Vital Signs Heart Rate: 120 & Bounding Respiratory Rate: 28 Blood Pressure: 160/90 Temperature: 97.9 Temporal A nurse administered a bolus of normal saline to an elderly patient. After administration the patient begins complaining of shortness, has bounding pulses, and crackles in all lung fields upon auscultation. What adverse effect does the nurses suspect?

A. Fluid Volume Overload: Rapid administration of isotonic saline increases intravascular volume, which can overwhelm cardiac compensatory mechanisms. Elevated hydrostatic pressure promotes fluid movement into the pulmonary interstitium and alveoli, producing crackles and hypoxemia. Bounding pulses, hypertension, tachycardia, and decreased oxygen saturation reflect increased preload and pulmonary congestion consistent with volume excess. B. Fluid Volume Deficit: Fluid deficit is characterized by hypotension, weak and thready pulses, tachycardia, dry mucous membranes, and decreased urine output. Pulmonary findings typically include clear lung fields rather than crackles. The presence of bounding pulses, elevated blood pressure, and respiratory distress following fluid administration doesn’t align with hypovolemia. C. Hypokalemia: Hypokalemia primarily affects neuromuscular and cardiac conduction systems, leading to muscle weakness, arrhythmias, and ECG changes such as flattened T waves. It does not directly cause acute pulmonary crackles, bounding pulses, or rapid onset dyspnea after fluid infusion. The clinical presentation described reflects circulatory overload. D. Hypernatremia: Hypernatremia develops from free water loss or excessive sodium intake and presents with neurologic symptoms such as confusion, irritability, or seizures. Although normal saline contains sodium, acute pulmonary crackles and bounding pulses are related to volume expansion rather than sodium concentration alone.