Choice A reason: Hyperglycemia. This is incorrect because dextrose 5% in water (D5W) is not likely to cause hyperglycemia in a dehydrated client. D5W is a hypotonic solution that provides free water and glucose to the body. The glucose is rapidly metabolized by the cells, leaving only water in the intravascular space. This water then moves into the intracellular and interstitial compartments, rehydrating the tissues. Therefore, D5W does not increase the blood glucose level significantly in a dehydrated client.

Choice B reason:

Hyperkalemia. This is incorrect because dextrose 5% in water (D5W) does not contain any potassium or other electrolytes. Hyperkalemia is a condition of high potassium level in the blood, which can be caused by renal failure, acidosis, tissue injury, or excessive intake of potassium-rich foods or supplements. D5W does not affect the potassium level in the blood.

Choice C reason:

Fluid overload. This is correct because dextrose 5% in water (D5W) can cause fluid overload in a client who has impaired fluid regulation mechanisms, such as heart failure, kidney disease, or liver disease. Fluid overload is a condition of excess fluid volume in the body, which can lead to edema, hypertension, dyspnea, crackles, jugular venous distension, and pulmonary congestion. D5W can cause fluid overload by expanding the intravascular volume and shifting water into the interstitial and intracellular spaces.

Choice D reason:

Metabolic acidosis. This is incorrect because dextrose 5% in water (D5W) does not cause metabolic acidosis in a dehydrated client. Metabolic acidosis is a condition of low pH and low bicarbonate level in the blood, which can be caused by diabetic ketoacidosis, lactic acidosis, renal failure, diarrhea, or ingestion of toxic substances. D5W does not affect the pH or bicarbonate level in the blood.

Choice A reason:

Assess the client's blood pressure and pulse frequently. This is correct because a client who has hypovolemia due to third-space shifting has lost fluid from the intravascular space to the interstitial space, resulting in decreased blood volume and pressure. The nurse should monitor the client's vital signs to assess the response to fluid replacement and detect any signs of fluid overload or electrolyte imbalance.

Choice B reason:

Monitor the client's serum electrolyte levels. This is correct because lactated Ringer's solution contains sodium, chloride, potassium, calcium, and lactate, which are important electrolytes for maintaining fluid balance, acid-base balance, nerve conduction, muscle contraction, and cellular function. The nurse should monitor the client's serum electrolyte levels to ensure they are within normal range and to identify any abnormalities that may require intervention.

Choice C reason:

Warm the solution to body temperature before infusion. This is incorrect because warming the solution is not necessary and may cause hemolysis (destruction of red blood cells) or bacterial growth. The nurse should infuse the solution at room temperature or use a fluid warmer device if indicated.

Choice D reason:

Use a filter needle when drawing the solution from the bag. This is incorrect because using a filter needle is not required when drawing the solution from the bag. A filter needle is used to remove particles or air bubbles from a vial or ampule before injection. The nurse should use a sterile spike to pierce the bag and connect it to the IV tubing.

Choice E reason:

Check the solution for cracks or leaks. This is incorrect because checking the solution for cracks or leaks is not specific to lactated Ringer's solution. The nurse should check any IV fluid for cracks or leaks before administration to prevent contamination or infection. The nurse should also check the expiration date, color, clarity, and label of the solution before use.

Choice A reason:

To prevent hypernatremia and dehydration. This is the correct reason because exercise increases fluid loss through sweating and breathing, which can lead to dehydration and high sodium levels in the blood (hypernatremia) Dehydration and hypernatremia can cause symptoms such as thirst, confusion, weakness, and seizures. Therefore, increasing fluid intake before, during, and after active exercise can help maintain fluid and electrolyte balance in clients who have diabetes mellitus.

Choice B reason:

To dilute excess glucose and ketones in the blood. This is not a correct reason because increasing fluid intake does not lower blood glucose or ketone levels significantly. Clients who have diabetes mellitus should monitor their blood glucose and ketone levels regularly and adjust their insulin dosage and carbohydrate intake accordingly. Fluid intake alone is not enough to prevent hyperglycemia or ketoacidosis, which are serious complications of diabetes mellitus.

