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NCLEX · Fluid and Electrolyte Imbalances

A client has a serum sodium level of 122 mEq/L (normal 135-145). Which assessment finding would the nurse expect with this level of hyponatremia?

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Correct answer

Neurological changes — confusion, headache, lethargy, muscle weakness, and in severe cases seizures; severe hyponatremia causes cerebral edema as water shifts into brain cells

  1. A Increased urine output with high specific gravity
  2. B Flushed dry skin
  3. C Extreme thirst and dry mucous membranes
  4. D Neurological changes — confusion, headache, lethargy, muscle weakness, and in severe cases seizures; severe hyponatremia causes cerebral edema as water shifts into brain cells

Why this is the answer

HYPONATREMIA (low sodium, <135 mEq/L): 122 mEq/L is significantly low.

Neurological effects dominate: Sodium imbalances primarily affect the brain because water shifts based on sodium concentration; LOW SODIUM = water moves INTO cells (including brain cells) = cerebral edema; SYMPTOMS by severity: Mild: headache, nausea, malaise; Moderate: confusion, lethargy, muscle weakness, disorientation; Severe (<120): seizures, coma, respiratory arrest, death.

Causes: SIADH, excessive water intake, diuretics, heart failure, vomiting/diarrhea with water replacement.

Treatment: Depends on cause and severity — fluid restriction (if dilutional), careful sodium replacement (hypertonic saline for severe symptomatic cases — corrected SLOWLY to avoid osmotic demyelination syndrome).

Safety: Seizure precautions for severe hyponatremia; LPN role: monitor neuro status, report changes, implement safety measures.

Source: NCLEX-PN Physiological — Fluid/Electrolytes, Hyponatremia

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About this topic: Fluid and Electrolyte Imbalances

Fluid and electrolyte questions cover normal ranges for sodium, potassium, calcium and magnesium, the signs of each imbalance, and the nursing actions and client teaching for dehydration and fluid overload. This is one of 9 PN: Physiological Integrity questions on fluid and electrolyte imbalances, each with a full explanation on a single study page.

New to this exam? Our NCLEX exam guide explains the format, scoring, and how to prepare.

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