Anxiety in a patient receiving IV saline for dehydration signals a need for immediate nurse reporting.

Which finding should a nurse report to the primary healthcare provider for a client receiving IV normal saline for dehydration?

• A. Blood pressure of 136/84
• B. Report of nausea
• C. Client exhibiting anxiety
• D. Urinary output of 50 mL/hour

Answer: (C)

In this scenario, the most critical finding to report to the primary healthcare provider is the client's anxiety. While all the listed options may warrant attention, anxiety can be indicative of an underlying physiological issue, such as fluid overload, electrolyte imbalances, or an exacerbation of the client’s dehydration, which may require prompt medical evaluation and intervention. Anxiety in a client receiving IV fluids can signal distress that might not be immediately observable through vital signs or lab results. It's essential for the healthcare provider to assess the client further, as anxiety can escalate quickly and affect treatment outcomes. Addressing the underlying cause of the anxiety may lead to a more effective management plan and ensure the client’s safety. Monitoring physiological parameters like blood pressure or urinary output is also crucial, but in the context of potential complications related to IV fluid administration, the psychological and emotional state of the client can provide significant insights into their overall condition and may require immediate attention.

IV fluids are a staple in hospital care, especially when a patient is dehydrated. Normal saline (0.9% NS) is a common first-line choice because it mirrors our body’s fluid balance well enough to help restore volume without tipping the scales too far. But the real safety net isn’t just what the monitor shows. It’s how the person feels, how they’re moving, and what their nerves are telling you in the moment. In this kind of nursing scenario, the quiet signs often carry the most weight.

Let’s unpack the scenario and pull out what’s most important for patient safety.

A quick reality check: what the scenario looks like

Imagine a patient who’s getting IV normal saline for dehydration. You’re watching a few variables:

• Blood pressure: 136/84. That’s within a normal range, maybe leaning toward the higher side depending on the patient, but not immediately alarming.

• Nausea: The patient reports feeling nauseated. That could be related to dehydration, the infusion itself, or something else entirely.

• Anxiety: The patient is anxious or agitated. This is the key sign that should prompt you to tell the primary provider right away.

• Urinary output: 50 mL/hour. For many adults, that’s a decent output, showing the kidneys are at least making some urine. It doesn’t rule out trouble, but it’s not a red flag by itself.

Now, why is anxiety the signal to escalate?

You might think anxiety is just a mood or a moment, but in the context of IV fluids, anxiety can hint at deeper issues. It can be an early cue that something isn’t settling right—perhaps the fluid rate is too fast for this patient, or there’s a shift in electrolytes, or the patient is developing a reaction to the IV, or they’re experiencing respiratory discomfort that isn’t yet obvious on a monitor. The important thing: anxiety can change quickly and may precede more obvious physical changes.

Let’s break down the logic

• Vital signs vs. feelings: Numbers matter, but a patient’s reported discomfort or mood change can reveal problems a monitor misses. Anxiety can signal distress in organs that aren’t immediately reflected in a blood pressure reading.

• Fluid balance isn’t only about volume: If the body starts to hold onto fluid, you can get a cocktail of symptoms—tremors, restlessness, or breathlessness—that aren’t always obvious at first glance.

• Electrolyte shifts matter: Normal saline does carry sodium. If there’s an imbalance, a patient might feel unsettled or anxious even before other signs show up.

• Individual response varies: Some people tolerate IV fluids beautifully; others feel unsettled or anxious as the therapy starts addressing dehydration. It’s a reminder to tailor care to the person in front of you.

How a nurse should respond in the moment

If anxiety is the standout finding, here’s a practical way to approach the situation without overcomplicating things:

1. Acknowledge and assess calmly

• Let the patient know you’re listening: “I hear you’re feeling anxious. Let’s check a few things together.”

• Do a quick check of the mental state: orientation, confusion, agitation, or restlessness.

• Briefly check symptoms related to the anxiety: shortness of breath, chest tightness, dizziness, or sweating.

