Exam Three Study Questions & Answers with Solutions

The nurse is admitting a client who is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) and has a serum sodium of 118 mEq/L. Which health care provider prescriptions should the nurse anticipate receiving? Select all that apply. a. Initiate an infusion of 3% NaCl b. Administer IV furosemide c. Restrict fluids to 800 mL over 24 hours d. Elevate the head of the bed to high Fowler's e. Administer a vasopressin antagonist as prescribed - a. Initiate an infusion of 3% NaCl c. Restrict fluids to 800 mL over 24 hours e. Administer a vasopressin antagonist as prescribed Clients with SIADH experience excess secretion of antidiuretic hormone (ADH), which leads to excess intravascular volume, a declining serum osmolality, and dilutional hyponatremia. Management is directed at correcting the hyponatremia and preventing cerebral edema. Hypertonic saline is prescribed when the hyponatremia is severe. Fluid restriction is a useful strategy aimed at correcting dilutional hyponatremia. Vasopressin antagonists are used to treat SIADH (furosemide is only safe to use if the serum sodium is at least 125 mEq/L). A client is administered to an emergency department, and a diagnosis of myxedema coma is made. Which action should the nurse prepare to carry out initially? a. Warm the client b. Maintain a patent airway c. Administer thyroid hormone d. Administer fluid replacement - b. Maintain a patent airway In myxedema coma, the initial nursing action is to maintain a patent airway. Oxygen should be administered, followed by fluid replacement, keeping the client warm, monitor for vital signs, and administering thyroid hormones by the intravenous route. The nurse is completing an assessment on a client who is primary hyperparathyroidism. Which client complaint would be characteristic of this disorder? Select all that apply. a. Polyuria b. Headache c. Bone pain d. Nervousness e. Weight gain - a. Polyuria c. Bone pain In hyperparathyroidism, PTH levels are high, which causes bone reabsorption. Elevated serum calcium levels produce osmotic diuresis and thus polyuria. The nurse is teaching a client with hyperparathyroidism how to manage the condition at home. Which response by the client indicates the need for additional teaching? a. "I should limit my fluids to 1 liter per day" b. "I should use my treadmill or go for walks daily" c. "I should follow a moderate-calcium, high-fiber diet" d. "My alendronate helps to keep calcium from coming out of my bones" - a. "I should limit my fluids to 1 liter per day" When PTH levels are high, there is excess calcium levels, there is a risk of nephrolithiasis. One to two liters of fluids daily should be encouraged to protect the kidneys and decrease risk of nephrolithaliasis. A client with a diagnosis of addisonian crisis is being admitted to the intensive care unit. Which findings will the interprofessional health care team focus on? Select all that apply. a. Hypotension b. Leukocytosis c. Hyperkalemia d. Hypercalcemia e. Hypernatremia - a. Hypotension c. Hyperkalemia Hypotension occurs when vascular tone is decreased and blood vessels cannot respond to epinephrine and norepinephrine. When there is insufficient aldosterone, salt and water are lost and potassium builds up; this leads to hypotension from decreased vascular volume, hyponatremia, and hyperkalemia. The remaining options are not associated with addisonian crisis.