| Course | NU651 AGACNP Introduction to Acute Care Management Clinical I |
|---|---|
| Unit | Unit 7 |
| Paper type | Clinical question brief |
| Length | About 670 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU651 Unit 7
Would Saline Do as Well? A Clinical Question Brief on Balanced Crystalloids for Noncritically Ill Adults on the Medical Floor
[Student Name]
Purdue University Global
NU651: AGACNP Introduction to Acute Care Management Clinical I
Unit 7 Clinical Question Brief
[Instructor Name]
[Date]
The bedside exchange is composite; the trials and their results are real and cited.
Where the Question Came From
On the second morning of the rotation, my preceptor ordered lactated Ringer's at [125] mL per hour for a [52]-year-old woman admitted to the medical floor after [two] days of vomiting from gastroenteritis. Her nurse asked, without challenge, whether saline would do as well, since it was what the unit stocked in larger quantities. My preceptor said the evidence favored balanced fluids and asked me to find out how strong that evidence was for a patient like this one.
The Question
P: noncritically ill adults receiving intravenous fluids in hospital. I: balanced crystalloids, lactated Ringer's or Plasma-Lyte. C: 0.9 percent saline. O: major adverse kidney events within 30 days, a composite of death, new dialysis or persistent kidney dysfunction, with hospital-free days as a second outcome. Limiting the population to patients outside intensive care is what makes the question answerable, and it is also what keeps most of the famous trials out of the answer.
Search
PubMed and CINAHL, searched on [Day 2] with the terms balanced crystalloid, lactated Ringer's, Plasma-Lyte, saline, sodium chloride and randomized, limited to adults, English and 2015 onward. The search returned [148] records; [four] randomized trials addressed the comparison directly, one in noncritically ill patients and three in intensive care.
Evidence Table
1. SALT-ED (Self et al., 2018). Population: 13,347 adults treated with fluids in one emergency department and admitted outside intensive care. Design: pragmatic, cluster crossover by month. Primary outcome: hospital-free days, no difference (median 25 in each group). Secondary outcome: major adverse kidney events within 30 days, 4.7 percent with balanced fluids against 5.6 percent with saline.
2. SMART (Semler et al., 2018). Population: 15,802 critically ill adults in five intensive care units. Primary outcome: major adverse kidney events within 30 days, 14.3 against 15.4 percent, favoring balanced fluids.
3. BaSICS (Zampieri et al., 2021). Population: 11,052 critically ill adults in Brazil. Primary outcome: 90-day mortality, no significant difference between a balanced solution and saline.
4. PLUS (Finfer et al., 2022). Population: 5,037 critically ill adults in Australia and New Zealand. Primary outcome: 90-day mortality, 21.8 against 22.0 percent, no difference; no difference in new dialysis.
Bottom Line
For noncritically ill adults like the patient who prompted the question, one large pragmatic trial found no difference in the primary outcome, hospital-free days, and a small reduction in major kidney events with balanced fluids, about one event avoided for every hundred patients. That kidney finding was a secondary outcome, from one center, with crossover by month rather than individual randomization, so the certainty is moderate at best. The intensive care trials are mixed: SMART found a similar small kidney benefit, while BaSICS and PLUS, both larger and blinded or individually randomized, found no difference in death or dialysis. They cannot be pooled with SALT-ED, because critically ill patients receive more fluid for longer.
Certainty, graded in words: moderate that balanced fluids do not change hospital length of stay for noncritically ill adults; low to moderate that they slightly reduce kidney events; low that they change mortality in any hospital population.
What This Means at the Bedside
For this patient, lactated Ringer's is a reasonable default and at least as safe as saline, but the evidence does not make saline wrong. The practical answer to the nurse is that either fluid is acceptable for a short course in a noncritically ill adult, that balanced fluids may carry a small kidney advantage, and that the choice matters more when volumes are large or the patient has acidosis or kidney injury. I will share the table with the unit's practice council, since stocking decisions are where this question will actually be settled.