Choice C reason:

To promote renal perfusion and urine output. This is not a correct reason because increasing fluid intake does not improve kidney function or urine output in clients who have diabetes mellitus. Clients who have diabetes mellitus are at risk of developing diabetic nephropathy, which is a chronic kidney disease caused by damage to the blood vessels and glomeruli of the kidneys. Diabetic nephropathy can lead to reduced renal perfusion and urine output, as well as proteinuria, edema, hypertension, and renal failure. Therefore, increasing fluid intake does not prevent or treat diabetic nephropathy.

Choice D reason:

To replace lost electrolytes and prevent acidosis. This is not a correct reason because increasing fluid intake does not replenish electrolytes or prevent acidosis in clients who have diabetes mellitus. Clients who have diabetes mellitus are at risk of developing diabetic ketoacidosis (DKA), which is a life-threatening condition caused by insufficient insulin production or utilization, resulting in high blood glucose and ketone levels. DKA causes metabolic acidosis, which lowers the pH of the blood and body fluids. DKA also causes electrolyte imbalances, such as low potassium, sodium, chloride, and bicarbonate levels. Therefore, increasing fluid intake does not correct the metabolic acidosis or electrolyte imbalances caused by DKA.

Choice A reason:

This is incorrect because dextrose 5% in normal saline is a hypertonic solution that will increase the blood sugar level, not lower it. Patients with Addison's crisis have low cortisol levels, which can impair glucose metabolism and cause hypoglycemia, so they need glucose supplementation.

Choice B reason:

This is partially correct because dextrose 5% in normal saline will provide some nutrition with glucose, but this is not the main reason for using this solution in Addison's crisis. Patients with Addison's crisis have low aldosterone levels, which can cause hyponatremia and hypovolemia, so they need sodium and fluid replacement.

Choice C reason:

This is correct because dextrose 5% in normal saline will correct the low sodium level caused by aldosterone deficiency in Addison's crisis. Sodium is essential for maintaining blood pressure, fluid balance, and nerve and muscle function. Dextrose 5% in normal saline will also increase the blood volume and prevent dehydration and shock.

Choice D reason:

This is partially correct because dextrose 5% in normal saline will increase the blood volume, but this is not the only solution that can do that. Other isotonic or hypertonic solutions can also expand the intravascular space. Dextrose 5% in normal saline is preferred in Addison's crisis because it also provides glucose and sodium, which are both deficient in this condition.

Choice A reason:

Decreased serum osmolarity. This is the correct answer because the goal of therapy for diabetic ketoacidosis (DKA) is to restore fluid and electrolyte balance, correct acidosis, and lower blood glucose levels. 0.45% sodium chloride (1/2 normal saline) is a hypotonic solution that helps to rehydrate the intracellular and extracellular compartments and reduce the serum osmolarity, which is elevated in DKA due to hyperglycemia and dehydration.

Choice B reason:

Increased urine specific gravity. This is incorrect because urine specific gravity reflects the concentration of solutes in the urine. In DKA, urine specific gravity is usually high due to osmotic diuresis caused by hyperglycemia and ketonuria. Effective therapy for DKA should lower the urine specific gravity as the blood glucose level and hydration status improve.

Choice C reason:

Decreased serum bicarbonate level. This is incorrect because serum bicarbonate level reflects the metabolic component of acid-base balance. In DKA, serum bicarbonate level is low due to increased production of ketoacids that consume bicarbonate as a buffer. Effective therapy for DKA should increase the serum bicarbonate level as the acidosis is corrected by insulin and fluid administration.

Choice D reason:

Increased serum potassium level. This is incorrect because serum potassium level is affected by several factors in DKA, such as insulin deficiency, acidosis, osmotic diuresis, and fluid therapy. In DKA, serum potassium level may be normal or high initially due to the shift of potassium from the intracellular to the extracellular space, but the total body potassium is depleted. Effective therapy for DKA should normalize the serum potassium level by replacing potassium losses and correcting the factors that cause potassium shift.