The nurse is creating the care plan for a patient with symptoms of DI who was admited to the hospital for evaluation and treatment of the condition. An appropriate nursing diagnosis for the patient is:

Excess ﬂuid volume related to intake greater than output.

Risk for impaired skin integrity related to generalized edema.

Activity intolerance related to muscle cramps and weakness.

Insomnia related to waking at night to void.

Answer and Explanation

The Correct Answer is A

Excess ﬂuid volume related to intake greater than output would be the most appropriate nursing diagnosis for a patient with symptoms of DI (diabetes insipidus). This condition results in excessive urine output and, as a consequence, can lead to dehydration and electrolyte imbalances. Therefore, monitoring and managing ﬂuid volume is a priority for patients with DI.

Risk for impaired skin integrity related to generalized edema is more commonly associated with conditions that cause ﬂuid retention such as heart failure, liver failure, or kidney disease, rather than DI.

Activity intolerance related to muscle cramps and weakness is a possible nursing diagnosis for patients with conditions that aﬀect muscle function, such as muscular dystrophy or multiple sclerosis, but not specifically for DI.

Insomnia related to waking at night to void is more commonly associated with urinary frequency or nocturia due to conditions such as urinary tract infections or benign prostatic hyperplasia, but not specifically for DI.

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Correct Answer is A

Explanation

Broccoli and kale are good sources of calcium, and by adding them to their diet, the client can increase their calcium intake without consuming milk. It is important to note that some calcium supplements may irritate the stomach but stopping them altogether is not advisable without consulting a healthcare provider. Vitamin D is not a milk product, and it is essential for calcium absorption. Avoiding foods with vitamin D can worsen the low calcium levels. Cheese is a milk product and may not be suitable for someone with a milk allergy.

A. Electrocardiographic (ECG) changes and dysrhythmias related to hypokalemia. B. The presence of hypovolemic shock related to osmotic diuresis. C. Cardiovascular collapse resulting from the eﬀects of hyperglycemia. D. Fluid overload resulting from aggressive ﬂuid replacement.

Correct Answer is A

Explanation

Electrocardiographic (ECG) changes and dysrhythmias related to hypokalemia are the main reasons for initiating cardiac monitoring in patients with diabetic ketoacidosis. In diabetic ketoacidosis, insulin deficiency causes the body to break down fat for energy, leading to the production of ketones and resulting in metabolic acidosis. In addition, glucose and potassium are lost in the urine due to osmotic diuresis. Hypokalemia can cause ECG changes and dysrhythmias, which can be life-threatening.

Hypokalemia is a common complication of DKA and can lead to ECG changes such as ST-segment depression, T-wave inversion, and U waves².

Hypovolemic shock related to osmotic diuresis is an important consideration in the management of diabetic ketoacidosis, but it is not the primary reason for initiating cardiac monitoring.

Cardiovascular collapse resulting from the eﬀects of hyperglycemia is not a common complication of diabetic ketoacidosis, and it is not the primary reason for initiating cardiac monitoring.

Fluid overload resulting from aggressive ﬂuid replacement is a potential complication of diabetic ketoacidosis, but it is not the primary reason for initiating cardiac monitoring.

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The nurse is creating the care plan for a patient with symptoms of DI who was admited to the hospital for evaluation and treatment of the condition. An appropriate nursing diagnosis for the patient is:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching nutritional strategies to a client who has a low calcium level and an allergy to milk. Which of the following statements by the client indicates an understanding of the teaching?

Correct Answer is A

Explanation

Cardiac monitoring is initiated for a patient with diabetic ketoacidosis. The nurse determines that this measure is important to identify:

Correct Answer is A

Explanation

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