The nurse has just completed an infusion of a 1000 ml bolus of 0.9% normal saline in a patient with severe sepsis. One hour later, which laboratory result requires immediate nursing action?

Rationale: A. This value is within the normal range (135–145 mEq/L). Although sepsis and aggressive fluid resuscitation can alter sodium levels, a value of 140 mEq/L does not require immediate intervention. B. Lactate is a marker of tissue hypoperfusion and anaerobic metabolism. In severe sepsis, a lactate level >4 mmol/L indicates that organs and tissues are not receiving adequate oxygen despite fluid resuscitation. This suggests ongoing septic shock. Immediate nursing actions include notifying the provider, ensuring adequate IV access for further fluid resuscitation, monitoring vital signs and urine output, and preparing for additional sepsis interventions such as vasopressors or antibiotics if indicated. Persistently high lactate is associated with increased mortality and signals the need for rapid escalation of care. C. This is within normal limits (3.5–5.0 mEq/L). While potassium must be monitored in sepsis due to risks of hypo- or hyperkalemia from fluid shifts, medications, or renal impairment, a value of 3.8 mEq/L does not require urgent intervention. D. This value is within normal limits (0.6–1.3 mg/dL). Creatinine reflects kidney function, which can be affected in sepsis; however, at this level, there is no acute kidney injury, and it does not necessitate immediate action.