A nurse is reviewing data for a client who has a head injury. Which of the following findings should indicate to the nurse that the client might have diabetes insipidus?

Urine output 800 mL/hr

Blood glucose 198 mg/dL

Serum sodium 145 mEq/L

Urine specific gravity 1.028

Answer and Explanation

The Correct Answer is A

Choice A Reason: Urine output 800 mL/hr is a sign of diabetes insipidus, as it indicates that the kidneys are producing large amounts of diluted urine due to the lack of antidiuretic hormone (ADH) or its action.

Choice B Reason: Blood glucose 198 mg/dL is not a sign of diabetes insipidus, but it may indicate diabetes mellitus or hyperglycemia.

Choice C Reason: Serum sodium 145 mEq/L is not a sign of diabetes insipidus, but it is within the normal range (135-145 mEq/L).

Choice D Reason: Urine specific gravity 1.028 is not a sign of diabetes insipidus, but it indicates concentrated urine due to dehydration or other causes.

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Correct Answer is D

Explanation

Choice A Reason: High glucose level is not a finding that confirms bacterial meningitis, but it may indicate other conditions such as diabetes mellitus or hyperglycemia.

Choice B Reason: Low protein concentration is not a finding that confirms bacterial meningitis, but it may indicate other conditions such as malnutrition or liver disease.

Choice C Reason: Decreased CSF pressure is not a finding that confirms bacterial meningitis, but it may indicate other conditions such as dehydration or spinal cord injury.

Choice D Reason: Cloudy CSF is a finding that confirms bacterial meningitis, as it indicates that there is an infection and inflammation in the meninges that surround the brain and spinal cord.

A. Contact the health care provider. B. Administer PRN pain medication. C. Document the findings. D. Elevate the extremity.

Correct Answer is A

Explanation

Choice A Reason: Contacting the health care provider is the first nursing action that the nurse should perform, as it indicates that the client may have compartment syndrome, which is a medical emergency that requires immediate intervention to prevent tissue necrosis and nerve damage.

Choice B Reason: Administering PRN pain medication is not the first nursing action that the nurse should perform, as it may not relieve the pain and may mask the symptoms of compartment syndrome.

Choice C Reason: Documenting the findings is not the first nursing action that the nurse should perform, as it may delay the treatment and worsen the outcome of compartment syndrome.

Choice D Reason: Elevating the extremity is not the first nursing action that the nurse should perform, as it may decrease blood flow and increase tissue ischemia in compartment syndrome.

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A nurse is reviewing data for a client who has a head injury. Which of the following findings should indicate to the nurse that the client might have diabetes insipidus?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

Correct Answer is A

Explanation

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