The patient in the progressive care unit following arteriovenous fistula implantation in his left upper arm, and is due to have blood drawn with his next set of vital signs and assessment. When the nurse assesses the patient, what should he/she do?

Rationale:
A. Rupture of a bleb is correct because spontaneous pneumothorax often occurs when a subpleural bleb ruptures, allowing air to escape into the pleural space and causing lung collapse. This is commonly seen in young, tall, thin individuals or patients with underlying lung disease.

B. Lung abscess is incorrect because a lung abscess is a localized infection with pus formation within lung tissue. While it causes inflammation and destruction of lung parenchyma, it does not typically introduce air into the pleural space unless it ruptures, which is uncommon and not considered a primary cause of pneumothorax.

C. Central line placement is correct because iatrogenic pneumothorax can occur during procedures such as subclavian or internal jugular central venous catheter insertion if the pleura or lung is accidentally punctured.

D. Dyspnea is incorrect because dyspnea is a symptom, not a cause. It commonly occurs as a result of pneumothorax but does not cause one.

E. Trauma is correct because blunt or penetrating chest trauma (such as rib fractures or stab wounds) can allow air to enter the pleural space, leading to a traumatic pneumothorax.

Rationale:
A. Fatigue is incorrect because, although patients with diabetes insipidus (DI) may experience fatigue, this symptom is nonspecific. Fatigue can result from many conditions, including dehydration, electrolyte imbalances, chronic illness, or sleep disturbances. In DI, fatigue may develop secondary to fluid and electrolyte loss, but it is not a primary or diagnostic feature of the disorder.

B. Polydipsia is correct because it is the most indicative and classic symptom of DI. Diabetes insipidus results from either a deficiency of antidiuretic hormone (ADH, also called vasopressin) in central DI or the kidneys’ inability to respond to ADH in nephrogenic DI. Without adequate ADH activity, the kidneys cannot concentrate urine, leading to the excretion of large volumes of dilute urine (polyuria), sometimes up to 3–20 liters per day in severe cases. The body attempts to compensate for this fluid loss by triggering intense thirst (polydipsia), often resulting in the patient drinking large amounts of water to prevent dehydration. Polydipsia is thus a hallmark symptom and a key diagnostic clue for DI.

C. Weight gain is incorrect because the fluid loss associated with DI typically causes weight loss rather than gain. Patients may have decreased body mass due to the ongoing loss of water and potential electrolyte depletion. Weight gain is not associated with DI unless there is excessive water intake beyond renal capacity, which is uncommon.

D. Diarrhea is incorrect because DI affects renal water reabsorption, not gastrointestinal function. Diarrhea is unrelated to the pathophysiology of DI and may indicate a separate gastrointestinal issue rather than the endocrine disorder itself.