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: Encouraging increased oral intake is inappropriate for SIADH, as it exacerbates water retention caused by excessive ADH. This would worsen dilutional hyponatremia and fluid overload, potentially leading to severe complications like cerebral edema, making fluid restriction the preferred approach to manage this condition.

Choice B reason: Infusing IV fluids rapidly is contraindicated in SIADH, as it increases fluid overload. Excessive ADH already causes water retention, diluting serum sodium. Rapid IV fluid administration could worsen hyponatremia and lead to neurological complications, such as seizures, due to further dilution of electrolytes.

Choice C reason: Administering glucose-containing IV fluids is not appropriate for SIADH, as it adds to the fluid volume, worsening water retention and hyponatremia. Glucose fluids do not address the underlying ADH excess and may exacerbate dilutional effects, increasing the risk of cerebral edema or other complications.

Choice D reason: Restricting fluids is the appropriate intervention for SIADH, as excessive ADH causes water retention, leading to hyponatremia. Limiting fluid intake helps correct the dilutional effect, increasing serum sodium concentration and reducing the risk of complications like cerebral edema, aligning with the goal of restoring fluid balance.

Reasoning:

Choice A reason: Glucose in the urine, or glycosuria, is not characteristic of diabetes insipidus, which results from antidiuretic hormone (ADH) deficiency, impairing water reabsorption in the kidneys’ collecting ducts. Glycosuria is typically seen in diabetes mellitus, where elevated blood glucose exceeds the renal threshold, leading to glucose excretion. This is unrelated to the water balance issue in diabetes insipidus.

Choice B reason: Highly dilute urine is a hallmark of diabetes insipidus due to insufficient ADH, which normally facilitates water reabsorption in the renal collecting ducts. Without ADH, the kidneys produce large volumes of dilute urine with low osmolality and specific gravity, reflecting the inability to concentrate urine and conserve water, leading to polyuria.

Choice C reason: Leukocytes in the urine indicate urinary tract infection or inflammation, not diabetes insipidus. This condition involves hormonal dysregulation of water balance, not immune or infectious processes in the urinary tract. Leukocyturia would suggest a separate pathology, such as cystitis, rather than the expected dilute urine output of diabetes insipidus.

Choice D reason: Albumin in the urine, or proteinuria, suggests glomerular damage, as seen in conditions like nephrotic syndrome. Diabetes insipidus is a disorder of water regulation due to ADH deficiency, not affecting protein filtration in the kidneys. Thus, albuminuria is not an expected finding, as the condition does not impair glomerular barrier function.