Exam 4 Medsurg Notes Questions With Complete Solutions
The nurse has admitted a patient with hyperglycemic
hyperosmolar state (HHS). Which medical intervention
would the nurse expect to see ordered for this patient?
a. rapid rehydration with intravenous fluids
b. insertion of a pulmonary artery catheter
c. administration of high dose intravenous insulin
d. hourly monitoring of uring glucose and ketones levels
a. rapid rehydration with intravenous fluids
•rapid rehydration, insulin replacement, and correction of
electrolyte abnormalities, specifically potassium replacement.
The underlying stimulus of HHS must be discovered and treated.
The same basic principles used to treat DKA are used for the
patient with HHS.
•rapid rehydration to restore the intravascular volume.
Physiologic saline solution (0.9%) is infused at 1 L/h, especially
for the patient in hypovolemic shock if there is no
cardiovascular contraindication. Infusion volumes are adjusted
according to the patient’s hydration state and sodium level.
A patient has been admitted after surgery for removal of a
brain tumor. The nurse suspects the patient may be
developing diabetes insipidus (DI). Which findings would
confirm the nurse’s suspicion?
a. hyperglycemia and hyperosmolarity
,b. hyperglycemia and peripheral edema
c. intense thirst and passage of excessively large quantities of
dilute urine
d. peripheral edema and pulmonary crackles
c. intense thirst and passage of excessively large quantities of
dilute urine
-very dilute urination
-Clinical manifestations
•Increased dilute UO, Severe thirst, restlessness, agitation, ↓
reflexes, seizures, bladder distention, tachycardia, hypotension
-Laboratory studies
•Serum sodium > 145 mEq/L (reference: 134~145)
•Serum osmolality > 295 mOsm/kg H2O (reference 275~295)
•Urine osmolality < 300 mOsm/kg H2O (Reference: 300~1400)
•Urine SG < 1.005 (Reference: 1.005~1.030)
•Measurement of ADH (reference: 1~5 pg/mL)
•Urine output: 1~1.5L/hr (reference: 1~1.5L/day)
The nurse is caring for a patient with a head injury who has
developed diabetes insipidus (DI). What medication would
the nurse expect to be prescribed for the patient?
a. vasopressin
b. insulin
,c. glucagon
d. propylthiouracil
a. vasopressin
•Patients with central DI who are unable to synthesize ADH
require replacement with ADH or an ADH analogue. The most
commonly prescribed medication is the synthetic analogue of
ADH, desmopressin (DDAVP). It is preferred over vasopressin
(Pitressin) because it has a stronger antidiuretic action with little
effect on BP.
•The mainstay of therapy is to stop any medications that are
inducing the ADH resistance. Nephrogenic DI is not a diagnosis
encountered in critical care unless the patient is admitted with
this condition. It is treated with the diuretic hydrochlorothiazide,
with the dosage titration based upon the patient’s antidiuretic
response.
Which pathophysiologic mechanism occurs in the syndrome
of inappropriate antidiuretic hormone(SIADH)?
a. hemoconcentration
b. dilutional hyponatremia
c. massive diuresis
d. hypermetabolism
b. dilutional hyponatremia
>Fluid and electrolyte disturbances: Overhydration
>Altered sodium balance: dilutional hyponatremia
, •The patient with SIADH has an excess of ADH secreted into
the bloodstream, more than the amount needed to maintain
normal blood volume and serum osmolality. Excessive water is
resorbed at the kidney tubule, leading to dilutional
hyponatremia.
Which nursing intervention should be initiated on all patients
with the syndrome of inappropriate antidiuretic hormone
(SIADH)?
a. placing the patient on an air mattress
b. encouraging oral fluids
c. initiating seizures precautions
d. applying soft restraints
c. initiating seizures precautions
•Symptoms of severe hyponatremia include inability to
concentrate, mental confusion, apprehension, seizures,
decreased level of consciousness, coma, and death.
