The nurse is providing care for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) and is critically ill. Which of the following lab findings requires immediate intervention?

Serum potassium 5.0 mEq/L

Serum calcium 8.0 mg/dL

Serum sodium 125 mEq/L

Blood urea nitrogen (BUN) 24 mg/dL

Answer and Explanation

The Correct Answer is C

Choice A reason:

A serum potassium level of 5.0 mEq/L is within the normal range (3.5-5.0 mEq/L). While it is on the higher end of normal, it does not require immediate intervention in the context of SIADH. Potassium levels are crucial for cardiac and muscle function, but this value does not indicate a critical imbalance.

Choice B reason:

A serum calcium level of 8.0 mg/dL is slightly below the normal range (8.5-10.2 mg/dL). Mild hypocalcemia can occur in various conditions, but it is not typically associated with SIADH and does not require immediate intervention unless symptomatic or significantly lower.

Choice C reason:

A serum sodium level of 125 mEq/L indicates hyponatremia, which is a hallmark of SIADH. Hyponatremia can lead to severe neurological symptoms, including seizures, confusion, and coma, especially if it develops rapidly. Immediate intervention is required to correct the sodium imbalance and prevent serious complications.

Choice D reason:

A blood urea nitrogen (BUN) level of 24 mg/dL is within the upper normal range (7-20 mg/dL). While slightly elevated, it is not critically high and does not require immediate intervention in the context of SIADH. BUN levels can be influenced by various factors, including hydration status and renal function.

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Correct Answer is B

Explanation

Choice A Reason:

Conivaptan hydrochloride is a vasopressin receptor antagonist used to treat hyponatremia in patients with SIADH. It works by blocking the action of vasopressin, thereby promoting water excretion without significant loss of sodium. This helps to correct the water imbalance caused by SIADH. Conivaptan is typically administered intravenously and is effective in increasing serum sodium levels.

Choice B Reason:

Vasopressin, also known as antidiuretic hormone (ADH), is contraindicated in patients with SIADH because it exacerbates the condition. SIADH is characterized by excessive release of ADH, leading to water retention and hyponatremia. Administering vasopressin would further increase water reabsorption in the kidneys, worsening the hyponatremia.

Choice C Reason:

Sodium chloride tablets are used to manage hyponatremia in SIADH by increasing sodium intake. This helps to counteract the dilutional hyponatremia caused by excessive water retention. Sodium chloride tablets are often prescribed alongside fluid restriction to help raise serum sodium levels.

Choice D Reason:

Tolvaptan is another vasopressin receptor antagonist used to treat hyponatremia in SIADH. It works similarly to conivaptan by blocking the action of vasopressin, promoting water excretion, and increasing serum sodium levels. Tolvaptan is typically administered orally and is effective in managing SIADH.

A. Take this medication with high-protein foods. B. Take this medication with a full glass of water or fruit juice. C. Take this medication before a meal or several hours after a meal. D. Take this medication during your morning meal.

Correct Answer is C

Explanation

Choice A Reason:

Taking levothyroxine with high-protein foods can interfere with the absorption of the medication. High-protein foods can bind to the medication, reducing its effectiveness. Therefore, it is not recommended to take levothyroxine with high-protein foods.

Choice B Reason:

While it is important to take levothyroxine with a full glass of water to ensure the tablet is swallowed properly and to aid in its absorption, taking it with fruit juice is not recommended. Certain juices, like grapefruit juice, can interfere with the absorption of levothyroxine.

Choice C Reason:

Levothyroxine should be taken on an empty stomach, ideally 30 to 60 minutes before breakfast or at least 3 to 4 hours after the last meal. This timing helps ensure optimal absorption of the medication. Food can significantly reduce the absorption of levothyroxine, making it less effective.

Choice D Reason:

Taking levothyroxine during a meal is not recommended because food can interfere with the absorption of the medication. It is best to take it on an empty stomach to ensure maximum absorption and effectiveness.

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The nurse is providing care for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) and is critically ill. Which of the following lab findings requires immediate intervention?

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