Diagnostic testing of an adult patient reveals renal glycosuria. The nurse should recognize the need for
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1007
the patient to be assessed for what health problem?
A) Diabetes insipidus
B) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
C) Diabetes mellitus
D) Renal carcinoma

Ans: C
Feedback:
Renal glycosuria can occur on its own as a benign condition. It also occurs in poorly controlled diabetes,
the most common condition that causes the blood glucose level to exceed the kidneys reabsorption
capacity. Glycosuria is not associated with SIADH, diabetes insipidus, or renal carcinoma.

What should the nurse suspect when hourly assessment of urine output on a patient postcraniotomy
exhibits a urine output from a catheter of 1,500 mL for two consecutive hours?
A) Cushing syndrome
B) Syndrome of inappropriate antidiuretic hormone (SIADH)
C) Adrenal crisis
D) Diabetes insipidus

Ans: D
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1248
Feedback:
Diabetes insipidus is an abrupt onset of extreme polyuria that commonly occurs in patients after brain
surgery. Cushing syndrome is excessive glucocorticoid secretion resulting in sodium and water
retention. SIADH is the result of increased secretion of ADH; the patient becomes volume-overloaded,
urine output diminishes, and serum sodium concentration becomes dilute. Adrenal crisis is
undersecretion of glucocorticoids resulting in profound hypoglycemia, hypovolemia, and hypotension.

When caring for a patient with increased ICP the nurse knows the importance of monitoring for possible
secondary complications, including syndrome of inappropriate antidiuretic hormone (SIADH). What
nursing interventions would the nurse most likely initiate if the patient developed SIADH?
A) Fluid restriction
B) Transfusion of platelets
C) Transfusion of fresh frozen plasma (FFP)
D) Electrolyte restriction

Ans: A
Feedback:
The nurse also assesses for complications of increased ICP, including diabetes insipidus, and SIADH.
SIADH requires fluid restriction and monitoring of serum electrolyte levels. Transfusions are
unnecessary.

After a subarachnoid hemorrhage, the patients laboratory results indicate a serum sodium level of less
than 126 mEq/L. What is the nurses most appropriate action?
A) Administer a bolus of normal saline as ordered.
B) Prepare the patient for thrombolytic therapy as ordered.
C) Facilitate testing for hypothalamic dysfunction.
D) Prepare to administer 3% NaCl by IV as ordered.

Ans: D
Feedback:
The patient may be experiencing syndrome of inappropriate antidiuretic hormone (SIADH) or cerebral
salt-wasting syndrome. The treatment most often is the use of IV hypertonic 3% saline. A normal saline
bolus would exacerbate the problem and there is no indication for tests of hypothalamic function or
thrombolytic therapy.

A patient is admitted through the ED with suspected St. Louis encephalitis. The unique clinical feature
of St. Louis encephalitis will make what nursing action a priority?
A) Serial assessments of hemoglobin levels
B) Blood glucose monitoring
C) Close monitoring of fluid balance
D) Assessment of pain along dermatomes

Ans: C
Feedback:
A unique clinical feature of St. Louis encephalitis is SIADH with hyponatremia. As such, it is important
to monitor the patients intake and output closely.

new book

giddens 2nd ed

The nurse is caring for a patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What is the nurse’s best action?

a. Encourage increased fluid and water intake

b. Teach about risk for malignancies

c. Monitor for changes in level of consciousness

d. Assess labwork for potassium level changes

ANS: C

As the name suggests, SIADH is a condition in which antidiuretic hormone (ADH) is secreted despite normal or low plasma osmolarity, resulting in water retention and dilutional hyponatremia. In response to increased plasma volume, aldosterone secretion increases and further contributes to sodium loss. Hyponatremia frequently manifests with changes in level of consciousness from confusion to coma. A large number of clinical conditions can cause SIADH including malignancies, pulmonary disorders, injury to the brain, and certain pharmacologic agents. Malignancies often lead to SIADH versus SIADH causing malignant conditions. Water intoxication can lead to hyponatremia, therefore water intake is restricted. The most affected electrolyte from SIADH is sodium versus potassium.

