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.