The nurse understands which of the following actions is an effective treatment approach for SIADH?
Administering diuretics to promote diuresis and eliminate excess fluid.
Increasing fluid intake to promote dilution of electrolytes.
Restricting fluid intake to prevent fluid overload.
Administering hypertonic 3% saline to restore electrolyte balance.
Correct Answer : C,D
Choice A rationale
Administering diuretics in SIADH can worsen hyponatremia by promoting water excretion with a concomitant loss of sodium, further diluting serum sodium concentration. The underlying issue in SIADH is excessive antidiuretic hormone leading to water retention, not primarily excess extracellular fluid that needs diuresis.
Choice B rationale
Increasing fluid intake is contraindicated in SIADH. The syndrome involves excessive reabsorption of water, leading to dilutional hyponatremia and fluid overload. Increasing fluid intake would exacerbate these issues, further lowering serum sodium levels and potentially leading to cerebral edema.
Choice C rationale
Restricting fluid intake is a cornerstone of SIADH management. By limiting water intake, the body's excessive water retention is mitigated, allowing serum sodium concentration to rise towards normal levels. This helps prevent further dilution of electrolytes and reduces the risk of fluid overload and cerebral edema.
Choice D rationale
Administering hypertonic 3% saline is an effective treatment for symptomatic severe hyponatremia in SIADH. This solution provides a concentrated source of sodium, helping to raise serum sodium levels by drawing water out of cells and into the extracellular space, thereby correcting the dilutional hyponatremia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Adjusting levothyroxine dosage daily based on blood levels is generally not appropriate due to the drug's long half-life, which necessitates stable drug concentrations before accurate assessment. Frequent adjustments risk inducing fluctuations in thyroid hormone levels, potentially leading to hyperthyroidism or continued hypothyroidism and making precise titration challenging for maintaining euthyroid state.
Choice B rationale
Remaining on the initial dosage throughout treatment is highly improbable for levothyroxine. Thyroid hormone replacement therapy requires individualized dosing due to variations in patient metabolism, weight, and the severity of hypothyroidism. Regular monitoring of thyroid stimulating hormone (TSH) levels is essential to titrate the dose, ensuring optimal therapeutic effect and avoiding complications.
Choice C rationale
Starting levothyroxine at a high dosage is contraindicated, particularly in older adults or those with cardiovascular comorbidities, due to the risk of precipitating adverse cardiac events such as arrhythmias or angina. High doses can overwhelm the cardiovascular system, demanding increased metabolic activity. Gradual titration minimizes these risks and allows for physiological adaptation.
Choice D rationale
Starting on a low dosage and gradually increasing levothyroxine is the standard and safest approach. This strategy allows the body to adapt to the exogenous thyroid hormone, minimizing the risk of adverse effects like cardiac arrhythmias, particularly in sensitive individuals. Gradual titration prevents rapid metabolic shifts and allows for careful monitoring of patient response and TSH levels.
Correct Answer is D
Explanation
Choice A rationale
A normal serum sodium level ranges from 135 to 145 mEq/L. A value of 120 mEq/L is significantly below the normal range, indicating hyponatremia, not an elevated level. Therefore, reporting it as elevated would be incorrect.
Choice B rationale
While laboratory errors can occur, a serum sodium level of 120 mEq/L in a client with chronic renal failure is a plausible finding due to impaired fluid and electrolyte balance, making a repeat analysis not the immediate primary interpretation without further clinical context.
Choice C rationale
While electrolyte abnormalities are common in chronic renal failure, a serum sodium of 120 mEq/L is a low sodium level (hyponatremia), not necessarily an "expected" abnormality in the sense of being benign or typical without specific context. It reflects a significant imbalance.
Choice D rationale
Chronic renal failure often leads to fluid retention due to impaired kidney excretion. This excessive water retention dilutes the body's sodium concentration, leading to a condition known as dilutional hyponatremia, where the total body sodium may be normal or even elevated, but its concentration is lowered by the excess fluid.
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