References
Finfer, S., Micallef, S., Hammond, N., Navarra, L., Bellomo, R., Billot, L., Delaney, A., Gallagher, M., Gattas, D., Li, Q., Mackle, D., Mysore, J., Saxena, M., Taylor, C., Young, P., & Myburgh, J. (2022). Balanced multielectrolyte solution versus saline in critically ill adults. New England Journal of Medicine, 386(9), 815-826. https://doi.org/10.1056/NEJMoa2114464
Self, W. H., Semler, M. W., Wanderer, J. P., Wang, L., Byrne, D. W., Collins, S. P., Slovis, C. M., Lindsell, C. J., Ehrenfeld, J. M., Siew, E. D., Shaw, A. D., Bernard, G. R., & Rice, T. W. (2018). Balanced crystalloids versus saline in noncritically ill adults. New England Journal of Medicine, 378(9), 819-828. https://doi.org/10.1056/NEJMoa1711586
Semler, M. W., Self, W. H., Wanderer, J. P., Ehrenfeld, J. M., Wang, L., Byrne, D. W., Stollings, J. L., Kumar, A. B., Hughes, C. G., Hernandez, A., Guillamondegui, O. D., May, A. K., Weavind, L., Casey, J. D., Siew, E. D., Shaw, A. D., Bernard, G. R., & Rice, T. W. (2018). Balanced crystalloids versus saline in critically ill adults. New England Journal of Medicine, 378(9), 829-839. https://doi.org/10.1056/NEJMoa1711584
Zampieri, F. G., Machado, F. R., Biondi, R. S., Freitas, F. G. R., Veiga, V. C., Figueiredo, R. C., Lovato, W. J., Amêndola, C. P., Serpa-Neto, A., Paranhos, J. L. R., Guedes, M. A. V., Lúcio, E. A., Oliveira-Júnior, L. C., Lisboa, T. C., Lacerda, F. H., Maia, I. S., Grion, C. M. C., Assunção, M. S. C., Manoel, A. L. O., . . . Cavalcanti, A. B. (2021). Effect of intravenous fluid treatment with a balanced solution vs 0.9% saline solution on mortality in critically ill patients: The BaSICS randomized clinical trial. JAMA, 326(9), 818-829. https://doi.org/10.1001/jama.2021.11684
NU651 Unit 7 instructions, in plain terms
The Unit 7 assignment asks you to turn a question that came up during your rotation into a searchable clinical question and answer it from the best available evidence. You describe where the question came from, state it in PICO form, document the search, summarize the relevant studies in a table, give a bottom line graded by certainty and explain what it means for the patient who prompted it. Most prompts expect two pages. The question should be narrow enough that a small set of studies can answer it, and studies from other populations should be labeled as indirect rather than pooled.
Inside the NU651 Unit 7 example
The example opens with the bedside exchange in a few sentences, including the preceptor's request that started the search. The PICO question is set out one element per line, and a highlighted sentence explains why limiting the population matters. The search paragraph names databases, terms, limits and counts. A numbered evidence table gives each trial's population, design and results, with SALT-ED first because it matches the population. The bottom line distinguishes the primary and secondary outcomes and explains why the intensive care trials cannot be pooled. Certainty is graded separately for length of stay, kidney events and mortality. A closing paragraph gives the nurse a plain answer and names where the table will go next.
NU651 Unit 7 rubric: what earns full points
The Unit 7 rubric awards points for the clinical question, the search strategy, the appraisal and summary of evidence, the conclusion and its application. The question earns full credit when every PICO element is specific. The search counts when it could be repeated from what is written. Appraisal is judged on reporting results accurately and on noting design features, such as SALT-ED's crossover by month. The conclusion should match the strength of the evidence rather than overstate it. Application earns points when the answer returns to the original patient and the nurse's question, and when the brief says who should receive it next. A table that a reader can scan in under a minute also helps the grader find each result.
Common NU651 Unit 7 mistakes, and how to avoid them
The most common mistake is asking a question too broad to answer, such as which IV fluid is best. Another is pooling intensive care trials with a floor population. Students often report a secondary outcome as though it were the primary one. Search strategies are frequently described too vaguely to repeat. Some briefs conclude that one fluid is always better, which the evidence does not support. Certainty is often left ungraded. And many briefs never return to the bedside, leaving the nurse who asked without an answer she can use. Also date the search, because a brief on a question like this can age within a year or two.
Get an NU651 Unit 7 example written to your instructions
Bring the rough bedside question as it was first asked; the NU651 Unit 7 sample does the narrowing, population and outcome first. Add the rubric and whatever evidence hierarchy applies, and the inputs are complete. The first brief costs nothing, is back within 24-48h and reports primary results before secondary ones. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NU651 Unit 7 questions, answered
How narrow should a clinical question be?
Narrow enough that a small set of studies answers it directly. The sample limits the population to noncritically ill adults and fixes one outcome before searching, which is why a single pragmatic trial can carry the answer. A question about all hospitalized patients and every outcome would need a systematic review the brief cannot produce.
Why include intensive care trials if they do not match?
Because a reader will ask about them, and they show whether the floor finding is consistent with evidence in sicker patients. The sample labels them as indirect and does not pool them with the matching trial. Presenting neighboring evidence honestly, with its limits named, is stronger than ignoring it or letting it stand in for a direct answer.
Does the brief tell clinicians which fluid to use?
It states what the evidence suggests for the population in the question, graded by certainty, and names the exceptions. Fluid choices for real patients rest with treating teams and their protocols. The sample is an exercise framed around an invented bedside exchange, and nothing in it is advice about an actual patient.
Where can I find a free NU651 Unit 7 sample paper?
This page contains the full NU651 Unit 7 clinical question brief, with the PICO question, search, four-trial evidence table and graded bottom line. For a question from your own rotation, a free brief can be drafted from what you send.
Is lactated Ringer's better than saline for floor patients in NU651 Unit 7?
The sample finds no difference in hospital-free days and a small reduction in major kidney events with balanced fluids in SALT-ED, graded as moderate certainty at best. Either fluid is reasonable for a short course; the choice matters more with large volumes.