During a period of extreme excess fluid volume, a renal dialysis patient may be administered which type of IV solution to shrink the swollen cells by pulling water out of the cell?

Correct Answer: C

Rationale: The correct answer is C: 3% sodium chloride. In extreme excess fluid volume, a hypertonic solution like 3% sodium chloride is used to shrink swollen cells by creating an osmotic gradient that pulls water out of the cells. This solution has a higher concentration of solutes than the intracellular fluid, causing water to move out of the cells and into the bloodstream. Explanation for other choices: A: 0.9% sodium chloride is isotonic and would not pull water out of the cells. B: 5% dextrose and water is isotonic and would not cause water movement out of the cells. D: Lactated Ringer solution is isotonic and would not lead to water leaving the swollen cells.

Correct Answer: A

Rationale: Rationale for Correct Answer A (Your potassium level is high, and so I need you to let me know if you feel numbness, tingling, or weakness): 1. Acknowledges the high potassium level directly. 2. Provides specific symptoms related to hyperkalemia. 3. Encourages client involvement in monitoring and reporting symptoms promptly. Summary of Incorrect Answers: B: Mentions brain function changes, which is not a primary concern with elevated potassium levels. C: Focuses on heart-related symptoms only, missing other important symptoms of hyperkalemia. D: Suggests resolving high potassium levels solely through IV fluid changes, which is not always sufficient.

Correct Answer: A

Rationale: The correct answer is A: Administer oral rehydration salts. This is the most immediate course of action because the runner is likely experiencing dehydration and electrolyte imbalance due to the hot and humid climate. Oral rehydration salts will help replenish lost fluids and electrolytes quickly. Providing plain water (choice B) may not be sufficient to address the electrolyte imbalance. Beginning intravenous fluid therapy (choice C) is not necessary at this stage unless the runner is in severe condition. Cooling the patient with ice packs and fans (choice D) may help with heat exhaustion but does not address the underlying issue of dehydration and electrolyte imbalance.

Correct Answer: A

Rationale: The correct answer is A: Administer calcium gluconate IV. In severe hypermagnesemia, excess magnesium suppresses neuromuscular function, leading to diminished reflexes and respiratory depression. Calcium gluconate antagonizes the effects of hypermagnesemia and can quickly restore neuromuscular function, including respiratory drive. Prioritizing this intervention is crucial to prevent further respiratory compromise. Choice B (Initiate dialysis immediately) may be necessary for severe cases, but it is not the initial priority in managing acute symptoms. Choice C (Start an infusion of potassium chloride) is incorrect as it can worsen hypermagnesemia by further disrupting electrolyte balance. Choice D (Provide oral phosphate supplements) is not appropriate for immediate management of severe hypermagnesemia.

Correct Answer: C

Rationale: A serious infection and fever increase metabolic rate due to the body's response to illness, requiring nutritional support.