Which patient statement indicates to the nurse that additional instruction is needed for a patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH)?
"I should eat foods high in potassium because diuretics cause potassium loss."
"I need to limit my fluid intake to no more than 1 quart of liquids a day."
"I need to shop for foods low in sodium and avoid adding salt to food."
"I should weigh myself daily and report sudden weight loss or gain."
The Correct Answer is C
Choice A reason: Eating foods high in potassium can be important for patients taking diuretics, as diuretics can cause potassium loss. However, for SIADH patients, this is not a primary focus unless they are on diuretics that specifically lead to potassium loss.
Choice B reason: Limiting fluid intake is crucial for patients with SIADH to prevent fluid overload and hyponatremia. This statement aligns with proper management of the condition.
Choice C reason: Patients with SIADH need to carefully manage their sodium intake. Rather than reducing sodium, they often need to maintain or increase their sodium intake to help counteract the effects of SIADH, which causes dilutional hyponatremia (low blood sodium levels). Therefore, this statement indicates a need for additional instruction.
Choice D reason: Weighing oneself daily is an important practice for SIADH patients to monitor for sudden weight changes, which can indicate fluid imbalances. This statement is appropriate and does not require additional instruction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Teaching the patient to use guided imagery can be an effective pain management strategy, but it might not be the most immediate and reassuring intervention for a patient experiencing fear about postoperative pain. This approach is more useful as an additional technique rather than the primary intervention.
Choice B reason: Describing the type of pain expected with the patient's particular surgery can provide some insight into what to anticipate, but it does not necessarily alleviate fear or provide concrete strategies for managing pain. It might even increase anxiety by focusing on the details of the pain itself.
Choice C reason: Explaining the pain management plan, including the use of a pain rating scale, is the most effective intervention. This approach directly addresses the patient's concerns by providing them with a clear understanding of how their pain will be managed and controlled postoperatively. Knowing that there is a structured plan in place, with specific methods to assess and manage pain, helps build confidence and reduces fear. The use of a pain rating scale also empowers the patient to communicate their pain levels effectively, ensuring timely and appropriate interventions.
Choice D reason: Informing the patient that pain medication will be available is helpful, but it lacks the detail and comprehensive approach of explaining the entire pain management plan. Patients may still have concerns about how their pain will be assessed and addressed specifically.
Correct Answer is C
Explanation
Choice A reason: Administering Furosemide (Lasix) 40 mg IV is important for reducing fluid overload, but the immediate priority is to address the patient's low oxygen saturation levels.
Choice B reason: Assessing lung sounds and peripheral edema is important for ongoing monitoring, but the immediate action should focus on stabilizing the patient's oxygen levels.
Choice C reason: Placing the patient on oxygen to titrate to oxygen saturations 94% or greater is the most immediate and critical intervention. The patient's oxygen saturation is significantly low at 86%, and addressing this ensures adequate oxygenation and reduces the risk of hypoxia.
Choice D reason: Educating the patient on lifestyle modifications is important for long-term management but is not the immediate priority in an acute situation.
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