A nurse is caring for a client with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which finding would indicate that the client has developed fluid overload?

Confusion and diarrhea

Hypertension and weight gain without edema

Pulmonary congestion and muscle cramps

Dyspnea and hypertension

Answer and Explanation

The Correct Answer is D

Reasoning:

Choice A reason: Confusion may occur in SIADH due to hyponatremia-induced cerebral edema, but diarrhea is not a typical sign of fluid overload. Diarrhea causes fluid loss, which is opposite to the water retention seen in SIADH, making this combination less indicative of fluid overload compared to cardiovascular or respiratory signs.

Choice B reason: Hypertension may occur in SIADH due to fluid overload, but weight gain without edema is less specific. SIADH often causes subtle fluid retention without overt edema, but weight gain alone does not fully indicate fluid overload, as it lacks the respiratory or cardiovascular specificity of dyspnea and hypertension.

Choice C reason: Pulmonary congestion may indicate fluid overload in SIADH, as excess water can lead to pulmonary edema. However, muscle cramps are more related to hyponatremia than fluid overload itself. This combination is less precise than dyspnea and hypertension for identifying fluid overload in this context.

Choice D reason: Dyspnea and hypertension are key indicators of fluid overload in SIADH. Excessive ADH causes water retention, increasing blood volume, which raises blood pressure. Fluid accumulation in the lungs can cause dyspnea, reflecting pulmonary edema, a serious complication of fluid overload in SIADH, making this the most accurate finding.

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Correct Answer is B

Explanation

Reasoning:

Choice A reason: An increased number of erythrocytes is not indicative of iron-deficiency anemia, which is characterized by reduced red blood cell production due to low iron availability for hemoglobin synthesis. Increased erythrocytes suggest compensatory mechanisms or polycythemia, not the reduced erythropoiesis seen in iron deficiency.

Choice B reason: Microcytic and hypochromic erythrocytes are hallmarks of iron-deficiency anemia. Low iron impairs hemoglobin synthesis, leading to smaller (microcytic) and paler (hypochromic) red blood cells. This matches the client’s low hemoglobin and hematocrit, confirming iron deficiency as the cause of the anemia.

Choice C reason: Clustering of platelets with sickled red blood cells is specific to sickle cell anemia, not iron-deficiency anemia. Sickle cell disease involves hemoglobin S, causing cell deformation, not iron deficiency. Platelet clustering is unrelated to the microcytic, hypochromic cells of iron deficiency.

Choice D reason: Macrocytic and hyperchromic erythrocytes suggest megaloblastic anemia, typically from vitamin B12 or folate deficiency, not iron deficiency. Iron-deficiency anemia produces microcytic, hypochromic cells due to impaired hemoglobin synthesis, making macrocytic, hyperchromic cells inconsistent with the client’s laboratory findings.

A. Encouraging increased oral intake B. Infusing IV fluids rapidly as ordered C. Administering glucose-containing IV fluids as ordered D. Restricting fluids

Correct Answer is D

Explanation

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.

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A nurse is caring for a client with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which finding would indicate that the client has developed fluid overload?

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Naxlex Comprehensive Predictor Exams

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Explanation

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