A client with heart failure and kidney disease is receiving sodium bicarbonate. New crackles, jugular venous distention, edema, and sodium 152 mEq/L are noted. Which action is the priority?

1 Stop or pause the infusion according to protocol, assess breathing and circulation, and notify the authorized clinician. ✓ Correct answer
2 Increase the infusion rate to correct the acid-base disorder faster.
3 Give additional sodium-containing fluid without an order.
4 Document the findings as expected and reassess at discharge.

Explanation

The client shows sodium and volume-related toxicity. Prevent further exposure, assess cardiopulmonary status, and escalate for prescribed management.

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In-depth explanation

Quick answer
Interrupt further sodium load and address volume overload with hypernatremia.

Why this is correct
Sodium bicarbonate can cause sodium retention, edema, fluid overload, hypernatremia, and metabolic alkalosis. Heart failure and kidney disease increase vulnerability.

Easy analogy or mental picture
Do not keep filling a reservoir when the overflow alarms are already sounding.

Memory hook
Bicarbonate adds sodium: crackles and rising sodium demand action.

NCLEX decision rule
When treatment creates respiratory or electrolyte harm, stop further exposure, stabilize, assess, and notify rather than chasing the original problem faster.

Why the other choices are wrong
A faster infusion and more sodium worsen the mechanism; delayed documentation alone does not protect the client.

References

1DailyMed: Sodium Bicarbonate InjectionSodium retention, volume overload, and electrolyte monitoring

Clinical scenario

Sodium-load surveillance
Trend lung sounds, oxygenation, edema, intake and output, sodium, acid-base status, and cumulative sodium sources.

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For study reference only. Always follow current clinical guidelines and your institution’s protocols.

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A client with heart failure and kidney disease is receiving sodium bicarbonate. New crackles, jugular venous distention, edema, and sodium 152 mEq/L are noted. Which action is the priority?

In-depth explanation

Clinical scenario

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