Nokea
Which of the following laboratory values would be found in a patient with syndrome of inappropriate secretion of antidiuretic hormone?
- A. Fasting blood glucose 156 mg/dL
- B. Serum potassium 5.8 mEq/L
- C. Serum sodium 115 mEq/L
- D. Serum sodium 152 mEq/L
Correct Answer: C
Rationale: The correct answer is C, Serum sodium 115 mEq/L. In syndrome of inappropriate secretion of antidiuretic hormone (SIADH), there is excess release of ADH leading to water retention and dilutional hyponatremia. Low serum sodium levels (hyponatremia) are characteristic of SIADH due to water retention without proportional sodium retention. Choices A and B are not indicative of SIADH. Choice D, high serum sodium, is more likely in conditions causing dehydration or excessive sodium intake.
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A normal urine output is considered to be
- A. 80 to 125 mL/min.
- B. 180 L/day.
- C. 80 mL/min.
- D. 1 to 2 L/day.
Correct Answer: D
Rationale: The correct answer is D: 1 to 2 L/day. Normal urine output typically ranges from 1 to 2 liters per day, which is considered adequate for maintaining proper hydration and eliminating waste products. A: 80 to 125 mL/min is too low for daily output. B: 180 L/day is excessively high and unrealistic. C: 80 mL/min is also too low for daily urine output. Therefore, D is the most appropriate choice based on standard guidelines for urine excretion.
The patient is admitted with complaints of general malaise and fatigue, along with a decreased urinary output. The patient’s urinalysis shows coarse, muddy brown granular casts and hematuria. The nurse determines that the patient has:
- A. acute kidney injury from a prerenal condition.
- B. acute kidney injury from postrenal obstruction.
- C. intrarenal disease, probably acute tubular necrosis.
- D. a urinary tract infection.
Correct Answer: C
Rationale: The correct answer is C: intrarenal disease, probably acute tubular necrosis. The presence of coarse, muddy brown granular casts and hematuria in the urinalysis indicates damage to the renal tubules, which is characteristic of acute tubular necrosis. This condition is a type of intrarenal disease where there is direct damage to the kidney tubules, leading to decreased urinary output and symptoms like malaise and fatigue. Prerenal and postrenal conditions do not typically present with granular casts and hematuria, making choices A and B incorrect. Urinary tract infection is also unlikely to cause the specific findings seen in this case, ruling out choice D. Therefore, choice C is the most appropriate based on the urinalysis results and clinical presentation.
The patient is on intake and output (I&O), as well as daily weights. The nurse notes that output is considerably less than intake over the last shift, and daily weight is 1 kg more than yesterday. The nurse should
- A. draw a trough level after the next dose of antibiotic.
- B. obtain an order to place the patient on fluid restriction.
- C. assess the patient’s lungs.
- D. insert an indwelling catheter.
Correct Answer: C
Rationale: The correct answer is C: assess the patient's lungs. The discrepancy between intake, output, and weight gain indicates a potential fluid imbalance. By assessing the patient's lungs, the nurse can identify signs of fluid overload, such as crackles or difficulty breathing, which could explain the weight gain and imbalance. This step is crucial in determining the underlying cause and guiding further interventions. Drawing a trough level (A) or inserting an indwelling catheter (D) are not necessary at this point and may not address the immediate issue. Placing the patient on fluid restriction (B) should only be considered after a thorough assessment to determine the cause of the imbalance.
A patient has been on daily, high-dose glucocorticoid therapy for the treatment of rheumatoid arthritis. His prescription runs out before his next appointment with his physician. Because he is asymptomatic, he thinks it is all right to withhold the medication for 3 days. What is likely to happen to this patient?
- A. He will go into adrenal crisis.
- B. He will go into thyroid storm.
- C. His autoimmune disease will go into remission.
- D. Nothing; it is appropriate to stop the medication for 3 days.
Correct Answer: A
Rationale: The correct answer is A: He will go into adrenal crisis.
Rationale:
1. Glucocorticoids suppress the body's natural production of cortisol.
2. Abruptly stopping high-dose glucocorticoid therapy can lead to adrenal insufficiency.
3. Adrenal crisis can result in symptoms like weakness, fatigue, hypotension, and potentially life-threatening consequences.
4. This patient, being on high-dose glucocorticoid therapy, is at risk for adrenal crisis if he abruptly stops the medication.
Summary:
B: Thyroid storm is not related to abruptly stopping glucocorticoid therapy.
C: Autoimmune disease remission is unlikely to occur within 3 days of stopping medication.
D: It is not appropriate to stop high-dose glucocorticoid therapy abruptly, as it can lead to adverse effects like adrenal crisis.
In the management of diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome, when is an intravenous (IV) solution that contains dextrose started?
- A. Never; normal saline is the only appropriate solution in diabetes management
- B. When the blood sugar reaches 70 mg/dL
- C. When the blood sugar reaches 150 mg/dL
- D. When the blood glucose reaches 250 mg/dL
Correct Answer: D
Rationale: Correct Answer: D
Rationale: In diabetic emergencies, starting IV dextrose at 250 mg/dL prevents hypoglycemia while resolving ketoacidosis. Below 250 mg/dL, the body can use endogenous glucose, so IV dextrose is not necessary.
Summary:
A: Incorrect. Normal saline may be used for initial fluid resuscitation but does not address the need for glucose.
B: Incorrect. Starting dextrose at 70 mg/dL may lead to unnecessary hyperglycemia and complications.
C: Incorrect. Waiting until 150 mg/dL delays the provision of necessary glucose for metabolic functions.