Remove causes of SIADH
Fluid restriction: 0.5-1L a day
Sodium replacement:
•Hypertonic solution (3% saline) over 24 hours slowly while
monitoring electrolytes (Na: no more than ↑10mEq/24hrs)
Medications: when water restriction does not work
•Vasopressin receptor antagonistsConivaptan (Vaprisol®)
Monitor side effects: e.g., hypotension
Nursing management
The nurse has admitted a patient with hyperglycemic
hyperosmolar state (HHS). Which medical intervention
would the nurse expect to see ordered for this patient?
a. rapid rehydration with intravenous fluids
b. insertion of a pulmonary artery catheter
c. administration of high dose intravenous insulin
d. hourly monitoring of uring glucose and ketones levels
a. rapid rehydration with intravenous fluids
•rapid rehydration, insulin replacement, and correction of
electrolyte abnormalities, specifically potassium replacement.
The underlying stimulus of HHS must be discovered and treated.
The same basic principles used to treat DKA are used for the
patient with HHS.
•rapid rehydration to restore the intravascular volume.
Physiologic saline solution (0.9%) is infused at 1 L/h, especially
for the patient in hypovolemic shock if there is no
cardiovascular contraindication. Infusion volumes are adjusted
according to the patient’s hydration state and sodium level.
A patient has been admitted after surgery for removal of a
brain tumor. The nurse suspects the patient may be
developing diabetes insipidus (DI). Which findings would
confirm the nurse’s suspicion?
a. hyperglycemia and hyperosmolarity
,b. hyperglycemia and peripheral edema
c. intense thirst and passage of excessively large quantities of
dilute urine
d. peripheral edema and pulmonary crackles
c. intense thirst and passage of excessively large quantities of
dilute urine
-very dilute urination
-Clinical manifestations
•Increased dilute UO, Severe thirst, restlessness, agitation, ↓
reflexes, seizures, bladder distention, tachycardia, hypotension
-Laboratory studies
•Serum sodium > 145 mEq/L (reference: 134~145)
•Serum osmolality > 295 mOsm/kg H2O (reference 275~295)
•Urine osmolality < 300 mOsm/kg H2O (Reference: 300~1400)
•Urine SG < 1.005 (Reference: 1.005~1.030)
•Measurement of ADH (reference: 1~5 pg/mL)
•Urine output: 1~1.5L/hr (reference: 1~1.5L/day)
The nurse is caring for a patient with a head injury who has
developed diabetes insipidus (DI). What medication would
the nurse expect to be prescribed for the patient?
a. vasopressin
b. insulin
,c. glucagon
d. propylthiouracil
a. vasopressin
•Patients with central DI who are unable to synthesize ADH
require replacement with ADH or an ADH analogue. The most
commonly prescribed medication is the synthetic analogue of
ADH, desmopressin (DDAVP). It is preferred over vasopressin
(Pitressin) because it has a stronger antidiuretic action with little
effect on BP.
•The mainstay of therapy is to stop any medications that are
inducing the ADH resistance. Nephrogenic DI is not a diagnosis
encountered in critical care unless the patient is admitted with
this condition. It is treated with the diuretic hydrochlorothiazide,
with the dosage titration based upon the patient’s antidiuretic
response.
Which pathophysiologic mechanism occurs in the syndrome
of inappropriate antidiuretic hormone(SIADH)?
a. hemoconcentration
b. dilutional hyponatremia
c. massive diuresis
d. hypermetabolism
b. dilutional hyponatremia
>Fluid and electrolyte disturbances: Overhydration
>Altered sodium balance: dilutional hyponatremia
, •The patient with SIADH has an excess of ADH secreted into
the bloodstream, more than the amount needed to maintain
normal blood volume and serum osmolality. Excessive water is
resorbed at the kidney tubule, leading to dilutional
hyponatremia.
Which nursing intervention should be initiated on all patients
with the syndrome of inappropriate antidiuretic hormone
(SIADH)?
a. placing the patient on an air mattress
b. encouraging oral fluids
c. initiating seizures precautions
d. applying soft restraints
c. initiating seizures precautions
•Symptoms of severe hyponatremia include inability to
concentrate, mental confusion, apprehension, seizures,
decreased level of consciousness, coma, and death.
Remove causes of SIADH
Fluid restriction: 0.5-1L a day
Sodium replacement:
•Hypertonic solution (3% saline) over 24 hours slowly while
monitoring electrolytes (Na: no more than ↑10mEq/24hrs)
Medications: when water restriction does not work
•Vasopressin receptor antagonistsConivaptan (Vaprisol®)
Monitor side effects: e.g., hypotension
Nursing management