2. Review the IV setup and balance

• Confirm the IV rate and the infusion pump settings. Is the rate appropriate for dehydration but not rushing the system?

• Inspect the IV site for signs of infiltration, redness, or warmth. An irritated site can worsen distress.

• Check for signs of an adverse reaction to the IV fluid: wheezing, hives, or a sudden drop in oxygen saturation would change the plan.

3. Look at the bigger picture in the room

• Monitor respiratory status: rate, effort, and oxygen saturation. Anxiety can be a clue of hypoxia or evolving fluid overload in some contexts.

• Check for subtle fluid overload signs if the infusion is ongoing: crackles in the lungs, a sense of fullness in the legs, or elevated neck veins (as appropriate to your setting and patient).

4. Connect the dots with other data

• Compare the anxiety with the nausea. Sometimes nausea and anxiety share a root cause—like evolving dehydration symptoms or a reaction to IV access.

• Review recent labs if they’re available: electrolytes, kidney function, or acid-base status can help explain why a patient might feel unsettled.

5. Communicate and escalate thoughtfully

• Notify the primary healthcare provider with a concise, objective summary: this patient with dehydration on NS infusion is experiencing noticeable anxiety that could indicate a reaction, electrolyte shift, or evolving distress needing evaluation.

• Document clearly: when you noticed the anxiety, what you did to assess, the patient’s responses, and any actions taken.

• If the anxiety worsens, or if new symptoms appear (shortness of breath, chest pain, confusion, fainting), escalate immediately and consider stopping or slowing the IV per protocol.

A practical checklist you can keep handy

• Vitals and mental status: compare now to baseline; note any changes in orientation, mood, or agitation.

• IV assessment: rate, site condition, and pump alarms.

• Respiratory check: breath sounds, rate, effort, oxygen saturation.

• Cardio check: heart rate, rhythm, blood pressure trends.

• I&O at a glance: current urine output, urine color, and any signs of urinary issues.

• Pain and nausea: intensity, location, and how they respond to comfort measures or medications.

• Documentation: time, exact observation, what you informed the provider, and the plan.

A little context helps, not just clinical notes

Dehydration care isn’t just about fluids; it’s about a person who is trying to recover, sometimes while feeling a little vulnerable. A nurse’s voice, the way symptoms are acknowledged, and the responsiveness of the care team can make a big difference in how quickly a situation stabilizes. Anxiety, while tricky, can be a real driver for timely evaluation. It’s a cue that says, “Something deserves our careful attention now.”

Digressions that still point back to safety

If you’ve ever watched a patient regain color or a quiet sigh settle into a relieved breath after a quick adjustment—maybe the IV rate slowed, or a ladder of questions helped identify a trigger—you know what this is about. Small changes can have outsized effects when someone is recovering from dehydration. The same idea shows up when handing off care to a colleague: a quick, precise note about anxiety plus the context around the infusion rate creates a smoother continuation of care.

Two quick reminders that help most nurses

• Mental status matters in IV therapy as much as pulse and BP. If the patient feels off, investigate before the feeling becomes a crisis.

• Communication is part of the treatment. Clear, timely updates to the care team and to the patient can prevent a problem from growing.

A final thought

Anxiety in a patient receiving IV fluids isn’t inherently a “problem.” It’s a signal—a pointer toward a potential issue that deserves attention. The right response is a careful blend of clinical checks and compassionate listening. When you combine observation with quick communication, you’re not just managing fluids; you’re safeguarding a person’s safety, comfort, and confidence in their care.

If you’re moving through similar scenarios in your studies or daily rounds, keep this mindset: look for the signals beyond the numbers, check the patient’s experience as you check the lab results, and escalate when signs of distress emerge. That approach can make a real difference in outcomes, even in something as routine as IV normal saline for dehydration. And yes, that quiet anxiety your patient expresses? It just might be the most telling part of the whole picture.