A nurse is assessing a client who has syndrome of inappropriate antidiuretic hormone. Which of the following findings should the nurse expect?
Excessive urinary output
Elevated sodium level
Bounding peripheral pulses
Hyperactive deep tendon reflexes
The Correct Answer is C
A. Excessive urinary output: In syndrome of inappropriate antidiuretic hormone (SIADH), there is decreased urinary output, not excessive output. The body retains water due to increased antidiuretic hormone (ADH), leading to fluid retention.
B. Elevated sodium level: Due to excessive water retention and dilution of electrolytes, clients with SIADH typically experience hyponatremia (decreased sodium level), not an elevated sodium level. The retained water dilutes the body's sodium concentration.
C. Bounding peripheral pulses: Bounding peripheral pulses are expected in SIADH due to fluid overload, as the body retains excessive water. This leads to increased blood volume and can cause the peripheral pulses to feel strong or "bounding."
D. Hyperactive deep tendon reflexes: Hyperactive deep tendon reflexes are typically associated with conditions such as hypercalcemia or hyperthyroidism, not SIADH. SIADH is more likely to cause muscle weakness and fatigue due to hyponatremia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Use the autoinjector if shortness of breath is the only symptom of anaphylaxis: An epinephrine autoinjector should be used for any signs of anaphylaxis, not just shortness of breath. Symptoms such as hives, swelling, or difficulty breathing should all trigger its use.
B. Use the second autoinjector immediately after the first dose: The second dose of epinephrine is typically used if symptoms persist or recur after 5 to 15 minutes, not immediately after the first dose. The client should call emergency services after using the first dose and only use a second dose if directed by a healthcare provider.
C. Hold the autoinjector firmly down for 10 seconds while injecting: The correct procedure for using the epinephrine autoinjector is to hold it in place for 10 seconds to ensure the full dose is administered. This is an important step to ensure the medication is fully delivered.
D. Inject into the buttock or deltoid: The epinephrine autoinjector should be injected into the outer thigh (vastus lateralis muscle), not the buttock or deltoid. The thigh muscle allows for rapid absorption of the medication in an emergency.
Correct Answer is C
Explanation
A. Ensure the door to the client's room remains open: The door should be kept closed to minimize exposure to radiation. Keeping the door open increases the risk of radiation exposure to others in the area.
B. Wear sterile gloves during patient care: Sterile gloves are not required for care during internal radiation therapy unless there is direct contact with bodily fluids or radioactive materials. Standard precautions are sufficient.
C. Wear a lead apron when providing client care: A lead apron is recommended for healthcare workers to protect themselves from radiation exposure during internal radiation therapy. The lead apron absorbs radiation and helps reduce the risk of harmful exposure.
D. Place a dosimeter on the client's gown: The dosimeter is typically worn by healthcare workers to measure radiation exposure, not the client. The client would not wear a dosimeter in this situation.
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