Uttarakhand CHO - 2021
Medical Surgical Nursing
Easy
If a doctor has prescribed Hypotonic IV solution for a patient, which of the following solutions will the Nurse/CHO use?
Appeared in: Uttarakhand CHO - 2021
Explanation
- Hypotonic solutions have a lower solute concentration than body fluids, causing water to move into cells.
- 45% Saline (Half-Normal Saline) has an osmolarity of approximately 154 mOsm/L, which is significantly lower than the blood's osmolarity (around 275-295 mOsm/L), making it a hypotonic solution.
- It is specifically used to treat cellular dehydration by shifting fluid from the extracellular space into the cells.
Why Other Options Were Wrong
- Option B: 5% Dextrose in Saline (assuming 0.9% Saline, D5NS) is a hypertonic solution. Its high osmolarity (approx. 560 mOsm/L) would draw water out of cells, which is the opposite effect of a hypotonic solution.
- Option C: 10% Dextrose in Water (D10W) is a hypertonic solution in the bag due to its high dextrose concentration (approx. 505 mOsm/L). Although the dextrose is metabolized, leaving free water (a hypotonic effect), the initial solution is hypertonic.
- Option D: 5% Dextrose in 0.9% Saline (D5NS) is a hypertonic solution with an osmolarity of about 560 mOsm/L. It increases the osmolarity of the blood, causing fluid to shift from the intracellular to the extracellular space.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Classification and clinical use of intravenous (IV) solutions based on tonicity to guide bedside assessment, documentation, and the next nursing action.
- Administering the correct IV fluid is a critical nursing responsibility. Using the wrong type can lead to serious complications like cerebral edema (with hypotonic fluids) or cellular dehydration (with hypertonic fluids).
- Nurses must always double-check the provider's order against the IV bag and understand the rationale for the prescribed fluid.
- What if the patient had increased intracranial pressure (ICP)? In that case, administering a hypotonic solution like 0.45% Saline would be contraindicated. It would cause fluid to shift into the brain cells, worsening the swelling and increasing the ICP, which could be fatal. A hypertonic solution (like 3% Saline) might be used instead to draw fluid out of the brain cells.
How to Approach the Question
- First, identify the key term in the question: 'Hypotonic IV solution'.
- Define 'hypotonic': a solution with a lower solute concentration than the body's cells.
- Recall or look up the properties of the common IV fluids listed in the options.
- Evaluate each option: A) 0.45% Saline is half the concentration of normal saline (0.9%), making it hypotonic. B) D5NS is a combination of dextrose and normal saline, making it hypertonic. C) D10W has a high concentration of dextrose, making it hypertonic. D) D5 in 0.9% Saline is the same as option B and is hypertonic.
- Conclude that 0.45% Saline is the only hypotonic solution among the choices.
Concept Tested & Keywords
- Concept Tested: Classification and clinical use of intravenous (IV) solutions based on tonicity.
- Stem keywords: Hypotonic IV solution, prescribed
- Lead-in keywords: which of the following
Question ID
QEKY7jo6dXUhtuXTTZpHLl
Reference Book
E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 142-144
E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 68-70
Practise the full Uttarakhand CHO - 2021
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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