A 70-kg client with rhabdomyolysis is receiving prescribed isotonic intravenous fluid. Which finding best indicates that the fluid therapy is meeting its intended goal without causing overload?
1Urine output is 20 mL/hr, and the serum creatinine is increasing
2Urine output is 350 mL/hr, and new bilateral crackles are present
3Urine output is 100 mL/hr, and the anterior lung sounds remain clear✓ Correct answer
4Urine output is absent, and dependent edema is becoming more pronounced
Explanation
Goal-directed fluid therapy for rhabdomyolysis uses urine output to support renal perfusion while avoiding fluid overload. This client's urine output is within the recommended weight-based range, and clear lungs indicate no current pulmonary congestion.
Quick answer The urine output is within the treatment target and the lungs remain clear, showing adequate resuscitation without evident overload.
Why this is correct Rhabdomyolysis releases myoglobin that can injure the kidneys, so isotonic fluid is titrated to maintain renal flow. Urine output within the prescribed weight-based goal supports effectiveness, while clear lungs support tolerance of the fluid.
Easy analogy or mental picture Fluid therapy is like flushing debris through a drain while watching that the sink does not overflow. Urine output represents flow and lung assessment helps detect overflow, but the analogy does not replace electrolyte, creatinine, and hemodynamic monitoring.
Memory hook Rhabdomyolysis fluids need enough urine flow without signs of fluid overload.
NCLEX decision rule To evaluate fluid resuscitation for rhabdomyolysis, pair a goal-directed urine output with assessment for overload. Low or absent output suggests inadequate renal clearance, while new crackles warn that simply increasing fluid may be harmful.
Why the other choices are wrong Low output with rising creatinine suggests kidney injury. Very high output with crackles signals poor fluid tolerance, and anuria with increasing edema shows that additional uncritical fluid could worsen overload.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
AAST: Rhabdomyolysis Clinical Consensus DocumentAmerican Association for the Surgery of Trauma Critical Care Committee