Choice A reason:

Administering hypertonic saline solution IV is not appropriate for a client with hypernatremia, because it will increase the serum sodium level and worsen the condition. Hypertonic saline is only used in severe cases of hyponatremia, when the serum sodium level is very low.

Choice B reason:

Encouraging the client to drink caffeinated beverages is not helpful for a client with hypernatremia, because caffeine can act as a diuretic and cause further fluid loss and dehydration. The client should be encouraged to drink water or hypotonic fluids to dilute the sodium concentration in the blood.

Choice C reason:

Monitoring the client's serum sodium level is the correct action for the nurse to take, because it will help to evaluate the effectiveness of the treatment and detect any changes in the client's condition. The normal serum sodium level is 135 to 145 mEq/L (135 to 145 mmol/L) The nurse should monitor the client's serum sodium level frequently and report any abnormal values to the provider.

Choice D reason:

Increasing the client's sodium intake is contraindicated for a client with hypernatremia, because it will raise the serum sodium level and aggravate the symptoms. The client should avoid foods high in sodium, such as processed meats, cheese, canned soups, and salty snacks.

Choice A reason:

Serum sodium level less than 135 mEq/L. This is an expected finding of hyponatremia, which is a condition of low sodium concentration in the blood. Sodium is an electrolyte that helps regulate fluid balance, nerve impulses, and muscle contractions. Hyponatremia can result from excessive fluid intake, diuretic use, vomiting, diarrhea, or kidney disease.

Choice B reason:

Serum osmolality less than 280 mOsm/kg. This is an expected finding of hyponatremia, which is a measure of the concentration of solutes in the blood. Osmolality reflects the body's ability to maintain fluid balance and hydration status. Hyponatremia causes a decrease in osmolality due to dilution of the blood by excess water.

Choice C reason:

Urine specific gravity less than 1.010. This is an expected finding of hyponatremia, which is a measure of the concentration of solutes in the urine. Specific gravity reflects the kidney's ability to concentrate or dilute urine. Hyponatremia causes a decrease in specific gravity due to increased urine output and water excretion.

Choice D reason:

Urine sodium level greater than 20 mEq/L. This is an expected finding of hyponatremia, which is a measure of the amount of sodium excreted in the urine. Sodium excretion reflects the kidney's ability to regulate sodium balance and fluid volume. Hyponatremia causes an increase in urine sodium level due to impaired sodium reabsorption and increased sodium loss.

Choice E reason:

Serum potassium level greater than 5 mEq/L. This is not an expected finding of hyponatremia, but rather a finding of hyperkalemia, which is a condition of high potassium concentration in the blood. Potassium is an electrolyte that helps regulate cardiac and neuromuscular function. Hyperkalemia can result from renal failure, acidosis, tissue injury, or medications that affect potassium excretion or shift.

Choice A reason:

Avoiding foods that are high in protein is not necessary for a client with diabetes insipidus. Protein intake does not affect the serum sodium level or the urine output in this condition. Therefore, this statement does not indicate a need for further teaching.

Choice B reason:

Drinking water whenever thirsty is not adequate for a client with diabetes insipidus. This condition causes excessive urine output and dehydration, which can lead to hypernatremia (high sodium level in the blood) The client should drink fluids according to a prescribed schedule and monitor the urine specific gravity to prevent fluid imbalance. Therefore, this statement indicates a need for further teaching.

Choice C reason:

Taking the prescribed medication as directed is important for a client with diabetes insipidus. The medication is usually a synthetic form of antidiuretic hormone (ADH), which helps the kidneys retain water and reduce urine output. This can prevent dehydration and hypernatremia. Therefore, this statement does not indicate a need for further teaching.

Choice D reason:

Limiting the intake of salt and salty foods is advisable for a client with diabetes insipidus. Salt intake can increase the serum sodium level and worsen the fluid imbalance. The client should follow a low-sodium diet and avoid processed foods, canned foods, and table salt. Therefore, this statement does not indicate a need for further teaching.

Choice A reason:

A headache that won't go away is a possible complication of hyponatremia, which is a low level of sodium in the blood. Hyponatremia can cause brain swelling, which can lead to headaches, confusion, seizures, and coma.

Choice B reason:

Feeling very thirsty all the time is not a complication of hyponatremia, but rather a symptom of diabetes insipidus, which is a condition that causes the body to produce large amounts of dilute urine and lose water. Diabetes insipidus occurs when there is a deficiency of antidiuretic hormone (ADH), which is the opposite of SIADH.

Choice C reason:

Having trouble sleeping at night is not a complication of hyponatremia, but rather a common problem that can have many causes, such as stress, anxiety, caffeine, noise, or medication. Having trouble sleeping at night is not directly related to SIADH or sodium levels.

Choice D reason:

Losing weight recently is not a complication of hyponatremia, but rather a possible sign of fluid loss or dehydration. Fluid loss can occur in conditions that cause excessive urination, such as diabetes insipidus or diuretic use. Fluid loss can also cause hyponatremia, but it is not caused by SIADH.

• Choice A reason:

• Administering calcium supplements orally or IV is not an appropriate intervention for a client with hypocalcemia. Calcium supplements can cause hypercalcemia, which can lead to cardiac arrhythmias, kidney stones, and constipation. Calcium supplements should only be given if the hypocalcemia is severe or symptomatic and under the supervision of a physician.

• Choice B reason:

• Monitoring the client for signs of tetany and seizures is an appropriate intervention for a client with hypocalcemia. Hypocalcemia can cause increased neuromuscular excitability, which can manifest as muscle spasms, cramps, twitching, or convulsions. Tetany is a condition where the muscles contract involuntarily and can affect the hands, feet, face, or larynx. Seizures are a result of abnormal electrical activity in the brain that can be triggered by low calcium levels. The nurse should monitor the client for these signs and intervene promptly to prevent complications.

• Choice C reason:

• Providing a high-phosphorus diet is not an appropriate intervention for a client with hypocalcemia. Phosphorus and calcium have an inverse relationship in the body, meaning that when one is high, the other is low. A high-phosphorus diet can lower the serum calcium level further and worsen the hypocalcemia. The nurse should advise the client to avoid foods high in phosphorus, such as dairy products, meat, poultry, fish, eggs, nuts, seeds, beans, and cola drinks.

• Choice D reason:

• Avoiding stimulating the facial nerve is not an appropriate intervention for a client with hypocalcemia. Stimulating the facial nerve can elicit a positive Chvostek's sign, which is a facial twitching that occurs when the nerve is tapped near the ear. A positive Chvostek's sign indicates hypocalcemia and increased neuromuscular irritability. However, avoiding stimulating the facial nerve does not prevent or treat hypocalcemia. The nurse should monitor the client for other signs of hypocalcemia and administer calcium as prescribed.