Pediatric Fluid and Electrolyte Imbalances · NCLEX Exam

A 4-year-old child receiving maintenance IV fluids is ordered 0.45% sodium chloride at full maintenance rate. The nurse recognises a risk when the child’s serum sodium is 130 mEq/L because:

  1. Hypotonic fluid may worsen hyponatremia and risk cerebral edema
  2. Hypotonic fluid is preferred to restore sodium quickly
  3. Serum sodium has little bearing on IV fluid selection
  4. The ordered rate is appropriate as long as sodium is low
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Correct answer: Hypotonic fluid may worsen hyponatremia and risk cerebral edema

Hypotonic fluids in the setting of low sodium may lower serum sodium further, risking cerebral edema; children must have appropriate tonicity.

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