NORCET 2 - 2021 (shift-1)
Medical & Surgical Nursing
Medium
In moderate dehydration, which is the fluid of choice?
Appeared in: NORCET 2 - 2021 (shift-1)
Explanation
- Normal Saline (NS) is an isotonic crystalloid solution, meaning its solute concentration is similar to that of blood plasma.
- This property allows it to remain in the vascular compartment, effectively and rapidly expanding the intravascular volume to correct the deficit from dehydration.
- It restores circulation and organ perfusion without causing major, harmful shifts of fluid into or out of the body's cells.
- It is the first-line choice for treating hypovolemic states and for resuscitation efforts.
Why Other Options Were Wrong
- Option A: D-10 (10% Dextrose) is a hypertonic solution. It would pull fluid from the intracellular space into the bloodstream, worsening cellular dehydration. Its primary use is to correct hypoglycemia, not for volume resuscitation.
- Option B: D-5 (5% Dextrose) becomes a hypotonic solution in the body once the dextrose is metabolized. This causes fluid to shift out of the vascular space and into cells, making it ineffective for expanding blood volume and risking complications like cerebral edema.
- Option C: D-7.5 (7.5% Dextrose) is also a hypertonic solution. Like D-10, it is not used for initial fluid resuscitation in dehydration because it would exacerbate cellular dehydration.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Intravenous Fluid Selection for Dehydration as background academic context rather than a clinical decision trigger.
- Nurses are responsible for administering IV fluids and must understand the correct fluid choice to ensure patient safety and prevent complications like dangerous fluid shifts or electrolyte imbalances.
- Key nursing actions include assessing the patient for signs of dehydration (e.g., tachycardia, hypotension, poor skin turgor), monitoring vital signs and urine output during fluid replacement, and watching for signs of fluid overload (e.g., crackles in the lungs, edema).
- What if the patient is dehydrated AND hypoglycemic? In this specific case, the immediate priority is still volume resuscitation with an isotonic crystalloid like NS. Once the patient is hemodynamically stable, a dextrose-containing solution may be added or switched to address the hypoglycemia.
How to Approach the Question
- First, identify the core of the question: selecting the best fluid for volume replacement in a patient with moderate dehydration.
- Recall the primary goal of treating dehydration: to expand the intravascular (blood vessel) volume to improve circulation and organ perfusion.
- Next, categorize the given options based on their tonicity: NS is isotonic; D-5 becomes hypotonic in the body; D-7.5 and D-10 are hypertonic.
- Relate the tonicity of each fluid to its function in the body. Isotonic solutions stay in the vascular space, making them ideal for volume expansion.
- Hypotonic solutions move fluid into cells, and hypertonic solutions pull fluid out of cells. Neither is appropriate for initial volume resuscitation.
- Based on this reasoning, conclude that the isotonic solution, Normal Saline (NS), is the correct choice.
Concept Tested & Keywords
- Concept Tested: Intravenous Fluid Selection for Dehydration
- Stem keywords: moderate dehydration, fluid of choice
- Lead-in keywords: which is
Question ID
QOGkzLRyb8lFQc4SD7iXxO
Reference Book
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 576-578
E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 142-144
Practise the full NORCET 2 - 2021 (shift-1)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
More Fluid and Electrolytes: Balance and Distribution Questions
- All are crystalloid solution; except:
- ECG of the patient is showing ST depression, Prominent U wave and inverted T wave. Which of the electrolyte imbalance present?
- A patient reports calcium loss. What is the nursing intervention?
- The principle of hemodialysis in which the water is moving under high pressure to an area of lower pressure is:
- Measurement of arterial blood gas shows pH: 7.2, PaCO2 : 70 mm Hg, HCO3: 27 mmol/L and PaO2: 59 mm Hg. Interpret this:
- Fluid volume deficit or hypovolemia describes the loss of
- 100 mL fluid is given to patient and patient's CVP is 3 mm Hg, then what is the next intervention?
- A patient presents to the emergency department with a serum pH of 7.25, pCO2 of 40 mmHg, HCO3 of 22 mEq/L, sodium of 150 mEq/L, and chloride of 100 m…
- A 65-year-old patient is admitted to the hospital with a serum sodium level of 132 mmol/L. Despite being asymptomatic at admission, the patient begin…
- How would you most accurately assess fluid volume status in a patient with 20% total body surface area (TBSA) burns?
More NORCET 2 - 2021 (shift-1) Questions
- Which type of bandage used in ankle injury?
- A nurse knows that under the National Family Health Program, the duration of Copper T 380A is?
- Which diet should be avoided in acute renal failure disease?
- What was the first indigenous vaccine in India?
- Which bone is known as the breast bone?
- What is the most common type of episiotomy performed during labor?
- A child comes to the emergency room with acute bronchospasm after a bee sting. What is the most preferred route of adrenaline administration?
- What is the chemical name of Baking soda?
- Which solution is used in the COVID area for disinfection?
- A client is scheduled for a total gastrectomy. The on-duty nursing officer knows that after surgery, this client may be at risk for what condition?