Chitranjjan National Cancer Institute Kolkata - 2021
Medical & Surgical Nursing
Medium
Which of the following is not an isotonic fluid?
Appeared in: Chitranjjan National Cancer Institute Kolkata - 2021
Explanation
- Dextrose 5% in normal saline (D5NS) is classified as a hypertonic solution.
- It is a combination of two substances: 5% dextrose and 0.9% sodium chloride (Normal Saline).
- This combination results in a high solute concentration (osmolality) that is greater than that of blood plasma.
- When infused, its hypertonicity causes water to shift from the intracellular and interstitial spaces into the intravascular space.
Why Other Options Were Wrong
- Option A: 9% Sodium Chloride, also known as Normal Saline (NS), is the standard isotonic solution. Its osmolality is very close to that of blood plasma.
- Option B: Ringer's Lactate (RL) is another common isotonic solution. It contains multiple electrolytes in concentrations similar to plasma.
- Option C: Dextrose 5% in water (D5W) is considered isotonic in the IV bag. Although it becomes physiologically hypotonic once the dextrose is metabolized, it is not hypertonic.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Classification of intravenous (IV) fluids based on tonicity as background academic context rather than a clinical decision trigger.
- Administering hypertonic solutions like D5NS requires vigilant nursing assessment for signs of fluid volume overload, such as crackles in the lungs, shortness of breath, jugular vein distention, and peripheral edema.
- Patients receiving hypertonic fluids must be monitored for hypernatremia and changes in neurological status, as rapid fluid shifts can be dangerous.
- What if? If a patient had critical, symptomatic hyponatremia (low sodium), a more potent hypertonic solution like 3% Saline might be ordered to rapidly pull water out of swollen brain cells. This is a high-risk intervention requiring intensive care monitoring, and D5NS would not be sufficient.
How to Approach the Question
- First, identify the negative keyword 'NOT'. This tells you to look for the one option that is different from the others, specifically the one that is not isotonic.
- Second, recall the definitions of the three main types of IV fluids: isotonic (same concentration as blood), hypotonic (lower concentration), and hypertonic (higher concentration).
- Third, analyze each option based on its composition. 0.9% (Normal Saline) and RL (Ringer's Lactate) are classic isotonic solutions.
- Fourth, consider the special cases. D5W is isotonic in the bag but becomes hypotonic in the body. D5NS is a combination of an isotonic solution (NS) and dextrose, which makes the final product hypertonic.
- Fifth, based on the analysis, Dextrose 5% in normal saline is the only hypertonic solution among the choices.
- Finally, select this option as it is the one that is 'NOT' isotonic.
Concept Tested & Keywords
- Concept Tested: Classification of intravenous (IV) fluids based on tonicity.
- Stem keywords: isotonic fluid
- Lead-in keywords: not
- Negative lead-in flag: The question asks to identify the option that is an exception, meaning it is NOT an isotonic fluid.
Question ID
Qr3K2z0epTwMTM72IczfMA
Reference Book
E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 68-70
E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 142-144
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