Nokea
The nurse is teaching a patient with persistent syndrome of inappropriate antidiuretic hormone (SIADH) about long-term management. Which of the following patient statements indicate that additional instruction is needed?
- A. I should weigh myself daily and report any sudden weight loss or gain.
- B. I need to limit my fluid intake to no more than 1 L of liquids a day.
- C. I will eat foods high in potassium because the diuretics cause potassium loss.
- D. I need to shop for foods that are low in sodium and avoid adding salt to foods.
Correct Answer: D
Rationale: Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other patient statements are correct and indicate successful teaching has occurred.
You may also like to solve these questions
After receiving change-of-shift report, which of the following four patients should the nurse assess first?
- A. A 31-year-old with Cushing's syndrome and a blood glucose level of 13.7 mmol/L.
- B. A 22-year-old admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 130 mmol/L.
- C. A 70-year-old who recently started taking levothyroxine and has an irregular pulse of 134
- D. A 53-year-old who has Addison's disease and is due for a scheduled dose of hydrocortisone.
Correct Answer: C
Rationale: Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The patient's high pulse rate needs rapid investigation by the nurse to assess for and intervene with any cardiac problems. The other patients also require nursing assessment and/or actions but are not at risk for life-threatening complications.
The nurse is caring for a patient who has had a transsphenoidal resection of a pituitary tumour. Which of the following nursing actions should be included in the postoperative plan of care?
- A. Monitor urine output every hour.
- B. Palpate extremities for dependent edema.
- C. Check hematocrit hourly for first 12 hours.
- D. Obtain continuous pulse oximetry for 24 hours.
Correct Answer: A
Rationale: After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema and monitoring of urine output and urine specific gravity is essential. Hemorrhage is not a common problem. There is no need to check the hematocrit hourly. The patient is at risk for dehydration, not volume overload. The patient is not at high risk for problems with oxygenation, and continuous pulse oximetry is not needed.
A patient is being treated with a medication to block the effect of antidiuretic hormone to control the symptoms of syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings indicates that the medication is effective?
- A. Decreased peripheral edema
- B. Increased weight
- C. Increased urine specific gravity
- D. Increased urinary output
Correct Answer: D
Rationale: Agents that block the effect of ADH on the renal tubules may be prescribed, thereby allowing more dilution of urine leading to an increased urine output. An increase in weight or an increase in urine specific gravity indicates that the SIADH is not corrected. Peripheral edema does not occur with SIADH. A sudden weight gain without edema is a common clinical manifestation of this disorder.
When developing a plan of care for a patient with syndrome of inappropriate antidiuretic hormone (SIADH), which of the following interventions should the nurse include?
- A. Encourage fluids to 2000 mL/day.
- B. Offer patient ice chips to suck on.
- C. Monitor for increased peripheral edema.
- D. Keep head of bed elevated to 30 degrees.
Correct Answer: B
Rationale: Sucking on ice chips or chewing sugarless gum decreases thirst for a patient on fluid restriction. Patients with SIADH are on fluid restrictions of 800-1000 mL/day. Peripheral edema is not seen with SIADH. The head of the bed is elevated no more than 10 degrees to increase left atrial filling pressure and decrease antidiuretic hormone (ADH) release.
Which of the following information obtained by the nurse when caring for a patient who has diabetes insipidus (DI) is most important to report to the health care provider?
- A. History of a recent head injury
- B. Confusion and lethargy
- C. Urine output of 400 mL/hour
- D. Urine specific gravity is 1.003
Correct Answer: B
Rationale: The patient's confusion and lethargy may indicate hypernatremia and should be addressed quickly. In addition, patients with DI compensate for fluid losses by drinking copious amounts of fluids, but a patient who is lethargic will be unable to drink enough fluids and will become hypovolemic. A high urine output, low urine specific gravity, and history of a recent head injury are consistent with diabetes insipidus, but they do not require immediate nursing action to avoid life-threatening complications.