A 41-year-old male client has just been diagnosed with nephrogenic diabetes insipidus (NDI) and asks the nurse practitioner for more information about the disorder. Which one of the following statements is NOT correct?
"NDI occurs as a result of partial or absolute lack of antidiuretic hormone."
"NDI has been associated with a genetic (sex-linked) predilection in men."
"NDI is associated with normal antidiuretic hormone production and secretion."
"In NDI, large volumes of dilute urine are produced."
The Correct Answer is A
Choice A reason: NDI is not caused by a lack of antidiuretic hormone (ADH); that would describe central diabetes insipidus. In NDI, the kidneys are unresponsive to ADH despite normal or elevated hormone levels.
Choice B reason: NDI can be linked to genetic mutations, particularly X-linked forms, which predominantly affect males. This makes this statement correct.
Choice C reason: NDI is characterized by normal or even elevated ADH levels because the kidney fails to respond appropriately, leading to excessive urination.
Choice D reason: A hallmark of NDI is the production of large volumes of dilute urine, which is a direct result of renal insensitivity to ADH.
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Correct Answer is D
Explanation
Choice A reason: Hydrocodone is an opioid analgesic and may be considered for severe pain, but it is not first-line for chronic neuropathic pain due to risk of dependence and side effects.
Choice B reason: Acetaminophen is effective for mild to moderate nociceptive pain but has limited efficacy in neuropathic pain.
Choice C reason: Amitriptyline is a tricyclic antidepressant effective for neuropathic pain and could be considered, but switching to pregabalin is often preferred for patients already partially responsive to gabapentin due to similar mechanisms but potentially better efficacy.
Choice D reason: This choice is correct because pregabalin is a first-line agent for neuropathic pain and can be considered when gabapentin provides only partial relief. It works similarly but has different pharmacokinetics and dosing flexibility, making it an appropriate next step.
Correct Answer is B
Explanation
Choice A reason: Providing limited information without consent still breaches patient confidentiality and legal protections under HIPAA.
Choice B reason: The patient, being 18, is legally an adult and has the right to confidentiality regarding her medical and psychiatric care. Consent must be obtained before sharing any information.
Choice C reason: Health insurance coverage does not give a parent the right to access a patient’s medical details; legal protections ensure patient privacy.
Choice D reason: Telling the father to make an appointment does not resolve the confidentiality issue and could lead to inappropriate disclosure.
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