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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.
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The nurse is admitting a patient with Graves' disease to the emergency department in thyrotoxic crisis. Which of these prescribed medications should the nurse administer first?
- A. Propranolol
- B. Propylthiouracil
- C. Methimazole
- D. Iodine
Correct Answer: A
Rationale: β-Adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm. The other medications take days to weeks to have an impact on thyroid function.
The nurse is caring for a patient with acute adrenal insufficiency. Which of the following findings indicate that the prescribed therapies are effective?
- A. Increasing serum sodium levels
- B. Decreasing blood glucose levels
- C. Decreasing serum chloride levels
- D. Increasing serum potassium levels
Correct Answer: A
Rationale: Clinical manifestations of Addison's disease include hyponatremia and an increase in sodium level indicates improvement. The other values indicate that treatment has not been effective.
The nurse is caring for a patient with inappropriate antidiuretic hormone (SIADH) due to a head trauma who is receiving a hypertonic saline IV solution to counteract hyponatremia. The nurse will expect the saline solution to be administered until the patient's serum sodium reaches which of the following levels?
- A. 120 mmol/L.
- B. 130 mmol/L.
- C. 128 mmol/L.
- D. 138 mmol/L.
Correct Answer: C
Rationale: If the patient is hyponatremic, hypertonic saline may be administered until the serum sodium level reaches at least 130 mmol/L. Hypernatremia is evident with a sodium level of 168 mmol/L.
The nurse is caring for a patient with hyperthyroidism who is being treated with radioactive iodine (RAI) at the clinic. Which of the following information should the nurse provide to the patient prior to discharge?
- A. Symptoms of hyperthyroidism should be relieved in about a week.
- B. Hypothyroidism may occur as the RAI therapy takes effect.
- C. Discontinue the antithyroid medications taken before the radioactive therapy.
- D. Teach radioactive precautions to use with urine, stool, and other body secretions.
Correct Answer: B
Rationale: There is a high incidence of postradiation hypothyroidism after RAI, and the patient should be monitored for symptoms of hypothyroidism. RAI has a delayed response, with the maximum effect not seen for 2-3 months, and the patient will continue to take antithyroid medications during this time. The therapeutic dose of radioactive iodine is low enough that no radiation safety precautions are needed.
The nurse is admitting a patient with possible syndrome of inappropriate antidiuretic hormone (SIADH) due to a head trauma. Which of the following information obtained by the nurse is most important to communicate rapidly to the health care provider?
- A. The patient complains of dyspnea with activity.
- B. The patient has a urine specific gravity of 1.025.
- C. The patient has a recent weight gain of 5.6 kg.
- D. The patient has a serum sodium level of 119 mmol/L.
Correct Answer: D
Rationale: A serum sodium of less than 120 mmol/L increases the risk for complications such as seizures and needs rapid correction. The other data are not unusual for a patient with SIADH and do not indicate the need for rapid action.