A patient with confusion and hyponatremia. What safety measure should the nurse implement first?

• A. Seizure precautions and monitor mental status; manage fluids as ordered
• B. Restrain the patient
• C. Increase oral sodium intake immediately
• D. Place patient in isolation

Answer: (A)

When confusion occurs with hyponatremia, the top priority is keeping the patient safe from injury as brain function is fragile and seizures can occur. Implementing seizure precautions and closely monitoring mental status directly addresses the immediate risk to the patient’s safety and neurologic status. This means preparing for potential seizures (quiet, padded environment, keep side rails up and padded if needed, suction and airway equipment ready, call bell within reach) and regularly assessing for changes in level of consciousness or new neurologic signs so you can respond quickly.

Fluid management and other orders come next and should be carried out exactly as prescribed, since correcting sodium too rapidly can cause serious complications. Restraining the patient or placing them in isolation don’t address the urgent safety risk and aren’t appropriate first steps. Increasing oral sodium immediately isn’t appropriate without a provider’s order and assessment, because the underlying cause of hyponatremia must be identified and corrected carefully.