Difficulty: Medium
Average Score: 95%
Simulated
A nurse is caring for a client who is receiving a 0.9% sodium chloride via IV infusion. The client has become dyspneic with a blood pressure of 140/100 mm Hg, a fluid intake of 960 mL, and an output of 300 mL in the past 12 hr. Which of the following actions should the nurse take?
Correct answer
A
Rationale
Dyspnea and fluid imbalance suggest fluid overload; slowing the infusion and notifying the provider are appropriate.