Di and Siadh

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Sample questions from Di and Siadh

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.In the post-anesthesia unit, a 31-year-old client is 6 hours post transsphenoidal hypophysectomy. Urine output has increased from 80 mL to 620 mL/hr over 2 hours, urine specific gravity is 1.002, serum sodium is 151 mEq/L, and the client reports intense thirst. Which action should the nurse take first?

   • A.Administer the next scheduled dose of corticosteroid.
   • B.Restrict oral fluids to prevent worsening hypernatremia.
   • C.Obtain a urine culture before taking further action.
   • D.Notify the surgeon of findings consistent with acute diabetes insipidus.

   Rationale: The abrupt high-volume dilute urine, thirst, and hypernatremia after pituitary surgery suggest acute diabetes insipidus requiring prompt provider notification and treatment. Restricting fluids would worsen the free-water deficit, and a urine culture does not address the immediate threat. Corticosteroids may be prescribed after pituitary surgery, but giving a scheduled dose does not treat this acute change.

2. 2.During a home visit, a 42-year-old client with central diabetes insipidus says, "I feel fine, so I sometimes skip my desmopressin when I am busy." The client reports urinating hourly and has dry oral mucosa. Which response by the nurse is most appropriate?

   • A.Take the medication only when urine output becomes uncomfortable.
   • B.Resume the prescribed schedule and contact the prescriber today about the missed doses and symptoms.
   • C.Double the next dose to make up for the missed doses.
   • D.Limit fluid intake until the frequent urination stops.

   Rationale: Frequent urination and dry mucosa suggest inadequate antidiuretic effect and possible dehydration, so the client needs guidance to resume the prescribed regimen and contact the prescriber promptly. Taking desmopressin only when symptoms are uncomfortable can allow significant fluid loss, while doubling a dose can cause water retention and hyponatremia. Fluid restriction is unsafe when diabetes insipidus is causing ongoing water loss.

3. 3.At change of shift, a nurse receives report on four clients. Which client should the nurse assess first?

   • A.A 54-year-old with SIADH whose sodium decreased from 124 to 122 mEq/L over 4 hours and who is newly disoriented
   • B.A 23-year-old with SIADH who reports nausea while receiving a prescribed fluid restriction
   • C.A 63-year-old with central diabetes insipidus whose urine output is 250 mL/hr and sodium is 148 mEq/L, unchanged from the prior result
   • D.A 71-year-old with diabetes insipidus who requests assistance to the bathroom for the third time this hour

   Rationale: New disorientation with a rapidly declining sodium level indicates worsening hyponatremia and possible cerebral edema, making this client the priority. The client with diabetes insipidus needs continued monitoring, but the stated output and sodium are unchanged and there is no acute neurologic change. Nausea and frequent urination warrant follow-up, but neither is as immediately concerning as acute mental-status change with falling sodium.

4. 4.Refer to the client's chart. A 16-year-old is being treated for SIADH after a central nervous system infection. Which findings require the nurse to escalate care promptly? Select all that apply.

   • A.Urine output is 20 mL/hr while the fluid restriction is in place.
   • B.The sodium level falls from 126 to 121 mEq/L over 2 hours.
   • C.The client reports mild thirst and has moist oral mucosa.
   • D.The client becomes difficult to arouse compared with the 0800 assessment.
   • E.The client has a generalized seizure at 1000.

   Answer and rationale are in the full material.

5. 5.A 78-year-old client with SIADH is receiving a continuous 3% sodium chloride infusion through a central venous catheter. The sodium level increased from 116 to 121 mEq/L in 4 hours. Which action should the nurse take?

   • A.Administer desmopressin to prevent further sodium elevation.
   • B.Continue the infusion at the current rate because the sodium remains below normal.
   • C.Pause the infusion and promptly clarify the order with the provider.
   • D.Encourage the client to drink water to slow the sodium increase.

   Answer and rationale are in the full material.