Which of the information below obtained when caring for a patient who has been admited for evaluation of diabetes insipidus will be of greatest concern to the nurse?

The patient has a urine output of 800 ml/hr.

The patient is confused and lethargic.

The patient's urine specific gravity is 1.003.

The patient had a recent head injury.

Answer and Explanation

The Correct Answer is B

Diabetes insipidus is a condition where the body is not able to regulate water balance properly, leading to excessive urine output and dehydration. The patient's urine output of 800 ml/hr (option A) and low urine specific gravity of 1.003 (option C) is consistent with diabetes insipidus and requires monitoring, but they are not as immediately concerning as the patient's confusion and lethargy.

Confusion and lethargy may indicate severe dehydration, electrolyte imbalances, or even brain swelling (if the patient had a recent head injury, as mentioned in option D). These symptoms require immediate attention to prevent further complications and ensure the patient's safety.

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Correct Answer is B

Explanation

Based on the given documentation, the nurse suspects that the client has respiratory alkalosis. The client's ABG results show a pH of 7.52, which indicates alkalosis and the PaO2 level is slightly low, suggesting respiratory involvement. Rapid breathing (RR44) and wheezing also support the possibility of respiratory alkalosis.

A. The patient’s voice is weak and hoarse sounding. B. The patient is complaining of a 7/10 incisional pain. C. The patient’s cardiac monitor shows a heart rate of 112. D. The patient is increasingly swelling at the neck.

Correct Answer is D

Explanation

This is a critical finding that could indicate bleeding or compromised airway, both of which are potentially life-threatening complications following a thyroidectomy. Immediate intervention may be necessary to prevent further harm to the patient. The other options are important to note and should be addressed, but they do not require immediate intervention as the swelling in the neck does.

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Which of the information below obtained when caring for a patient who has been admited for evaluation of diabetes insipidus will be of greatest concern to the nurse?

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Naxlex Comprehensive Predictor Exams

A client comes to the emergency department with Asthma. Based on the documentation noted below, the nurse suspects that the client has what abnormality? 10/1/2022 at 18:30 Client wheezing, RR44, BP 140/90, HR 104, T 98.4 F, ABG results show pH 7.52 mmHg, HCO3-26, PaO2 90 mmHg C. Wynn RN

Correct Answer is B

Explanation

While assessing a patient who has just arrived in the post-anesthesia recovery unit (PACU) after a thyroidectomy, the nurse obtains this data. Which is the most important to communicate to the surgeon?

Correct Answer is D

Explanation

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