A c t u a l Co m p l e t e R e a l E x a m Q u e s t i o n s A n d
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What symptoms would a patient with SIADH experience that are related to
hyponatremia?
lethargy and headaches, hostility, disorientation, altered level of
consciousness, decreased deep tendon reflexes, dull bounding pulses,
hypothermia
Will an SIADH patient have high or low blood osmolarity? What will that value
look like?
LOW, <270
Which of the following would be including in the plan of care for an SIADH
patient?
- continuous IV fluids
- neuro assessment every 2-4 hours
- assess for any S&S of pulmonary edema
- fluid restriction
- vitals every 6 hours
neuro assessment every 2-4 hours, assess for pulmonary edema, fluid restriction
How much fluid restriction could an SIADH patient be placed on?
500 to 1000 mL per day
,In an SIADH patient, what would you use to dilute tube feedings and irrigation?
saline, NOT WATER
What are the seizures precautions? Who would be placed on these?
suction at bedside, padded bed rails, do not restrict pt during seizure, place
close to nurses station; SIADH patients
What type of IV fluids would you place an SIADH patient on IF necessary?
3% normal saline
What type of solution is 0.45% normal saline?
hypotonic
What type of solution is 3% normal saline?
hypertonic
What type of solution is 0.9% normal saline?
isotonic
What type of drugs are administered to SIADH patients when hyponatremia is
present? What are examples of this drug?
vasopressin receptor antagonists; tolvaptan, conivaptan
,Which vasopressin receptor antagonist can be given orally?
tolvaptan
Which vasopressin receptor antagonist can be given intravenously?
conivaptan
What is the black box warning for tolvaptan and conivaptan? What does this
mean for nursing care?
RAPID increase in sodium levels (increase 12 mEq/L in 24 hours); can ONLY
administer these drugs IN THE HOSPITAL
If tolvaptan is used in high doses or longer than 30 days, what becomes of
concern?
liver failure --> death
When would diuretics be used in the treatment of SIADH?
if sodium level is 130-135
Why can diuretics only be used when sodium levels are higher in patients with
SIADH?
will further potentiate sodium loss, causing more problems
Which oral antibiotic is used for SIADH?
demeclocycline
, Why would demeclocycline be used in treatment for SIADH?
may help reach fluid and electrolyte balance---"off label" use
When wouldIV fluids be administered in treatment for patients with SIADH?
when sodium level is less than 115
Hypercortisolism/Cushing's is the ___ secretion of cortisol
excess
WBC is (increased/decreased) in patients with Cushing's
decreased
The decreased WBC in patients with Cushing's can cause what?
reduced immunity and increase risk for infection
List the common signs and symptoms of Cushing's.
moon face, buffalo hump, truncal obesity, hypertension, bruising, weakened
immune system, muscle atrophy in extremities, osteoporosis, thinning skin, striae,
acne, hirsutism, hyperglycemia, delayed wound healing