In reviewing admission orders for a patient admitted with SIADH, the nurse should question which order?

IV 3% NS at 10 mL/hr

Seizure precautions

Fluid restriction of 1000 mL/day

Sodium-restricted diet

Answer and Explanation

The Correct Answer is A

A. In SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion), the body retains excessive water, leading to dilutional hyponatremia (low sodium levels). Administering hypertonic saline (3% NS) can exacerbate the condition by rapidly increasing sodium levels, which may cause demyelination of neurons (a condition called osmotic demyelination syndrome). Hypertonic saline is typically only used in severe hyponatremia with neurologic symptoms and should be carefully monitored.
B. Seizure precautions are appropriate in SIADH due to the risk of seizures from severe hyponatremia, which can lead to cerebral edema and neurological compromise.
C. Fluid restriction of 1000 mL/day is appropriate in SIADH to manage the dilutional hyponatremia by preventing further fluid retention.
D. A sodium-restricted diet is also recommended in SIADH to avoid further dilution of sodium levels and prevent worsening of hyponatremia.

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Correct Answer is C

Explanation

A. Increase carbohydrate intake.: This is incorrect. Cushing’s disease is characterized by excessive cortisol, which can lead to increased blood glucose levels, making carbohydrate intake less desirable. Clients with Cushing's disease often need to manage their blood sugar levels, so they should not increase carbohydrates indiscriminately.
B. Limit intake of potassium-rich foods.: This is incorrect. In Cushing’s disease, elevated cortisol levels can lead to potassium depletion, so clients should actually increase their intake of potassium-rich foods to help counteract the effects of low potassium, not limit them.
C. Restrict sodium intake.: This is correct. Cushing’s disease often results in fluid retention and hypertension due to increased cortisol and aldosterone levels. Restricting sodium helps manage these symptoms and reduces the risk of complications such as edema and high blood pressure.
D. Decrease protein intake.: This is incorrect. While protein breakdown is a feature of Cushing's disease, protein intake should not necessarily be decreased. Adequate protein intake is important to prevent muscle wasting, a common issue in clients with Cushing’s disease.

A. Using a lift sheet to change the patient's position B. Assisting the patient to change positions slowly C. Padding the siderails of the patient's bed D. Keeping suctioning equipment at the patient's bedside

Correct Answer is B

Explanation

A. Using a lift sheet is helpful for preventing injury and ensuring safe handling of the patient, but it is not the most critical safety measure for a patient with Cushing’s syndrome.
B. Assisting the patient to change positions slowly is the most important safety measure for a patient with Cushing’s syndrome. Patients with Cushing’s syndrome often have osteoporosis and a risk of fractures due to prolonged exposure to high cortisol levels, which can lead to weakened bones. Orthostatic hypotension may also occur, so changing positions slowly can prevent falls.
C. Padding the siderails of the bed is typically done for patients at risk of seizures or those with neurological issues, not as a primary concern for patients with Cushing’s syndrome.
D. While keeping suction equipment at the bedside is important for patients at risk of aspiration or respiratory issues, it is not the most critical measure for a patient with Cushing’s syndrome. The most significant concern is the risk of falls and fractures due to bone weakening and potential hypotension.

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In reviewing admission orders for a patient admitted with SIADH, the nurse should question which order?

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Naxlex Comprehensive Predictor Exams

A nurse is providing dietary teaching for a client who has Cushing's disease. Which of the following recommendations should the nurse include in the teaching?

Correct Answer is C

Explanation

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Correct Answer is B

Explanation

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