What order by the health care provider should the nurse question? Test Name Result Reference Range WBC 12,000 4,000-11,000 Na+ 149 mEq/L 135-145 mEq/L K+ 5.0 mEq/L 3.5-5.0 mEq/L CI- 110 7.35-7.45 pH 7.34 7.35-7.45 PaCO2 34 mm Hg 35-45 mm Hg PaO2 78 mm Hg 80-100 mm Hg HCO3 21 mEq/L 22-26 mEq/L

A. Increase 0.9% Normal Saline infusion to 250 mL/hr per protocol: The client’s sodium level is elevated at 149 mEq/L (hypernatremia). Increasing the rate of isotonic saline would worsen sodium overload and could exacerbate hypernatremia, leading to cellular dehydration and neurologic complications. This order should be questioned because fluid management in hypernatremia involves hypotonic IV fluids to safely lower serum sodium levels. B. Administer Furosemide (Lasix) 20 mg IV push: Furosemide is a loop diuretic that can be used to manage fluid overload and reduce sodium retention. Given the client’s hypernatremia, administering a diuretic may aid in excreting excess sodium and fluid. This order aligns with medical management if the provider intends to correct hypernatremia and prevent overload. C. Collect UA for culture and sensitivity: The client has an elevated WBC of 12,000/mm³, suggesting possible infection. Ordering a urine culture is appropriate for identifying a urinary source of infection and guiding targeted antimicrobial therapy. This is a standard diagnostic step and does not pose immediate harm. D. Collect blood cultures and start Vancomycin 1 gm IV: Elevated WBC also indicates possible systemic infection. Blood cultures help identify bacteremia, and empiric broad-spectrum antibiotic therapy, such as Vancomycin, is clinically appropriate while awaiting culture results. This order is consistent with management of suspected sepsis or bacteremia.