A patient has hyponatremia with confusion and sodium 128 mEq/L. What is the immediate nursing approach?

• A. Rapidly correct sodium with hypertonic saline.
• B. Ensure safety, notify the provider, and monitor neuro status; investigate underlying cause and avoid rapid correction.
• C. Administer diuretics to raise sodium.
• D. Schedule follow-up education for patient and family.

Answer: (B)

The key idea is that when hyponatremia is accompanied by confusion or other neurologic symptoms, the priority is safety and careful medical management guided by a provider. The nurse should immediately protect the patient from harm, notify the provider, and keep a close eye on neurologic status while working to identify the underlying cause and ensuring that any correction of sodium proceeds gradually under orders.

So the immediate actions are: make sure the patient is safe (seizure precautions as needed, help with mobility, orient, keep call light within reach), assess and monitor neurologic status and vital signs, check intake and output, and promptly inform the provider. The provider will determine the appropriate treatment (for example, a controlled, physician-directed correction with hypertonic saline if indicated) and the safe rate of correction to avoid overshooting, which can cause osmotic demyelination syndrome. This approach addresses the acute neuro symptoms without risking rapid, unsupervised changes in sodium.

Why not other options: rushing to rapidly correct sodium with hypertonic saline without orders can be dangerous; diuretics to raise sodium are not appropriate as an immediate, general nursing action and can worsen imbalance; scheduling education for patient and family doesn’t address the urgent neuro changes and safety needs.