A nurse reviews a serum sodium of 128 mEq/L for a client with heart failure. The client is confused, reporting headache, and has decreased deep tendon reflexes. Which intervention is most appropriate for this client?
- A.Encourage oral fluid intake to dilute the serum sodium
- B.Administer 0.45% normal saline IV as ordered
- C.Implement fluid restriction and notify the provider
- D.Administer a loop diuretic to correct the sodium level
Show answer & rationale
Correct answer
C. Implement fluid restriction and notify the provider
Rationale
C is correct: In heart failure, hyponatremia is typically dilutional; caused by fluid overload and excess free water, not sodium depletion. Fluid restriction reduces free water and allows sodium to concentrate. The provider must be notified of neurological symptoms (confusion, headache, decreased DTRs), which indicate significant hyponatremia. A is incorrect: Encouraging fluid intake would worsen dilutional hyponatremia by adding more free water. B is incorrect: 0.45% NS is a hypotonic solution that would further dilute serum sodium and is contraindicated in dilutional hyponatremia. D is incorrect: Loop diuretics remove both sodium and water; while they may have a role in decompensated HF, they are not the direct treatment for hyponatremia correction without a specific provider order addressing both conditions.
Key concepts