REF: Page 132

OBJ: NCLEX® Client Needs Category: Physiological Integrity: Reduction of Risk Potential

new book

ignatavicius 9th ed

A nurse is caring for a client with meningitis. Which laboratory values should the nurse monitor to identify
potential complications of this disorder? (Select all that apply.)
a. Sodium level
b. Liver enzymes
c. Clotting factors
d. Cardiac enzymes
e. Creatinine level

ANS: A, C
Inflammation associated with meningitis can stimulate the hypothalamus and result in excessive production of
antidiuretic hormone. The nurse should monitor sodium levels for early identification of syndrome of
inappropriate antidiuretic hormone. A systemic inflammatory response (SIR) can also occur with meningitis. A
SIR can result in a coagulopathy that leads to disseminated intravascular coagulation. The nurse should
monitor clotting factors to identify this complication. The other laboratory values are not specific to
complications of meningitis.
DIF: Applying/Application REF: 868
KEY: Meningitis| assessment/diagnostic examination
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The
clients serum sodium level is 114 mEq/L. Which action should the nurse take first?
a. Consult with the dietitian about increased dietary sodium.
b. Restrict the clients fluid intake to 600 mL/day.
c. Handle the client gently by using turn sheets for re-positioning.
d. Instruct unlicensed assistive personnel to measure intake and output.

ANS: B
With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as
little as 500 to 600 mL/24 hr. Adding sodium to the clients diet will not help if he or she is retaining fluid and
diluting the sodium. The client is not at increased risk for fracture, so gentle handling is not an issue. The client
should be on intake and output; however, this will monitor only the clients intake, so it is not the best answer.
Reducing intake will help increase the clients sodium.
DIF: Applying/Application REF: 1251
KEY: Pituitary disorder| electrolyte imbalance
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

A nurse assesses clients with potential endocrine disorders. Which clients are at high risk for
hypopituitarism? (Select all that apply.)
a. A 20-year-old female with benign pituitary tumors
b. A 32-year-old male with diplopia
c. A 41-year-old female with anorexia nervosa
d. A 55-year-old male with hypertension
e. A 60-year-old female who is experiencing shock
f. A 68-year-old male who has gained weight recently

ANS: A, C, D, E
Pituitary tumors, anorexia nervosa, hypertension, and shock are all conditions that can cause hypopituitarism.
Diplopia is a manifestation of hypopituitarism, and weight gain is a manifestation of Cushings disease and
syndrome of inappropriate antidiuretic hormone. They are not risk factors for hypopituitarism.
DIF: Remembering/Knowledge REF: 1246
KEY: Pituitary disorder| health screening
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

A nurse assesses clients with potential endocrine disorders. Which clients are at high risk for adrenal
insufficiency? (Select all that apply.)
a. A 22-year-old female with metastatic cancer
b. A 43-year-old male with tuberculosis
c. A 51-year-old female with asthma
d. A 65-year-old male with gram-negative sepsis
e. A 70-year-old female with hypertension

ANS: A, B, D
Metastatic cancer, tuberculosis, and gram-negative sepsis are primary causes of adrenal insufficiency. Active
tuberculosis is a contributing factor for syndrome of inappropriate antidiuretic hormone. Hypertension is a key
manifestation of Cushings disease. These are not risk factors for adrenal insufficiency.
DIF: Remembering/Knowledge REF: 1248
KEY: Adrenal gland disorder| health screening
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

new book

lewis 7th- ch50

A patient with an antidiuretic hormone (ADH)-secreting small-cell cancer of the lung is treated with demeclocycline (Declomycin) to control the symptoms of syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse determines that the demeclocycline is effective upon finding that the

a. patient’s daily weight is stable.

b. urine specific gravity is increased.

c. patient’s urinary output is increased.

d. peripheral edema is decreased.

Correct Answer: C

Rationale: Demeclocycline blocks the action of ADH on the renal tubules and increases urine output. A stable body weight and an increase in urine specific gravity indicate that the SIADH is not corrected. Peripheral edema does not occur with SIADH; a sudden weight gain without edema is a common clinical manifestation of this disorder.

