ANCC MEDSURG-BC

Severe, symptomatic hyponatremia (very low sodium with seizures) is a medical emergency. The nurse’s immediate priority is patient safety: protect the airway and prevent injury by initiating seizure precautions and urgently escalating care (notify the provider/activate the emergency response team) while preparing for rapid treatment such as hypertonic saline when ordered or per protocol. Eating salty foods is not an effective or timely treatment for life-threatening hyponatremia. Waiting delays critical, time-sensitive stabilization. Plain water would further dilute serum sodium and can worsen cerebral edema and neurologic symptoms.

Suspected elder neglect must be reported to the appropriate agency (as required by law and facility policy) so an investigation and protective services can be initiated. Actions such as only advising the caregiver, only documenting in the chart, or only notifying family do not meet mandatory reporting responsibilities and may not ensure the patient’s immediate safety. While ensuring the patient is safe and receiving needed care is important, the priority duty in response to disclosure of neglect is to make the required report through the proper channels.

Reinforcing medication adherence and teaching a low-sodium diet are high-priority implementation interventions that directly support heart-failure self-management and reduce fluid retention and risk of exacerbations after discharge. Obtaining daily weights with strict intake and output and monitoring potassium/creatinine are important implementation activities, but they primarily support ongoing physiologic monitoring and safety during hospitalization rather than addressing the key behaviors that most strongly influence outpatient stability. Arranging a family meeting about long-term care placement is primarily discharge planning and care coordination, not the most immediate intervention for improving heart-failure self-management.