Your patient had emergency surgery to evacuate a subdural hematoma yesterday and appears to be doing well.
However, during your shift, you have suddenly had to empty the patient's Foley bag 4 times in the last 6 hours. You suspect your patient has developed what complication?
Diabetes insipidus.
SIADH.
Acute Kidney Injury.
Diabetes mellitus.
The Correct Answer is A
Choice A rationale
Diabetes insipidus is a condition characterized by the inability of the kidneys to conserve water, typically due to a deficiency in antidiuretic hormone (ADH) or kidney unresponsiveness to ADH. Post-neurosurgery, especially involving the pituitary or hypothalamus, ADH secretion can be impaired, leading to excessive urine output (polyuria), often exceeding 200 mL/hr, and dilute urine with a low specific gravity (normal range 1.005-1.030).
Choice B rationale
SIADH (Syndrome of Inappropriate Antidiuretic Hormone) is characterized by excessive ADH secretion, leading to water retention, hyponatremia, and concentrated urine. This condition would manifest as decreased urine output, not increased, and would be associated with a higher urine specific gravity (normal range 1.005-1.030) due to water reabsorption.
Choice C rationale
Acute Kidney Injury (AKI) involves a rapid decrease in kidney function, leading to the accumulation of waste products in the blood. While AKI can affect urine output, it typically results in oliguria (decreased urine output) or anuria (no urine output), rather than the profound polyuria observed in the patient.
Choice D rationale
Diabetes mellitus is a metabolic disorder characterized by high blood glucose levels due to insulin deficiency or resistance. While uncontrolled diabetes mellitus can cause polyuria due to osmotic diuresis from hyperglycemia, it would also present with other classic symptoms like polydipsia and polyphagia, and would be detected by elevated blood glucose levels (normal fasting plasma glucose <100 mg/dL).
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
The absence of lung sounds on the right side would indicate a problem in the right lung, such as a right-sided pneumothorax or severe atelectasis of the right lung. Given the scenario specifies a left-sided pneumothorax, the primary assessment findings would be localized to the affected (left) side, not the contralateral side.
Choice B rationale
A left-sided pneumothorax, characterized by air accumulating in the pleural space on the left side, will lead to collapse of the left lung. This collapse will result in an absence of breath sounds and diminished or absent chest rise on the affected (left) side due to the lung's inability to inflate and participate in ventilation.
Choice C rationale
Hypertension (elevated blood pressure) and bradypnea (slow respiratory rate) are not typical primary findings in an acute pneumothorax. While a pneumothorax can cause respiratory distress, it often leads to tachypnea (increased respiratory rate) as the body attempts to compensate for reduced lung function and potentially hypotension due to impaired venous return.
Choice D rationale
Lack of chest rise bilaterally would indicate a more generalized respiratory issue, such as severe bilateral atelectasis, bilateral mainstem bronchus obstruction, or a severe neurological impairment affecting respiratory drive. In a unilateral pneumothorax, the contralateral lung would typically still demonstrate some degree of chest rise, although it might be diminished. .
Correct Answer is D
Explanation
Choice A rationale
A chylothorax refers to the accumulation of chyle, a milky, lymphatic fluid, in the pleural space. This typically results from disruption of the thoracic duct, often due to trauma or malignancy. The fluid's characteristic milky appearance is due to its high triglyceride content, not a pus-like consistency.
Choice B rationale
A pneumothorax is the presence of air in the pleural space, leading to lung collapse. It is characterized by respiratory distress and diminished breath sounds, not the presence of fluid with a pus-like appearance. This condition involves gas, not liquid, accumulation in the pleural cavity.
Choice C rationale
A hemothorax is the accumulation of blood in the pleural space, usually due to trauma or a ruptured blood vessel. The fluid would appear bloody, not pus-like. While blood can become infected, a primary hemothorax itself presents as serosanguineous or frank blood, differing from purulent exudate.
Choice D rationale
Empyema refers to the accumulation of pus in the pleural space, most commonly caused by bacterial infection. The pus-like appearance of the drained fluid is a direct indication of a significant inflammatory and infectious process, where leukocytes, necrotic debris, and microorganisms are present, forming purulent exudate.
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