A client developed diabetes insipidus as a result of a severe traumatic brain injury. Which finding does the nurse expect to observe?

Serum osmolality 380 mOsm/kg

Urine output of 500 mL in 24 hours

Weight gain of 5 pounds in 48 hours

Decreased serum hematocrit levels

Answer and Explanation

The Correct Answer is A

Choice A reason: Serum osmolality 380 mOsm/kg is the expected finding because it is a sign of dehydration, which is a common complication of diabetes insipidus. Diabetes insipidus is a condition where the body does not produce enough antidiuretic hormone (ADH), which is a hormone that helps the kidneys retain water and regulate the fluid balance in the body. A severe traumatic brain injury can damage the pituitary gland or the hypothalamus, which are parts of the brain that produce and secrete ADH. Without enough ADH, the kidneys produce large amounts of diluted urine, which causes the loss of water and electrolytes from the body. This increases the concentration of solutes in the blood, which is measured by the serum osmolality. A normal serum osmolality is between 275 and 295 mOsm/kg, while a high serum osmolality is above 300 mOsm/kg.

Choice B reason: Urine output of 500 mL in 24 hours is not the expected finding because it is a sign of oliguria, which is a low urine output. Oliguria can be caused by various factors, such as dehydration, kidney failure, or urinary obstruction, and can result in symptoms such as fluid retention, swelling, or electrolyte imbalance. Oliguria is not a common finding in diabetes insipidus, because the condition causes polyuria, which is a high urine output. Polyuria can be defined as urine output of more than 3 liters in 24 hours, or more than 200 mL per hour.

Choice C reason: Weight gain of 5 pounds in 48 hours is not the expected finding because it is a sign of fluid overload, which is a condition where the body retains too much fluid, which can cause edema, hypertension, and heart failure. Fluid overload can be caused by various factors, such as heart failure, kidney failure, or liver failure, and can result in symptoms such as shortness of breath, chest pain, or fatigue. Fluid overload is not a common finding in diabetes insipidus, because the condition causes dehydration, which is a loss of fluid from the body. Dehydration can cause weight loss, not weight gain.

Choice D reason: Decreased serum hematocrit levels is not the expected finding because it is a sign of anemia, which is a condition where the blood has a low level of hemoglobin, which is the protein that carries oxygen in the red blood cells. Anemia can be caused by various factors, such as blood loss, iron deficiency, or bone marrow failure, and can result in symptoms such as fatigue, weakness, or pallor. Anemia is not a common finding in diabetes insipidus, because the condition does not affect the production or function of the red blood cells. Diabetes insipidus can cause increased serum hematocrit levels, not decreased, because the loss of water from the body can increase the proportion of red blood cells in the blood.

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Correct Answer is A

Explanation

Choice A reason: The client has hypoglycemia during the night and hyperglycemia in the morning is the best explanation because it is the definition of the Somogyi effect, which is a rebound phenomenon that occurs in some people with type 1 diabetes mellitus. Type 1 diabetes mellitus is a condition where the pancreas does not produce enough insulin, which is a hormone that helps the cells use glucose, which is a sugar that provides energy for the body. The Somogyi effect happens when the blood glucose level drops too low during the night, usually due to taking too much insulin or not eating enough carbohydrates before bedtime. This triggers the release of hormones, such as glucagon, epinephrine, and cortisol, that raise the blood glucose level by stimulating the liver to produce more glucose and by preventing the cells from using glucose. This results in a high blood glucose level in the morning, which is called hyperglycemia.

Choice B reason: The client has not taken the prescribed insulin dose prior to the evening meal is not the best explanation because it is a factor that can cause the opposite of the Somogyi effect, which is the dawn phenomenon. The dawn phenomenon is a condition where the blood glucose level rises in the early morning, usually due to the natural increase of hormones, such as growth hormone and cortisol, that occur during the night. These hormones reduce the effectiveness of insulin and increase the blood glucose level. The dawn phenomenon can be worsened by not taking enough insulin or by eating too many carbohydrates in the evening.

Choice C reason: The client will have an abnormal glycosylated hemoglobin (HbA1c) for the next two months is not the best explanation because it is a consequence, not a cause, of the Somogyi effect. Glycosylated hemoglobin (HbA1c) is a test that measures the average blood glucose level over the past two to three months, by showing how much glucose is attached to the hemoglobin, which is the protein that carries oxygen in the red blood cells. The Somogyi effect can cause the HbA1c level to be higher than expected, because it reflects the high blood glucose level in the morning, not the low blood glucose level during the night.

Choice D reason: The client will experience complications earlier than other clients with type 1 diabetes mellitus do is not the best explanation because it is a general statement, not a specific explanation, of the Somogyi effect. The Somogyi effect can increase the risk of complications, such as eye, kidney, nerve, and heart problems, because it causes fluctuations in the blood glucose level, which can damage the blood vessels and the organs. However, the Somogyi effect is not the only factor that can affect the development and progression of complications. Other factors, such as genetics, lifestyle, and comorbidities, can also play a role.

A. Lymph structures were removed and fluid cannot move out of the area easily. B. There is still too much swelling in the area of the surgery and fluid is accumulating. C. The veins were removed from the axilla during surgery and there is poor circulation now. D. You will need to wear a compression bandage to help fluids move from the area.

Correct Answer is A

Explanation

Choice A reason: Lymph structures were removed and fluid cannot move out of the area easily is the correct explanation because a radical mastectomy involves the removal of the breast, the underlying chest muscles, and the lymph nodes in the axilla. The lymph nodes are part of the lymphatic system, which is responsible for draining excess fluid from the tissues and returning it to the bloodstream. When the lymph nodes are removed, the fluid cannot be drained properly and accumulates in the affected arm and hand, causing edema.

Choice B reason: There is still too much swelling in the area of the surgery and fluid is accumulating is not the correct explanation because it does not address the underlying cause of the edema. Swelling is a normal response to surgery, but it usually subsides within a few days or weeks. The edema caused by lymph node removal is chronic and persistent, and it does not improve with time.

Choice C reason: The veins were removed from the axilla during surgery and there is poor circulation now is not the correct explanation because it is not true. The veins are not removed during a radical mastectomy, only the lymph nodes are. The veins are part of the circulatory system, which carries blood throughout the body. The blood flow to the arm and hand is not affected by the surgery, unless there is a complication such as a blood clot or an infection.

Choice D reason: You will need to wear a compression bandage to help fluids move from the area is not the correct explanation because it is a treatment, not a cause. A compression bandage is a type of elastic bandage that applies pressure to the arm and hand, which helps to reduce the swelling and prevent further fluid accumulation. However, it does not address the root cause of the edema, which is the removal of the lymph nodes.

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A client developed diabetes insipidus as a result of a severe traumatic brain injury. Which finding does the nurse expect to observe?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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