Nokea
A patient with pancreatic cancer has been admitted to the critical care unit with clinical signs consistent with syndrome of inappropriate secretion of antidiuretic hormone. The nurse anticipates that clinical management of this condition will include
- A. administration of 3% normal saline.
- B. administration of exogenous vasopressin.
- C. fluid restriction.
- D. low sodium diet.
Correct Answer: C
Rationale: Step 1: Syndrome of inappropriate antidiuretic hormone (SIADH) leads to excess water retention, diluting sodium levels in the blood.
Step 2: Fluid restriction is the mainstay of treatment to prevent further dilution of sodium.
Step 3: Administering 3% normal saline (choice A) can worsen the condition by further increasing sodium levels.
Step 4: Exogenous vasopressin (choice B) would exacerbate the problem by increasing water retention.
Step 5: Low sodium diet (choice D) may be beneficial in the long term but is not the immediate priority.
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The patient is diagnosed with acute kidney injury and has been getting dialysis 3 days per week. The patient complains of general malaise and is tachypneic. An arterial blood gas shows that the patient’s pH is 19, with a PCO of 30 mm Hg and a bicarbonate level of 13 mEq/L. The nurse prepares to
- A. administer morphine to slow the respiratory rate.
- B. prepare for intubation and mechanical ventilation.
- C. administer intravenous sodium bicarbonate.
- D. cancel tomorrow’s dialysis session.
Correct Answer: B
Rationale: The correct answer is B: prepare for intubation and mechanical ventilation. The patient's arterial blood gas results indicate metabolic acidosis (low pH, low bicarbonate) with respiratory compensation (low PCO). In this scenario, the patient is likely experiencing respiratory fatigue due to tachypnea from metabolic acidosis. Intubation and mechanical ventilation are needed to support the patient's respiratory effort and correct the acid-base imbalance. Administering morphine (choice A) can further depress the respiratory drive. Administering intravenous sodium bicarbonate (choice C) can temporarily correct the pH but does not address the underlying respiratory distress. Canceling dialysis (choice D) is not indicated as it does not address the acute respiratory compromise.
The nurse has been assigned the following patients. Which patients require assessment of blood glucose control as a nursing priority? (Select all that apply.)
- A. 18-year-old male who has undergone surgical correction of a fractured femur
- B. 29-year-old female who is undergoing evaluation for pheochromocytoma
- C. 43-year-old male with acute pancreatitis who is receiving total parenteral nutrition (TPN)
- D. 62-year-old morbidly obese female who underwent a hysterectomy for ovarian cancer
Correct Answer: C
Rationale: The correct answer is C because the patient with acute pancreatitis receiving TPN is at risk for hyperglycemia due to the high glucose content in TPN. Monitoring blood glucose levels is crucial to prevent complications.
Explanation for why other choices are incorrect:
A: The 18-year-old male post-surgery for a fractured femur does not have a direct correlation to blood glucose control assessment.
B: The 29-year-old female undergoing evaluation for pheochromocytoma is not directly related to blood glucose control assessment.
D: The 62-year-old morbidly obese female post-hysterectomy for ovarian cancer does not specifically require immediate blood glucose control assessment.
A patient with type 1 diabetes who is receiving a continuous subcutaneous insulin infusion via an insulin pump contacts the clinic to report mechanical failure of the infusion pump. The nurse instructs the patient to begin monitoring for signs of:
- A. adrenal insufficiency.
- B. diabetic ketoacidosis.
- C. hyperosmolar, hyperglycemic state.
- D. hypoglycemia.
Correct Answer: B
Rationale: The correct answer is B: diabetic ketoacidosis. When an insulin pump fails, the patient may experience a sudden decrease in insulin delivery, leading to a potential rise in blood glucose levels. This can trigger diabetic ketoacidosis, characterized by hyperglycemia, ketosis, and acidosis. Monitoring for signs such as increased thirst, frequent urination, fruity breath odor, and rapid breathing is crucial.
Incorrect choices:
A: Adrenal insufficiency is not directly related to insulin pump failure.
C: Hyperosmolar, hyperglycemic state is more common in type 2 diabetes and typically occurs with extreme hyperglycemia, not sudden pump failure.
D: Hypoglycemia is less likely with pump failure due to decreased insulin delivery.
The nurse is caring for a patient with a diagnosis of head trauma. The nurse notes that the patient’s urine output has increased tremendously over the past 18 hours. The nurse suspects that the patient may be developing
- A. diabetes insipidus.
- B. diabetic ketoacidosis.
- C. hyperosmolar hyperglycemic syndrome.
- D. syndrome of inappropriate secretion of antidiuretic hormone.
Correct Answer: A
Rationale: Rationale: A patient with head trauma may develop diabetes insipidus due to damage to the hypothalamus or pituitary gland, leading to decreased secretion of antidiuretic hormone (ADH). This results in excessive urine output and thirst. Other options are incorrect because:
B: Diabetic ketoacidosis is associated with high blood sugar and ketones, not increased urine output.
C: Hyperosmolar hyperglycemic syndrome is characterized by extreme hyperglycemia, not increased urine output.
D: Syndrome of inappropriate secretion of antidiuretic hormone results in decreased urine output due to excess ADH.
The nurse is caring for a patient who underwent pituitary surgery 12 hours ago. The nurse will give priority to monitoring the patient carefully for which of the following?
- A. Congestive heart failure
- B. Hypovolemic shock
- C. Infection
- D. Volume overload
Correct Answer: B
Rationale: The correct answer is B: Hypovolemic shock. After pituitary surgery, patients are at risk for hypovolemic shock due to potential intraoperative blood loss and fluid shifts. Monitoring for signs of shock, such as hypotension and tachycardia, is crucial for early intervention. A: Congestive heart failure is less likely immediately post-surgery. C: Infection is a concern but not the highest priority in the immediate postoperative period. D: Volume overload is not a common immediate complication of pituitary surgery.