis for atrial arrhythmias. This morning serum electrolytes were drawn. Which abnormality would require immediate intervention by the nurse after contacting the physician?
- Serum osmolality is elevated indicating hemoconcentration.The nurse should increase IV fluid rate.
- Serum sodium is low. The nurse should change IV fluids to normal saline.
- Blood urea nitrogen is subnormal. The nurse should increase the protein in the client's diet as soon as possible.
- Serum potassium is low. The nurse should administer KCl as ordered.
Answer(s): D
Explanation:
(A) An elevated serum osmolality poses no immediate danger and is not corrected rapidly. (B) A low serum sodium alone does not warrant changing IV fluids to normal saline. Other assessment parameters, such as hydration status, must be considered. (C) A low serum blood urea nitrogen is not necessarily indicative of protein deprivation. It may also be the result of overhydration. (D)A low serum potassium potentiates the effects of digitalis, predisposing the client to dangerous arrhythmias. It must be corrected immediately.
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