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 A

Explanation

A. Wheezes are continuous, high-pitched musical sounds produced by the narrowing of airways, commonly heard in conditions like asthma. They occur mainly during exhalation and are indicative of airflow obstruction.
B. Stridor is a high-pitched, harsh sound that occurs during inspiration, often associated with an upper airway obstruction, such as laryngospasm or a foreign body.
C. Crackles are fine, crackling sounds heard during inspiration, typically due to fluid accumulation in the lungs (e.g., in pneumonia or heart failure).
D. Rhonchi are low-pitched, snoring sounds caused by the obstruction or narrowing of larger airways, often heard in conditions like chronic bronchitis, but they are not high-pitched like wheezes.

A. Document the amount of drainage. B. Notify the client's provider. C. Obtain a culture of the drainage. D. Check the drainage for glucose.

Correct Answer is D

Explanation

A. While documenting the amount of drainage is important, it is not the most urgent action when clear drainage is observed after a transsphenoidal hypophysectomy.
B. Notifying the provider is important but should not be the first step. The nurse should first assess the nature of the drainage, as it could indicate a serious complication, such as cerebrospinal fluid (CSF) leakage.
C. A culture may be necessary if infection is suspected, but the priority action is to assess whether the drainage is CSF.
D. Checking the drainage for glucose is the most appropriate initial action. Clear drainage from the nasal packing could indicate a CSF leak, which is a complication that can occur after transsphenoidal surgery. CSF contains glucose, so testing for glucose in the drainage will help determine if it is CSF. If glucose is detected, the nurse should immediately notify the provider, as CSF leakage requires prompt intervention.

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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 auscultating the breath sounds of a client who has asthma. When the client exhales, the nurse hears continuous high-pitched squeaking sounds. The nurse should document this as which of the following adventitious breath sounds?

Correct Answer is A

Explanation

A nurse is caring for a client who is 1 day postoperative following a transsphenoidal hypophysectomy. While assessing the client, the nurse notes a large area of clear drainage seeping from the nasal packing. Which of the following should be the nurse's initial action?

Correct Answer is D

Explanation

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