MED SURG FINALS Chapter 50: Nursing Management: Endocrine Problems – Flashcards
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6. A patient is treated with demeclocycline (Declomycin) to control the symptoms of syndrome of inappropriate antidiuretic hormone (SIADH). The nurse determines that the demeclocycline is effective upon finding that the a. peripheral edema is decreased. b. patient's weight has increased. c. urine specific gravity is increased. d. patient's urinary output is increased.
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ANS: D Demeclocycline blocks the action of ADH on the renal tubules and increases urine output. An increase in weight or an increase in urine specific gravity indicates that the SIADH is not corrected. Peripheral edema does not occur with SIADH. A sudden weight gain without edema is a common clinical manifestation of this disorder.
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7. When teaching a patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) about long-term management of the disorder, the nurse determines that additional instruction is needed when the patient says, a. "I should weigh myself daily and report any sudden weight loss or gain." b. "I need to limit my fluid intake to no more than 1 quart of liquids a day." c. "I will eat foods high in potassium because the diuretics cause potassium loss." d. "I need to shop for foods that are low in sodium and avoid adding salt to foods."
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ANS: D Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other patient statements are correct and indicate successful teaching has occurred.
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8. A patient is hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The patient is confused and reports a headache, muscle cramps, and twitching. The nurse would expect the initial laboratory results to include a. an elevated hematocrit. b. a decreased serum sodium. c. an increased serum chloride. d. a low urine specific gravity.
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ANS: B When water is retained, the serum sodium level will drop below normal, causing the clinical manifestations reported by the patient. The hematocrit will decrease because of the dilution caused by water retention. Urine will be more concentrated with a higher specific gravity. The serum chloride level will usually decrease along with the sodium level.
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29. When developing a plan of care for a patient with syndrome of inappropriate antidiuretic hormone (SIADH), which interventions will the nurse include? a. Encourage fluids to 2000 mL/day. b. Offer patient hard candies to suck on. c. Monitor for increased peripheral edema. d. Keep head of bed elevated to 30 degrees.
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ANS: B Sucking on hard candies decreases thirst for a patient on fluid restriction. Patients with SIADH are on fluid restrictions of 800 to 1000 mL/day. Peripheral edema is not seen with SIADH. The head of the bed is elevated no more than 10 degrees to increase left atrial filling pressure and decrease antidiuretic hormone (ADH) release.
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38. A patient is admitted with possible syndrome of inappropriate antidiuretic hormone (SIADH). Which information obtained by the nurse is most important to communicate rapidly to the health care provider? a. The patient complains of dyspnea with activity. b. The patient has a urine specific gravity of 1.025. c. The patient has a recent weight gain of 8 lb. d. The patient has a serum sodium level of 119 mEq/L.
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ANS: D A serum sodium of less than 120 mEq/L increases the risk for complications such as seizures and needs rapid correction. The other data are not unusual for a patient with SIADH and do not indicate the need for rapid action.
