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NCLEX · Fluid and Electrolyte Imbalances

A client's serum sodium is 128 mEq/L (normal 135-145). They appear confused and report nausea and headache. What condition does this represent and what is the nursing priority?

Correct answer

Hyponatraemia — notify the RN urgently; severe hyponatraemia causes neurological symptoms from cerebral oedema; the nurse should NOT encourage the client to drink free water (worsens the condition) and should await medical orders for IV sodium replacement

  1. A Hypernatraemia — restrict fluids
  2. B Hyponatraemia — notify the RN urgently; severe hyponatraemia causes neurological symptoms from cerebral oedema; the nurse should NOT encourage the client to drink free water (worsens the condition) and should await medical orders for IV sodium replacement
  3. C Hypokalaemia — check the ECG
  4. D Dehydration — give oral fluids freely

Why this is the answer

HYPONATRAEMIA (Na <135 mEq/L): SEVERE (<125 mEq/L): Neurological symptoms — confusion, nausea, headache, seizures, and if untreated, cerebral oedema, herniation, and death; 128 mEq/L with symptoms = URGENT; CAUSES: SIADH (syndrome of inappropriate ADH secretion); heart failure; cirrhosis; excessive hypotonic IV fluids; psychogenic polydipsia; CRITICAL NURSING ACTION: Do NOT give free water or hypotonic fluids (water moves into cells and worsens cerebral oedema); Notify RN immediately; seizure precautions; TREATMENT (physician-ordered): Fluid restriction (most common); hypertonic saline (3% NaCl) for severe symptomatic cases — given only in ICU with strict monitoring; rate of correction must be controlled (correcting too fast causes osmotic demyelination syndrome); MONITORING: Neurological status (confusion, seizure activity); vital signs; serum sodium levels; strict I&O; safety measures (fall precautions for confusion).
Source: NCLEX-PN Physiological — Electrolytes, Severe Hyponatraemia

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