A patient with diabetes insipidus (DI) is admitted to the hospital for evaluation and treatment. Which intervention would the nurse implement immediately?

Obtain 24 hour dietary intake

Administer corticosteroids

Administer IV fluids

Obtain blood cultures

Answer and Explanation

The Correct Answer is C

A. Obtain 24-hour dietary intake: While monitoring dietary intake is important for long-term management of diabetes insipidus, it does not address the acute and potentially life-threatening fluid and electrolyte imbalance caused by excessive water loss. This is not the immediate priority.

B. Administer corticosteroids: Corticosteroids may be used in cases of secondary DI due to adrenal insufficiency, but they are not first-line therapy for the majority of DI patients. Immediate management focuses on correcting dehydration and hypernatremia rather than starting steroids.

C. Administer IV fluids: Patients with DI excrete large volumes of dilute urine, leading to dehydration and hypernatremia. Rapid IV fluid replacement is critical to restore circulating volume, correct electrolyte imbalances, and prevent hypovolemic shock. This intervention addresses the most urgent physiologic threat.

D. Obtain blood cultures: Blood cultures are indicated if infection is suspected but are not part of the immediate management of DI. Delaying fluid resuscitation to obtain cultures could worsen dehydration and hemodynamic instability.

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Correct Answer is B

Explanation

A. BP 102/56 mm Hg: This blood pressure is slightly low but may still be sufficient to maintain perfusion in some patients. Early compensatory mechanisms in shock can maintain perfusion despite borderline hypotension, so while it warrants monitoring, it is not the most critical finding.

B. Urine output 15 ml for 2 hours: Oliguria is a sensitive early indicator of inadequate tissue perfusion in shock. A urine output of less than 0.5 mL/kg/hr reflects decreased renal perfusion and potential impending acute kidney injury, making this the most urgent finding requiring immediate assessment and intervention.

C. Arterial oxygen saturation 92%: Oxygen saturation of 92% is mildly reduced and may indicate early hypoxemia. While concerning, it is less immediately critical than evidence of end-organ hypoperfusion, such as severely reduced urine output.

D. Apical pulse 110 beats/min: Tachycardia is a compensatory response in shock to maintain cardiac output. While it signals stress on the cardiovascular system, it is expected in early shock and is less immediately dangerous than oliguria indicating organ hypoperfusion.

A. Decreased B/P, decreased sodium, water retention B. Decreased B/P, increased sodium, polyuria C. Increased B/P, increased sodium, polydipsia D. Increased B/P. decreased sodium, oliguria

Correct Answer is B

Explanation

A. Decreased B/P, decreased sodium, water retention: This scenario reflects fluid overload with hyponatremia, which is opposite to the pathophysiology of diabetes insipidus. In DI, the kidneys fail to concentrate urine, leading to water loss rather than retention, so sodium levels typically rise rather than decrease.

B. Decreased B/P, increased sodium, polyuria: Diabetes insipidus is characterized by a deficiency of antidiuretic hormone (central DI) or renal insensitivity to ADH (nephrogenic DI). This leads to excessive free water loss, causing polyuria and dehydration. Dehydration results in hypotension and hypernatremia due to reduced plasma volume and concentration of serum sodium.

C. Increased B/P, increased sodium, polydipsia: While polydipsia is a hallmark of DI, blood pressure usually decreases rather than increases due to volume depletion. Elevated blood pressure is not consistent with the hypovolemic state caused by excessive fluid loss in DI.

D. Increased B/P, decreased sodium, oliguria: Oliguria and hyponatremia are not features of diabetes insipidus. Oliguria suggests reduced urine output, whereas DI presents with copious urine output. Hyponatremia results from water retention, not loss, and does not reflect the hypernatremia seen in DI.

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A patient with diabetes insipidus (DI) is admitted to the hospital for evaluation and treatment. Which intervention would the nurse implement immediately?

Nursing Test Bank

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