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.
A patient with a history of type 1 diabetes and an eating disorder is found unconscious. In the emergency department, the following lab values are obtained: Glucose: 648 mg/dL pH: 88 P CO : 20 mm Hg a 2 P O : 95 mm Hg a 2 HCO ¯: undetectable Anion gap: >31 Na+: 127 mEq/L K+: 5 mEq/L Creatinine: 8 mg/dL After the patient’s airway and ventilation have been established, the next priority for this patient is:
- A. administration of a 1-L normal saline fluid bolus.
- B. administration of 0.1 unit of regular insulin IV push followed by an insulin infusion.
- C. administration of 20 mEq KCl in 100 mL.
- D. IV push administration of 1 amp of sodium bicarbonate.
Correct Answer: A
Rationale: The correct answer is A: administration of a 1-L normal saline fluid bolus. In this scenario, the patient is likely experiencing diabetic ketoacidosis (DKA) due to the extremely high glucose levels, low bicarbonate, and anion gap metabolic acidosis. The priority is to correct the dehydration and electrolyte imbalances through fluid resuscitation with normal saline to improve perfusion and reverse the metabolic derangements. Options B, C, and D do not address the immediate need for volume resuscitation and correction of dehydration. Administering insulin or potassium without first addressing the fluid deficit could lead to further complications. Sodium bicarbonate is not recommended in DKA as it can worsen acidosis and has not been shown to improve outcomes.
Mechanisms for development of diabetes insipidus include which of the following? (Select all that apply.)
- A. ADH deficiency
- B. ADH excess
- C. ADH insensitivity
- D. ADH replacement therapy
Correct Answer: A
Rationale: The correct answer is A: ADH deficiency. Diabetes insipidus is caused by a deficiency of antidiuretic hormone (ADH), leading to excessive urine production and thirst. ADH is responsible for regulating water reabsorption in the kidneys. When ADH levels are low or absent, the kidneys cannot concentrate urine effectively, resulting in excessive urine output.
Explanation for why other choices are incorrect:
B: ADH excess would not lead to diabetes insipidus, as it would result in increased water reabsorption and concentrated urine.
C: ADH insensitivity refers to a condition where the body does not respond to ADH, but it does not cause diabetes insipidus.
D: ADH replacement therapy is actually a treatment for diabetes insipidus, not a mechanism for its development.
The patient’s potassium level is 0 mEq/L. Besides dialysis, which of the following actually reduces plasma potassium levels and total body potassium content safely in a patient with renal dysfunction?
- A. Sodium polystyrene sulfonate
- B. Sodium polystyrene sulfonate with sorbitol
- C. Regular insulin
- D. Calcium gluconate
Correct Answer: A
Rationale: The correct answer is A: Sodium polystyrene sulfonate. It works by exchanging sodium ions for potassium ions in the colon, leading to potassium excretion. A is the safest option without the risk of causing hypernatremia or intestinal necrosis like B. Regular insulin (C) may cause hypoglycemia and is not as effective as A in reducing potassium levels. Calcium gluconate (D) does not directly reduce potassium levels and is used for treating hyperkalemia-related cardiac toxicity.
Factors associated with the development of nephrogenic diabetes insipidus include which of the following? (Select all that apply.)
- A. Heredity
- B. Medications
- C. Meningitis
- D. Pituitary tumors
Correct Answer: A
Rationale: The correct answer is A: Heredity. Nephrogenic diabetes insipidus can be inherited as a genetic condition. The mutation in genes responsible for regulating water balance in the kidneys can lead to this disorder. Other choices are incorrect: B: Medications like lithium can cause acquired nephrogenic diabetes insipidus, not its development. C: Meningitis is an inflammatory condition that does not directly relate to nephrogenic diabetes insipidus. D: Pituitary tumors are associated with central diabetes insipidus, not nephrogenic.