A client sustained a head injury when falling from a ladder. While in the hospital, the client begins voiding large amounts of clear urine and reports being very thirsty. The client states feeling weak and having experienced an 8-pound weight loss since admission. What condition does the nurse expect the client to be tested for?

Diabetes insipidus (DI)

Pituitary tumor

Hypothyroidism

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Answer and Explanation

The Correct Answer is A

Reasoning:

Choice A reason: Diabetes insipidus is likely due to the client’s symptoms of polyuria, thirst, and weight loss following a head injury. Trauma can disrupt the posterior pituitary, reducing ADH secretion, leading to excessive dilute urine output, dehydration, and subsequent thirst and weight loss from fluid depletion, consistent with central DI.

Choice B reason: A pituitary tumor may cause diabetes insipidus but is not the condition itself. Tumors can disrupt ADH production, but the symptoms described—polyuria, thirst, and weight loss—point directly to diabetes insipidus as the primary condition, with a tumor being a potential underlying cause requiring further investigation.

Choice C reason: Hypothyroidism, caused by thyroid hormone deficiency, leads to symptoms like fatigue and weight gain, not polyuria or weight loss. It is unrelated to head injury or ADH dysfunction, making it an unlikely diagnosis for the client’s symptoms of excessive urine output and dehydration.

Choice D reason: SIADH causes water retention, leading to concentrated urine, hyponatremia, and potential weight gain, opposite to the client’s symptoms of dilute urine, weight loss, and thirst. Head injury may cause SIADH, but the clinical presentation aligns with diabetes insipidus, not water retention.

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Correct Answer is B

Explanation

Reasoning:

Choice A reason: Hair loss may not significantly decline with successful Cushing’s syndrome treatment. Excess cortisol causes hirsutism or hair thinning due to androgen excess or protein catabolism. Treatment reduces cortisol, but hair changes may persist due to slow hair growth cycles or irreversible follicular damage.

Choice B reason: Successful treatment of Cushing’s syndrome lowers serum glucose levels. Excess cortisol induces insulin resistance and gluconeogenesis, causing hyperglycemia. Reducing cortisol through treatment (e.g., surgery or medication) restores insulin sensitivity and reduces glucose production, normalizing blood sugar levels, a key indicator of effective management.

Choice C reason: Bone demineralization may not decline quickly with treatment. Chronic cortisol excess inhibits osteoblast activity and calcium absorption, causing osteoporosis. While treatment halts further bone loss, reversal is slow due to the time required for bone remodeling, making this less immediate than glucose normalization.

Choice D reason: Menstrual flow may not immediately increase with treatment. Cortisol excess disrupts gonadotropin release, causing amenorrhea. Restoring normal cortisol levels may improve menstrual cycles, but hormonal recovery is gradual, and changes in flow are less immediate or reliable than glucose level declines as a treatment outcome.

A. Normal hematocrit B. Low hematocrit C. High hematocrit D. Normal blood smear

Correct Answer is B

Explanation

Reasoning:

Choice A reason: Normal hematocrit is not typical in sickle cell anemia, a hemolytic disorder where red blood cells are destroyed prematurely due to abnormal hemoglobin (HbS). Chronic hemolysis reduces red blood cell mass, lowering hematocrit, making a normal value inconsistent with the disease’s pathophysiology.

Choice B reason: Low hematocrit is characteristic of sickle cell anemia due to chronic hemolysis. Sickled red blood cells have a shorter lifespan, reducing circulating red blood cells and hemoglobin, resulting in a decreased hematocrit. This reflects the anemia’s impact on oxygen-carrying capacity, a hallmark of the condition.

Choice C reason: High hematocrit is not associated with sickle cell anemia. Elevated hematocrit occurs in conditions like polycythemia, where red blood cell mass increases. Sickle cell anemia causes hemolysis, reducing red blood cells and hematocrit, making a high value inconsistent with the disease.

Choice D reason: A normal blood smear is not expected in sickle cell anemia. Blood smears show sickled red blood cells, anisocytosis, and poikilocytosis due to hemoglobin S polymerization. These abnormal findings contrast with a normal smear, which would not reflect the hemolytic and morphological changes of the disease.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is being successfully treated for Cushing's syndrome. The nurse should expect a decline in:

Correct Answer is B

Explanation

A client with sickle cell anemia has a:

Correct Answer is B

Explanation

A client is suspected to have a pituitary tumor due to signs of diabetes insipidus. What initial test does the nurse help to prepare the client for?

The nurse is caring for an older adult client who has been admitted to the unit with anemia. What would the nurse expect the client to possibly exhibit?

A client has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia?

The nurse should advise a client with iron deficiency anemia to take which action to prevent staining of the teeth?

The nurse assesses a client who has been diagnosed with Addison's disease. Which of the following is a diagnostic sign of this disease?

A client with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is being cared for on the critical care unit. The client with this condition is most at risk for which of the following?

A nurse is planning care for a client in acute Addisonian crisis. Which nursing diagnosis should receive the highest priority?

A client has just been diagnosed with an aneurysm. When planning discharge teaching for this client, what instructions should the nurse provide to the client?