A nurse is providing care for a client who has the syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings is consistent with a diagnosis of SIADH?

Choice A reason: Lower Extremities Edematous with Decreased Pulses and Cool to the Touch

Lower extremities that are edematous with decreased pulses and cool to the touch can indicate severe peripheral artery disease (PAD) and poor blood circulation1. While this is a serious condition that requires medical attention, it is not necessarily an immediate emergency unless there are signs of acute limb ischemia, such as sudden pain or loss of function. Chronic symptoms like these often require ongoing management and monitoring rather than immediate intervention.

Choice B reason: Pain, Pallor, and Paresthesia in the Foot

Pain, pallor, and paresthesia (the three Ps) in the foot are classic signs of acute limb ischemia, a medical emergency that requires immediate intervention. Acute limb ischemia occurs when there is a sudden decrease in blood flow to a limb, leading to tissue damage and potential loss of the limb if not treated promptly4. The presence of these symptoms indicates that the limb is not receiving adequate blood supply, necessitating urgent medical attention to restore circulation and prevent permanent damage.

Choice C reason: Presence of an Open Wound Near the Ankle with Serous Drainage and Pruritus

An open wound near the ankle with serous drainage and pruritus (itching) suggests a chronic wound or ulcer, which is common in patients with PAD5. While this condition requires medical treatment to prevent infection and promote healing, it does not typically constitute an immediate emergency unless there are signs of severe infection, such as increased redness, warmth, or purulent drainage. Chronic wounds need regular care and monitoring but are not usually life-threatening.

Choice D reason: Murmur Auscultated at the Left Sternal Border, Slight Dyspnea, and Lower Extremity Edema

A murmur auscultated at the left sternal border, slight dyspnea (shortness of breath), and lower extremity edema can indicate heart valve disease or heart failure. These symptoms are concerning and require medical evaluation, but they do not typically represent an immediate emergency unless the patient is experiencing severe symptoms such as acute heart failure or cardiogenic shock. These conditions require prompt but not necessarily emergent intervention.

Choice A Reason:

The adrenal glands play a crucial role in responding to low blood glucose levels by releasing epinephrine (adrenaline) and norepinephrine. These hormones help to increase blood glucose levels by stimulating glycogenolysis (the breakdown of glycogen to glucose) and gluconeogenesis (the production of glucose from non-carbohydrate sources) in the liver. This response is part of the body’s fight-or-flight mechanism, which ensures that sufficient glucose is available for immediate energy needs.

Choice B Reason:

The liver does not release glucagon; rather, it responds to glucagon, which is released by the pancreas. Glucagon stimulates the liver to convert stored glycogen into glucose (glycogenolysis) and to produce glucose from non-carbohydrate sources (gluconeogenesis). This process helps to raise blood glucose levels when they are low.

Choice C Reason:

Glycogenesis is the process of converting glucose into glycogen for storage, and it occurs primarily in the liver and muscle cells, not in the pancreas. The pancreas releases insulin to promote glycogenesis when blood glucose levels are high, but it does not perform glycogenesis itself.

Choice D Reason:

The brain primarily uses glucose for energy and does not switch to using protein unless glucose levels are extremely low and prolonged. In such cases, the brain can use ketone bodies derived from fat as an alternative energy source. Protein is not a primary energy source for the brain under normal conditions.