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: Systolic blood pressure above 70 mm Hg is a goal in hypovolemia but is not the most specific outcome for DIC-related bleeding. While low blood pressure reflects fluid loss, addressing bleeding directly prevents further volume depletion, making reduced bleeding a more targeted and measurable outcome.

Choice B reason: A stable level of consciousness is important but not directly tied to deficient fluid volume from bleeding in DIC. Altered consciousness may result from cerebral ischemia or hyponatremia, but reducing bleeding is the primary goal to stabilize fluid volume and prevent further hemodynamic compromise.

Choice C reason: Urine output of 30 mL/hour or more indicates adequate renal perfusion but is a secondary outcome in DIC-related bleeding. While it reflects fluid status, directly addressing bleeding through interventions like transfusions or clotting factor replacement is more specific to correcting the underlying fluid volume deficit.

Choice D reason: Decreased bleeding is the most appropriate outcome for deficient fluid volume in DIC, as bleeding from mucosal and venipuncture sites directly causes volume loss. Reducing hemorrhage through platelet or factor replacement stabilizes fluid volume, preventing hypovolemia and its complications, making this the most measurable and relevant outcome.

A. Above-normal urine osmolality level, below-normal serum osmolality level B. Above-normal urine and serum osmolality levels C. Below-normal urine osmolality level, above-normal serum osmolality level D. Below-normal urine and serum osmolality levels

Correct Answer is C

Explanation

Reasoning:

Choice A reason: Above-normal urine osmolality and below-normal serum osmolality are not consistent with diabetes insipidus. High urine osmolality suggests concentrated urine, typical in syndrome of inappropriate antidiuretic hormone (SIADH), where ADH is excessive. Low serum osmolality also aligns with SIADH due to water retention, not the water loss seen in diabetes insipidus.

Choice B reason: Above-normal urine and serum osmolality levels do not reflect diabetes insipidus. High urine osmolality indicates concentrated urine, which contradicts the dilute urine output of diabetes insipidus. High serum osmolality could occur with dehydration, but the combination with high urine osmolality suggests another condition, not ADH deficiency.

Choice C reason: Below-normal urine osmolality and above-normal serum osmolality are classic findings in diabetes insipidus. Arginine vasopressin (ADH) deficiency impairs water reabsorption, leading to dilute urine (low osmolality). The resulting water loss increases serum osmolality as the body becomes dehydrated, supporting the diagnosis of diabetes insipidus.

Choice D reason: Below-normal urine and serum osmolality levels are inconsistent with diabetes insipidus. Low urine osmolality occurs due to ADH deficiency, but low serum osmolality suggests water retention, as in SIADH. Diabetes insipidus causes dehydration, elevating serum osmolality, not lowering it, making this combination unlikely in this condition.

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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

Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

Correct Answer is C

Explanation

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