A client receives 2 liters of 0.9% normal saline in 4 hours. The nurse should monitor for which complication?

FLUID VOLUME EXCESS RISK from IV fluid administration is a significant clinical concern, especially with rapid infusion rates. 2 LITERS IN 4 HOURS = 500 mL/hour — a moderately rapid rate; this is often appropriate in acute resuscitation but requires monitoring for fluid overload.

High-risk populations: Heart failure patients (already have fluid overload tendency; reduced cardiac output cannot accommodate extra volume); Renal insufficiency (kidneys cannot excrete excess fluid normally); Elderly patients (reduced cardiac reserve and renal function); Hypoalbuminemia (low oncotic pressure means more fluid shifts to interstitial space).

Monitoring for fluid overload:

Respiratory: Increasing respiratory rate; crackles (rales) in lung bases (fluid accumulating in alveoli); dyspnea; orthopnea.

Cardiovascular: Rising blood pressure; bounding pulse; jugular vein distension; S3 gallop on auscultation.

Peripheral: Dependent edema (ankles if upright, sacrum if supine); pitting edema.

Weight: Rapid weight gain (1 kg = approximately 1 liter of fluid).

Urine output: Should increase appropriately with fluid bolus; oliguria despite infusion suggests fluid is not being cleared.

Intervention if overload develops: Slow or stop the infusion; notify RN/provider; elevate HOB; administer supplemental oxygen; prepare for possible diuretic administration; continuous monitoring.