A client with a new diagnosis of ischemic stroke was treated in the ED with tissue plasminogen activator (t-PA) and then admitted to the ICU. In addition to closely monitoring the client’s cardiac and neurologic status, the nurse monitors the client for signs of what complication?

Reasoning:

Choice A reason: Recent blood donation is not a primary cause of secondary polycythemia, which results from chronic hypoxia or erythropoietin excess, not blood loss. Donation may temporarily reduce red blood cell count, but it does not drive the increased erythropoiesis seen in secondary polycythemia, making it less relevant.

Choice B reason: A history of venous thromboembolism is a consequence, not a cause, of secondary polycythemia. Increased red blood cell mass elevates blood viscosity, raising clotting risk, but thromboembolism does not trigger polycythemia. The nurse should assess for underlying causes like hypoxia, not its complications.

Choice C reason: Evidence of lung disease is critical to assess, as secondary polycythemia is often caused by chronic hypoxia from conditions like chronic obstructive pulmonary disease. Low oxygen levels stimulate erythropoietin production, increasing red blood cell mass to enhance oxygen delivery, making lung disease a primary factor to evaluate.

Choice D reason: Impaired renal function is not a primary cause of secondary polycythemia. While kidneys produce erythropoietin, renal disease typically causes anemia due to reduced erythropoietin. Rarely, renal tumors may increase erythropoietin, but lung disease is a more common driver of secondary polycythemia in clinical practice.

Reasoning:

Choice A reason: Consuming adequate fluids is essential in diabetes insipidus to replace the large volumes of water lost through polyuria due to ADH deficiency. Adequate hydration prevents dehydration, maintains electrolyte balance, and alleviates excessive thirst, supporting the body’s compensatory mechanisms to manage the high urine output characteristic of this condition.

Choice B reason: Daily IV fluid therapy is not a practical or necessary intervention for diabetes insipidus. While severe dehydration may require IV fluids, oral hydration is sufficient for most patients to manage polyuria. Regular clinic visits for IV therapy are invasive, costly, and not standard for controlling thirst or fluid loss.

Choice C reason: Limiting fluid intake at night is counterproductive in diabetes insipidus, as it exacerbates dehydration caused by excessive urine output. Patients need to maintain hydration to compensate for water loss and reduce thirst. Restricting fluids could worsen symptoms and lead to complications like hypernatremia or hypovolemia.

Choice D reason: Daily weighing monitors fluid status but does not directly control thirst or compensate for urine loss in diabetes insipidus. While useful for assessing treatment response, it is a passive measure and does not address the active need to replace fluid losses through adequate oral intake to manage symptoms.