A nurse is caring for several clients on a medical-surgical unit. Which of the following clients have an elevated risk for fluid volume excess (FVE)? (Select all that apply.)

Choice A rationale Spironolactone is a potassium-sparing diuretic that functions by antagonizing aldosterone receptors in the distal renal tubules. This action promotes the excretion of sodium and water while retaining potassium, which effectively reduces total body fluid volume. Therefore, a client taking this medication is at a significantly lower risk for fluid volume excess. In fact, they are more likely to experience fluid volume deficit or hyperkalemia, where normal potassium levels are 3.5 to 5.0 mEq/L. Choice B rationale Nasogastric suctioning involves the continuous or intermittent removal of gastric contents, including water, hydrochloric acid, and electrolytes like sodium and potassium. This process results in the loss of isotonic fluid from the extracellular compartment, putting the client at a high risk for fluid volume deficit rather than excess. Additionally, this loss can lead to metabolic alkalosis. Clients with nasogastric tubes require careful monitoring of intake and output to prevent dehydration and significant electrolyte imbalances. Choice C rationale Syndrome of inappropriate antidiuretic hormone involves the excessive release of ADH, which causes the kidneys to reabsorb high amounts of water regardless of serum osmolality. This leads to dilutional hyponatremia and a significant increase in total body water, resulting in fluid volume excess. Serum sodium levels in these clients often fall below the normal range of 135 to 145 mEq/L. The water retention expands the intravascular space, potentially leading to hypertension, edema, and weight gain. Choice D rationale Renal impairment significantly reduces the glomerular filtration rate, which is the ability of the kidneys to filter waste and excess fluid from the blood. When the kidneys cannot effectively excrete water and sodium, these substances accumulate in the systemic circulation, leading to hypervolemia. Normal creatinine levels are roughly 0.6 to 1.2 mg/dL; elevations indicate reduced function. This fluid retention can manifest as peripheral edema, pulmonary congestion, and increased blood pressure, making fluid management critical. Choice E rationale Heart failure occurs when the cardiac muscle cannot pump blood efficiently, leading to decreased cardiac output and subsequent activation of the renin-angiotensin-aldosterone system. This hormonal activation causes the kidneys to retain sodium and water to increase circulating volume, which the failing heart cannot handle. This cycle results in systemic and pulmonary venous congestion. Clients often present with jugular venous distention and crackles in the lungs, necessitating strict fluid restrictions and the use of diuretic therapy.