The Nurse Is Caring for a Client Who Has Been

question 20

Multiple Choice

The nurse is caring for a client who has been hospitalized for 2 days and is receiving normal saline IV at 100 mL/hour, has a nasogastric tube to low suction, and is NPO. Which of the following assessment findings by the nurse is the priority to reporttothehealth care provider?

• A)Serum sodium level of 138 mmol/L
• B)Gradually decreasing level of consciousness (LOC)
• C)Oral temperature of 37.8°C (100°F) with bibasilar lung crackles
• D)Weight gain of 1 kg above the admission weight

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