A nurse is caring for a child with renal disease and is analyzing the child's laboratory results. The nurse notes a sodium level of 148 mEq/L, on the basis of this finding, which clinical manifestation would the nurse expect to note in the child?

1. A

   Lethargy

2. B

   Diaphoresis

3. C

   Cold, wet skin

4. D

   Dry, sticky mucous membranes

Appeared in: DHS 2018 shift 1st

Explanation

• The normal serum sodium level for a child is between 135 and 145 mEq/L. A level of 148 mEq/L indicates hypernatremia (high sodium).
• Hypernatremia increases the osmotic pressure of the extracellular fluid, causing water to shift out of the body's cells to balance the concentration.
• This process, known as cellular dehydration, leads to classic signs of dehydration.
• Dry, sticky mucous membranes are a hallmark clinical manifestation of cellular dehydration and, therefore, hypernatremia.

Why Other Options Were Wrong

• Option A: While lethargy can be a sign of severe hypernatremia due to brain cell shrinkage, it is a more classic and earlier sign of hyponatremia (low sodium), which causes cerebral edema (brain cell swelling).
• Option B: Diaphoresis (excessive sweating) is a potential cause of hypernatremia because it leads to the loss of free water, concentrating the sodium in the body. It is not a symptom that results from an already established state of hypernatremia.
• Option C: Cold, wet (or clammy) skin is typically a sign of circulatory compromise or shock, where blood is shunted away from the periphery. Hypernatremic dehydration typically presents with warm, dry, and flushed skin.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Clinical manifestations of hypernatremia helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Nurses must be vigilant in monitoring serum electrolyte levels, especially in at-risk populations like children and patients with renal disease, as imbalances can have severe neurological consequences.
• Recognizing the early signs of dehydration, such as dry mucous membranes and thirst, is a critical nursing assessment skill that allows for prompt intervention before the condition worsens.
• What if the child's sodium level was 128 mEq/L? In that case of hyponatremia, the nurse would expect to see signs of cerebral edema, making 'Lethargy' the most likely clinical manifestation due to brain cell swelling.

How to Approach the Question

• First, identify the key piece of data in the question: the laboratory value, which is a sodium level of 148 mEq/L.
• Next, compare this value to the normal range for serum sodium (135-145 mEq/L). Determine if the value is low, normal, or high. In this case, it is high.
• Recall the term for high sodium: hypernatremia.
• Think about the underlying pathophysiology of hypernatremia, which is cellular dehydration caused by water shifting out of cells.
• Review the options and select the one that is a direct and classic sign of cellular dehydration. Dry, sticky mucous membranes are a hallmark sign.
• Mentally eliminate the other options by recalling their association with other conditions (lethargy with hyponatremia, diaphoresis as a cause, cold/wet skin with shock).

Concept Tested & Keywords

• Concept Tested: Clinical manifestations of hypernatremia
• Stem keywords: child, renal disease, laboratory results, sodium level, 148 mEq/L
• Lead-in keywords: clinical manifestation, expect to note
• Clinical cues: A sodium level of 148 mEq/L is above the normal range of 135-145 mEq/L, indicating hypernatremia.
• Negative lead-in flag: NOT changes the reasoning strategy; look for the exception or incorrect statement rather than the true statement.

Question ID

QaFn0R_2luW-B-P9Vb4tEw

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 534-536

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 59-61