An older-adult patient is receiving IV 0.9% NaCl and new crackles are heard at the lung bases. What is the priority action?

• A. Notify a health care provider.
• B. Decrease the IV flow rate.
• C. Lower the head of the bed.
• D. Discontinue the IV site.

Answer: (B)

Crackles at the lung bases in an older adult who is receiving IV 0.9% NaCl point to fluid overload from the IV fluids. The priority action is to decrease the IV flow rate to stop or slow the added fluid entering the circulation, which directly addresses the cause of pulmonary edema and can improve breathing quickly. After reducing the rate, continue to monitor respiratory status and vitals and notify the provider for further orders (such as fluid restriction, diuretics, or a change in IV therapy). Lowering the head of the bed can help ease breathing but does not stop the ongoing fluid overload, and discontinuing the IV site isn’t needed unless the IV itself is problematic.