Cognitive Level: Application Text Reference: p. 1295

Nursing Process: Evaluation NCLEX: Physiological Integrity

When teaching a patient with chronic SIADH about long-term management of the disorder, the nurse determines that additional instruction is needed when the patient says,

a. “I need to shop for foods that are low in sodium and avoid adding salt to foods.”

b. “I should weigh myself daily and report any sudden weight loss or gain.”

c. “I need to limit my fluid intake to no more than 1 quart of liquids a day.”

d. “I will eat foods high in potassium because the diuretics cause potassium loss.”

Correct Answer: A

Rationale: Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other patient statements are correct and indicate successful teaching has occurred.

Cognitive Level: Application Text Reference: p. 1296

Nursing Process: Evaluation

NCLEX: Health Promotion and Maintenance

A patient is hospitalized with possible SIADH. The patient is confused and reports a headache, muscle cramps, and twitching. The nurse would expect the initial laboratory results to include a

a. serum sodium of 125 mEq/L (125 mmol/L).

b. hematocrit of 52%.

c. blood urea nitrogen (BUN) of 22 mg/dl (11.5 mmol/L).

d. serum chloride of 110 mEq/L (110 mmol/L).

Correct Answer: A

Rationale: When water is retained, the serum sodium level will drop below normal, causing the clinical manifestations reported by the patient. The hematocrit will decrease because of the dilution caused by water retention. The BUN is not helpful in diagnosis of SIADH and this BUN value is increased. The serum chloride level will usually decrease along with the sodium level. This chloride value is elevated.

Cognitive Level: Application Text Reference: p. 1295

Nursing Process: Assessment NCLEX: Physiological Integrity

A patient is admitted with possible SIADH. Which information obtained by the nurse is most important to communicate rapidly to the health care provider?

a. The patient complains of a severe headache.

b. The patient complains of severe thirst.

c. The patient has a urine specific gravity of 1.025.

d. The patient has a serum sodium level of 119 mEq/L.

Correct Answer: D

Rationale: A serum sodium of less than 120 mEq/L increases the risk for complications such as seizures and needs rapid correction. The other data are not unusual for a patient with SIADH and do not indicate the need for rapid action.

Cognitive Level: Application Text Reference: p. 1295

Nursing Process: Assessment NCLEX: Physiological Integrity

When developing a plan of care for a patient with SIADH, which interventions will the nurse include?

a. Encourage fluids to 2000 ml/day.

b. Offer patient hard candies to suck on.

c. Monitor for increased peripheral edema.

d. Keep head of bed elevated to 30 degrees.

Correct Answer: B

Rationale: Sucking on hard candies decreases thirst for patient on a fluid restriction. Patients with SIADH are on fluid restrictions of 800 to 1000 ml/day. Peripheral edema is not seen with SIADH. The head of the bed is elevated no more than 10 degrees to increase left atrial filling pressure and decrease ADH release.

Cognitive Level: Application Text Reference: p. 1296

Nursing Process: Planning NCLEX: Physiological Integrity

After receiving change-of-shift report about these four patients, which patient should the nurse assess first?

a. A 22-year-old admitted with SIADH who has a serum sodium level of 130 mEq/L.

b. A 31-year-old who has iatrogenic Cushing’s syndrome with a capillary blood glucose level of 244 mg/dl.

c. A 53-year-old who has Addison’s disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef).

d. A 70-year-old who recently started levothyroxine (Synthroid) to treat hypothyroidism and has an irregular pulse of 134.

Correct Answer: D

Rationale: Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The patient’s high pulse rate needs rapid investigation by the nurse to assess for and intervene with any cardiac problems. The other patients also require nursing assessment and/or actions but are not at risk for life-threatening complications.

Cognitive Level: Application Text Reference: p. 1306

Nursing Process: Planning NCLEX: Physiological Integrity

new book

lewis 9th ed

The nurse determines that demeclocycline (Declomycin) is effective for a patient with
syndrome of inappropriate antidiuretic hormone (SIADH) based on finding that the patient’s
a. weight has increased.
b. urinary output is increased.
c. peripheral edema is decreased.
d. urine specific gravity is increased.

