Registered Nurse (RN) Endocrine Licensure Exam

During IV treatment of a hypertonic solution for a patient with SIADH, which nursing finding requires intervention?

1. Sodium level of 136

2. Patient reports urinating more frequently

3. Potassium level of 5.0

4. Assessment finding of crackles throughout the lung fields

The correct answer is: Assessment finding of crackles throughout the lung fields

The identification of crackles throughout the lung fields as a significant finding in a patient receiving IV treatment with a hypertonic solution for Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) indicates potential fluid overload or pulmonary edema. In SIADH, the body retains excessive water due to inappropriate secretion of antidiuretic hormone, leading to dilutional hyponatremia. When administering hypertonic solutions, there is a risk of causing further fluid retention, which can overwhelm the body’s ability to manage fluid balance, especially in a patient already compromised by SIADH. The presence of crackles suggests that fluid is accumulating in the lungs, which can impede gas exchange and indicate a medical emergency that requires immediate intervention to prevent deterioration of the patient's respiratory status. Other findings, such as a sodium level of 136, a potassium level of 5.0, and increased urinary frequency, do not indicate acute complications requiring intervention in this context. The sodium level is within the normal range indicative that treatment is being effective, while the potassium level is also within acceptable limits. Moreover, increased urination may indicate an appropriate response to the hypertonic solution, which helps correct the body's fluid imbalance. Thus, these findings