A client with a history of diabetes insipidus seeks medical attention for an exacerbation of symptoms. Which laboratory finding indicates to the nurse that the client has been restricting fluids in an attempt to control the symptoms?

Sodium level of 150 mEq/L (range 135-145 mEq/L)

Phosphate level of 4.0 mg/dL (range 2.5-4.5 mg/dL)

Blood glucose level of 60 mg/dL (range 60-100 mg/dL)

Potassium level of 2.9 mmol/L (range 3.5-5 mEq/L)

Answer and Explanation

The Correct Answer is A

Reasoning:

Choice A reason: A sodium level of 150 mEq/L indicates hypernatremia, which occurs in diabetes insipidus when fluid restriction exacerbates water loss from polyuria. Without adequate ADH, the kidneys cannot conserve water, and restricting fluids further increases serum sodium concentration, reflecting dehydration and supporting the suspicion of fluid restriction.

Choice B reason: A phosphate level of 4.0 mg/dL is within the normal range and unrelated to fluid restriction in diabetes insipidus. Phosphate levels are affected by bone metabolism or renal function, not directly by ADH deficiency or fluid intake, making this finding irrelevant to the client’s fluid management strategy.

Choice C reason: A blood glucose level of 60 mg/dL is at the lower end of normal but unrelated to fluid restriction in diabetes insipidus. Glucose levels are affected by metabolic conditions like diabetes mellitus, not water balance issues caused by ADH deficiency, so this does not indicate fluid restriction.

Choice D reason: A potassium level of 2.9 mmol/L indicates hypokalemia, which is not directly linked to fluid restriction in diabetes insipidus. Potassium imbalances may result from other causes, like diuretic use or gastrointestinal losses, but they do not reflect the dehydration or sodium concentration changes associated with restricted fluid intake.

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Correct Answer is D

Explanation

Reasoning:

Choice A reason: Continuous oxygen therapy is not a standard preventive measure for sickle cell crises. Oxygen is used during acute crises to treat hypoxia from vaso-occlusion, but daily hydration is more effective for prevention, as it reduces blood viscosity and sickling, making this inappropriate.

Choice B reason: Avoiding all sports is overly restrictive for sickle cell anemia. Moderate exercise can be safe with proper hydration and rest. Complete avoidance does not directly prevent crises and may reduce quality of life, whereas hydration directly addresses the risk of sickling and vaso-occlusion.

Choice C reason: Avoiding activities causing shortness of breath is partially correct, as overexertion can trigger hypoxia and crises. However, it is less specific than hydration, which directly reduces blood viscosity and sickling, preventing crises more effectively across various situations, not just during exertion.

Choice D reason: Drinking at least 8 glasses of water daily is critical in sickle cell anemia to prevent crises. Adequate hydration reduces blood viscosity, preventing red blood cell sickling and vaso-occlusion. Dehydration increases sickling risk, making consistent fluid intake a key preventive strategy for this client.

A. Fluid intake is less than 2,500 ml/day B. Heart rate is 126 beats/minute C. Blood pressure is 90/50 mm Hg D. Urine output measures more than 200 ml/hour

Correct Answer is A

Explanation

Reasoning:

Choice A reason: Effective treatment of diabetes insipidus, typically with desmopressin, restores ADH function, reducing excessive urine output and thirst. Fluid intake below 2,500 ml/day indicates improved water reabsorption in the kidneys, normalizing fluid balance and reducing polyuria, which is a key sign of successful management of this condition.

Choice B reason: A heart rate of 126 beats/minute indicates tachycardia, often a sign of dehydration or hypovolemia in untreated diabetes insipidus. Effective treatment should normalize heart rate by correcting fluid balance, so persistent tachycardia suggests ongoing fluid loss and ineffective treatment, not a successful therapeutic outcome.

Choice C reason: Blood pressure of 90/50 mm Hg indicates hypotension, which can result from severe dehydration in untreated diabetes insipidus. Effective treatment should stabilize blood pressure by restoring fluid volume through improved water reabsorption, making low blood pressure an indicator of poor treatment response rather than success.

Choice D reason: Urine output exceeding 200 ml/hour reflects polyuria, a primary symptom of untreated diabetes insipidus due to ADH deficiency. Effective treatment reduces urine output by enhancing renal water reabsorption, so high urine output indicates persistent disease activity, not a successful response to therapy.

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A client with a history of diabetes insipidus seeks medical attention for an exacerbation of symptoms. Which laboratory finding indicates to the nurse that the client has been restricting fluids in an attempt to control the symptoms?

Nursing Test Bank

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Explanation

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Explanation

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