Practice Question
During a change-of-shift report, a nurse sees that a client’s IV bag of 0.9% sodium chloride has 909 mL of fluid left in it. The nurse makes rounds 30 min later and notes that the IV bag is empty. Which of the following actions should the nurse take?
Answer Choices:
Correct Answer:
Check the client’s respiratory rate and lung sounds
Rationale:
🟢 The IV bag running out quickly could indicate fluid overload, especially in clients with compromised cardiac or renal function.
🟢 Signs of fluid overload include dyspnea, tachypnea, and crackles in the lungs.
🟢 Monitoring lung sounds and respiratory rate will help assess if the client is developing pulmonary edema or if the rapid infusion is affecting their respiratory function.
🟢 If signs of fluid overload are present, the nurse should slow or stop the IV infusion and inform the healthcare provider for further evaluation.
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This question is from NUR 133~Acid-base & Electrolytes Exam 2 which contains 74 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: Fluids and Electrolytes
- Answer Choices: 4