A client who is under extreme stress will have an increased production of antidiuretic hormone (ADH) and aldosterone. The nurse should expect a decrease in which clinical finding?

Serum osmolarity

Urinary output

Insensible fluid loss

Blood pressure

Answer and Explanation

The Correct Answer is B

When a client experiences increased production of antidiuretic hormone (ADH) and aldosterone due to extreme stress, the body's response is aimed at retaining fluid to maintain blood pressure and hydration. As a result, urinary output decreases because the kidneys retain more water, leading to concentrated urine production. This decrease in urinary output helps conserve fluids and contributes to maintaining blood pressure and hydration levels in response to stress.

A. Serum osmolarity: With increased ADH production, serum osmolarity tends to remain stable or may even increase slightly due to the retention of water. ADH acts on the kidneys to increase water reabsorption, which can concentrate the blood and elevate serum osmolarity.

B. Urinary output: Increased production of ADH and aldosterone leads to decreased urinary output as the kidneys retain more water. This response helps conserve fluid volume and maintain hydration during times of stress.

C. Insensible fluid loss: Insensible fluid loss, which includes water lost through respiration and skin evaporation, is not directly affected by ADH and aldosterone. These hormones primarily influence renal water retention rather than insensible fluid loss.

D. Blood pressure: Although aldosterone can indirectly affect blood pressure by increasing sodium retention and therefore influencing fluid balance, its primary role is to regulate sodium and potassium levels. Blood pressure may be influenced by various factors, including stress, hydration status, and cardiovascular health, but it is not directly decreased as a result of increased ADH and aldosterone production.

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Correct Answer is B

Explanation

A. 17-year-old who has just had an ankle cast applied: While constipation may occur due to reduced mobility after having an ankle cast applied, teaching about the hazards of straining during bowel movements is not the priority for this client. The immediate concern may be related to cast care and mobility.

B. 60-year-old recovering from a heart attack: This client is recovering from a heart attack, and straining during bowel movements can increase intra-abdominal pressure and potentially lead to complications such as vagal stimulation, which may trigger arrhythmias or further stress the heart. Therefore, teaching about the hazards of straining during bowel movements is essential for this client to prevent complications and promote cardiac safety.

C. 80-year-old admitted for an infected tooth: While constipation may occur as a side effect of certain medications or due to decreased oral intake, teaching about straining during bowel movements is not the immediate priority for this client, given the primary reason for admission is an infected tooth. However, if constipation becomes a concern during the admission, it can be addressed accordingly.

D. 28-year-old new mother of twins: While postpartum mothers may experience constipation due to various factors such as changes in hormone levels, reduced mobility after delivery, and opioid use for pain management, teaching about the hazards of straining during bowel movements may not be the priority compared to other immediate postpartum care needs, such as breastfeeding support, perineal care, and newborn care.

A. Tell him that he shouldn't feel embarrassed, saying that there are more people than we know who feel this way. B. Provide information about support groups and other community resources for questioning and/or transgender people. C. Suggest that the client seek mental health care for medication to help him deal with his anxiety. D. Share with him that your nephew has experienced this, and tell him about that outcome.

Correct Answer is B

Explanation

A. Tell him that he shouldn't feel embarrassed, saying that there are more people than we know who feel this way: While offering reassurance and normalization of the client's feelings may be well-intentioned, it may not address the client's immediate needs or provide tangible support. Additionally, assuming that "more people than we know" feel this way may not be accurate and could potentially invalidate the client's experience.

B. Provide information about support groups and other community resources for questioning and/or transgender people: This is the correct response. Providing information about support groups and community resources acknowledges the client's feelings and offers practical assistance in accessing additional support and resources. It demonstrates empathy, validation, and a commitment to assisting the client in finding the help and support they need.

C. Suggest that the client seek mental health care for medication to help him deal with his anxiety: While mental health care may be beneficial for addressing anxiety related to gender identity concerns, suggesting medication as the first line of treatment may not be appropriate without a comprehensive assessment by a mental health professional. Additionally, focusing solely on medication overlooks the importance of psychosocial support and other interventions.

D. Share with him that your nephew has experienced this, and tell him about that outcome: Sharing personal anecdotes may not be helpful in this situation, as it could potentially detract from the client's experience and needs. Each individual's experience with gender identity is unique, and the client may benefit more from information about professional resources and support groups.

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A client who is under extreme stress will have an increased production of antidiuretic hormone (ADH) and aldosterone. The nurse should expect a decrease in which clinical finding?

Nursing Test Bank

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