The nurse is caring for a client with a medical diagnosis of increased intracranial pressure. Which IV fluid order should the nurse accept without questioning?
1. Normal saline at 125 mL/hour.
2. Dextrose 5% and water at 80 mL/hour.
3. Dextrose 5% and 0.45% NaCl at 75 mL/hour.
4. Normal saline 0.45% at 200 mL/hour.
3
Rationale 1: Isotonic and hypotonic fluids should not be administered to clients with increased intracranial pressure, because they increase the risk of cerebral edema. Normal saline is an isotonic solution and would need to be questioned.
Rationale 2: Isotonic and hypotonic fluids should not be administered to clients with increased intracranial pressure, because they increase the risk of cerebral edema. D5W is an isotonic solution and would need to be questioned.
Rationale 3: Isotonic and hypotonic fluids should not be administered to clients with increased intracranial pressure, because they increase the risk of cerebral edema. D5 in one-half normal saline is hypertonic, and would be an acceptable IV solution for this client.
Rationale 4: Isotonic and hypotonic fluids should not be administered to clients with increased intracranial pressure, because they increase the risk of cerebral edema. Half-normal saline is hypotonic and would not be advisable for this client.
Global Rationale: Isotonic and hypotonic fluids should not be administered to clients with increased intracranial pressure, because they increase the risk of cerebral edema. D5 in one-half normal saline is hypertonic, and would be an acceptable IV solution for this client. Normal saline and D5W are isotonic solutions, and so would need to be questioned. Half-normal saline is hypotonic, and so would not be advisable for this client.
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