ANS: B
Demeclocycline blocks the action of antidiuretic hormone (ADH) on the renal tubules and increases urine
output. An increase in weight or an increase in urine specific gravity indicates that the SIADH is not
corrected. Peripheral edema does not occur with SIADH. A sudden weight gain without edema is a
common clinical manifestation of this disorder.
DIF: Cognitive Level: Apply (application) REF: 1193-1194
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

The nurse determines that additional instruction is needed for a 60-year-old patient with
chronic syndrome of inappropriate antidiuretic hormone (SIADH) when the patient says which of
the following?
a. “I need to shop for foods low in sodium and avoid adding salt to food.”
b. “I should weigh myself daily and report any sudden weight loss or gain.”
c. “I need to limit my fluid intake to no more than 1 quart of liquids a day.”
d. “I will eat foods high in potassium because diuretics cause potassium loss.”

ANS: A
Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other
patient statements are correct and indicate successful teaching has occurred.
DIF: Cognitive Level: Apply (application) REF: 1194
TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity

A 56-year-old patient who is disoriented and reports a headache and muscle cramps is
hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The nurse
would expect the initial laboratory results to include a(n)
a. elevated hematocrit.
b. decreased serum sodium.
c. low urine specific gravity.
d. increased serum chloride.

ANS: B
When water is retained, the serum sodium level will drop below normal, causing the clinical
manifestations reported by the patient. The hematocrit will decrease because of the dilution caused by
water retention. Urine will be more concentrated with a higher specific gravity. The serum chloride level
will usually decrease along with the sodium level.
DIF: Cognitive Level: Understand (comprehension) REF: 1193
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

Which intervention will the nurse include in the plan of care for a 52-year-old male
patient with syndrome of inappropriate antidiuretic hormone (SIADH)?
a. Monitor for peripheral edema.
b. Offer patient hard candies to suck on.
c. Encourage fluids to 2 to 3 liters per day.
d. Keep head of bed elevated to 30 degrees.

ANS: B
Sucking on hard candies decreases thirst for a patient on fluid restriction. Patients with SIADH are on
fluid restrictions of 800 to 1000 mL/day. Peripheral edema is not seen with SIADH. The head of the bed
is elevated no more than 10 degrees to increase left atrial filling pressure and decrease antidiuretic
hormone (ADH) release.
DIF: Cognitive Level: Apply (application) REF: 1194
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

Which information is most important for the nurse to communicate rapidly to the
health care provider about a patient admitted with possible syndrome of inappropriate antidiuretic
hormone (SIADH)?
a. The patient has a recent weight gain of 9 lb.
b. The patient complains of dyspnea with activity.
c. The patient has a urine specific gravity of 1.025.
d. The patient has a serum sodium level of 118 mEq/L.

ANS: D
A serum sodium of less than 120 mEq/L increases the risk for complications such as seizures and needs
rapid correction. The other data are not unusual for a patient with SIADH and do not indicate the need for
rapid action.
DIF: Cognitive Level: Apply (application) REF: 1193
OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity

After receiving change-of-shift report about the following four patients, which patient
should the nurse assess first?
a. A 31-year-old female with Cushing syndrome and a blood glucose level of 244
mg/dL
b. A 70-year-old female taking levothyroxine (Synthroid) who has an irregular pulse
of 134
c. A 53-year-old male who has Addison’s disease and is due for a scheduled dose of
hydrocortisone (Solu-Cortef).
d. A 22-year-old male admitted with syndrome of inappropriate antidiuretic hormone
(SIADH) who has a serum sodium level of 130 mEq/L

ANS: B
Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The
patient’s high pulse rate needs rapid investigation by the nurse to assess for and intervene with any
cardiac problems. The other patients also require nursing assessment and/or actions but are not at risk for
life-threatening complications.
DIF: Cognitive Level: Analyze (analysis) REF: 1203
OBJ: Special Questions: Prioritization; Multiple Patients
TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment