Question: A client with primary diabetes insipidus is prescribed desmopressin (DDAVP). Which instruction should the nurse provide before the client is discharged?

1. "Administer desmopressin while the suspension is cold."

2. "Your condition isn't chronic, so you won't need to wear a medical identification bracelet."

3. "You may not be able to use desmopressin nasally if you have nasal discharge or blockage."

4. "You won't need to monitor your fluid intake and output after you start taking desmopressin."

Answer: 3

Desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes insipidus is treatable, the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and receive adequate fluid replacement

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Question: Which of the following would indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus?

1. Confusion and seizures

2. Sunken eyeballs and spasticity

3. Flaccidity and thirst

4. Tetany and increased blood urea nitrogen (BUN) levels.

Answer: 1

Classic signs of water intoxication include confusion and seizures, both of which are caused by cerebral edema. Weight gain will also occur. Sunken eyeballs, thirst, and increased BUN levels indicate fluid volume deficit. Spasticity, flaccidity, and tetany are unrelated to water intoxication.

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Question: A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?

1. Infusing I.V. fluids rapidly as ordered

2. Encouraging increased oral intake

3. Restricting fluids

4. Administering glucose-containing I.V. fluids as ordered

Answer: 3

To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.

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Question: The nurse is developing a teaching plan for a client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus?

1. Antidiuretic hormone (ADH)

2. Thyroid-stimulating hormone (TSH)

3. Follicle-stimulating hormone (FSH)

4. Luteinizing hormone (LH)

Answer: 1

Clients with diabetes insipidus lack the hormone ADH. The client's TSH, FSH, and LH levels aren't affected.

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Question: When caring for a client with diabetes insipidus, the nurse expects to administer:

1. vasopressin (Pitressin Synthetic).

2. furosemide (Lasix).

3. regular insulin.

4. 10% dextrose.

Answer: 1

Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus

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Question: Which sign suggests that a client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications?

1. Tetanic contractions

2. Neck vein distention

3. Weight loss

4. Polyuria

Answer: 2

SIADH secretion causes antidiuretic hormone overproduction, which leads to fluid retention. Severe SIADH can cause such complications as vascular fluid overload, signaled by neck vein distention. This syndrome isn't associated with tetanic contractions. It may cause weight gain and fluid retention (secondary to oliguria)

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Question: After falling off a ladder and suffering a brain injury, a client develops syndrome of inappropriate antidiuretic hormone (SIADH). Which findings indicate that the treatment he's receiving is effective?

Select all that apply:

1. Decrease in body weight

2. Rise in blood pressure and drop in heart rate

3. Absence of wheezes in his lungs

4. Increased urine output

5. Decreased urine osmolarity

Answer: 1, 4, 5

SIADH is an abnormality in which there is an abundance of the antidiuretic hormone. The predominant features are hyponatremia, oliguria, edema, and weight gain. Evidence of successful treatment includes a reduction in weight, an increase in urine output, and a decrease in the urine's concentration (urine osmolarity).

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Question: A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician will prescribe diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the client doesn't comply with the recommended treatment, which complication may arise?

1. Cerebral edema

2. Hypovolemic shock

3. Severe hyperkalemia

4. Tetany

Answer: 1

The Noncompliance with treatment for SIADH may lead to water intoxication from fluid retention caused by excessive antidiuretic hormone. This, in turn, limits water excretion and increases the risk of cerebral edema. Hypovolemic shock results from severe fluid volume deficit; in contrast, SIADH causes excessive fluid volume. The major electrolyte disturbance in SIADH is dilutional hyponatremia, not hyperkalemia. Because SIADH doesn't alter renal function, potassium excretion remains normal; therefore, severe hyperkalemia doesn't occur. Tetany results from hypocalcemia, an electrolyte disturbance not associated with SIADH.

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Question: When caring for a male client with diabetes insipidus, nurse Juliet expects to administer:
A. vasopressin (Pitressin Synthetic)
B. furosemide (Lasix).
C. regular insulin.
D. 10% dextrose.

Answer: A. vasopressin (Pitressin Synthetic)

Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.

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Question: Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus?

A. antidiuretic hormone (ADH).
B. thyroid-stimulating hormone (TSH).
C. follicle-stimulating hormone (FSH).
D. luteinizing hormone (LH).

Answer: A. antidiuretic hormone (ADH).

ADH is the hormone clients with diabetes insipidus lack. The client's TSH, FSH, and LH levels won't be affected.

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Question: A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?

A. Infusing I.V. fluids rapidly as ordered
B. Encouraging increased oral intake
C. Restricting fluids
D. Administering glucose-containing I.V. fluids as ordered

Answer: C. Restricting fluids

To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.

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Question: Which outcome indicates that treatment of a male client with diabetes insipidus has been effective?

A. Fluid intake is less than 2,500 ml/day.
B. Urine output measures more than 200 ml/hour.
C. Blood pressure is 90/50 mm Hg.
D. The heart rate is 126 beats/minute.

Answer: A. Fluid intake is less than 2,500 ml/day

Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.

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Question: A patient with SIADH is treated with water restriction and administration of IV fluids. The nurses evaluates that treatment has been effective when the patient experiences

A. Increased urine output, decreased serum sodium, and increased urine specific gravity

B. Increased urine output, increased serum sodium, and decreased urine specific gravity

C. Decreased urine output, increased serum sodium, and decreased urine specific gravity

D. Decreased urine output, decreased serum sodium, and increased urine specific gravity

Answer: B. increased urine output, increased serum sodium, and decreased urine specific gravity

The patient with SIADH has water retention with hyponatremia, decreased urine output and concentrated urine with high specific gravity. improvement in the patient's condition reflected by increased urine output, normalization of serum sodium, and more water in the urine, decreasing the specific gravity

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Question: The client diagnosed with a pituitary tumor developed syndrome of inappropriate antidiuretic hormone (SIADH). Which interventions should the nurse implement?

1. Assess for dehydration and monitor blood glucose levels.
2. Assess for nausea and vomiting and weigh daily.
3. Monitor potassium levels and encourage fluid intake.
4. Administer vasopressin IV and conduct a fluid deprivation test.

Answer: 2.

Early signs and symptoms are nausea and vomiting. The client has the syndrome of inappropriate secretion of antidiuretic (against allowing the body to urinate) hormone. In other words, the client is producing a hormone that will not allow the client to urinate.

1. The client has excess fluid and is not dehydrated, and blood glucose levels are not affected.
3. The client experiences dilutional hyponatremia, and the body has too much fluid already.
4. Vasopressin is the name of the antidiuretic hormone. Giving more increases the client's problem. Also, a water challenge test is performed, not a fluid deprivation test.

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Question: Which laboratory value should be monitored by the nurse for the client diagnosed with diabetes insipidus?

1. Serum sodium.
2. Serum calcium
3. Urine glucose.
4. Urine white blood cells.

Answer: 1

The client will have an elevated sodium level as a result of low circulating blood volume. The fluid is being lost through the urine. Diabetes means "to pass through" in Greek, indicating polyuria, a symptom shared with diabetes mellitus. Diabetes insipidus is a totally separate disease process.

2. Serum calcium is not affected by diabetes insipidus.
3. Urine glucose is monitored for diabetes mellitus.
4. White blood cells in the urine indicate the presence of a urinary tract infection.

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Question: The nurse is discharging a client diagnosed with diabetes insipidus. Which statement made by the client warrants further intervention?

1. "I will keep a list of my medications in my wallet and wear a Medic Alert bracelet."
2. "I should take my medication in the morning and leave it refrigerated at home."
3. "I should weigh myself every morning and record any weight gain."
4. "If I develop a tightness in my chest, I will call my health-care provider."

Answer: 2

Medication for DI is usually taken every 8 to 12 hours, depending on the client. The client should keep the medication close at hand.

1. The client should keep a list of medication being taken and wear a Medic Alert bracelet.
3. The client is at risk for fluid shifts. Weighing every morning allows the client to follow the fluid shifts. Weight gain indicates too much medication.
4. Tightness in the chest could be an indicator the medication is not being tolerated; if this occurs, the client should notify the health-care provider.

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Question: The client is admitted to the medical unit with a diagnosis of rule-out diabetes insipidus (DI). Which instructions should the nurse teach regarding a fluid deprivation test?

1. The client will be asked to drink 100 mL of fluid as rapidly as possible and then will not be allowed fluid for 24 hours.
2. The client will be administered an injection of antidiuretic hormone, and urine output will be measured for four (4) to six (6) hours.
3. The client will be NPO, and vital signs and weights will be done hourly until the end of the test.
4. An IV will be started with normal saline, and the client will be asked to try to hold the urine in the bladder until a sonogram can be done.

Answer: 3

The client is deprived of all fluids, and if the client has DI the urine production will not diminish. Vital signs and weights are taken every hour to determine circulatory status. If a marked decrease in weight or vital signs occurs, the test is immediately terminated.

1. The client is not allowed to drink during the test.
2. This test does not require any medications to be administered, and vasopressin will treat the DI, not help diagnose it.
4. No fluid is allowed and a sonogram is not involved.

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Question: The nurse is planning the care of a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which interventions should be implemented? Select all that apply.

1. Restrict fluids per health-care provider order.
2. Assess level of consciousness every two (2) hours.
3. Provide an atmosphere of stimulation.
4. Monitor urine and serum osmolality.
5. Weigh the client every three (3) day

Answer: 1, 2, 4

1. Fluids are restricted to 500 to 600 mL per 24 hours.
2. Orientation to person, place, and time should be assessed every two (2) hours or more often.
3. A safe environment, not a stimulating one, is provided.
4. Urine and serum osmolality are monitored to determine fluid volume status.
5. The client should be weighed daily.

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Question: The nurse is caring for a client diagnosed with diabetes insipidus (DI). Which intervention should be implemented?

1. Administer sliding-scale insulin as ordered.
2. Restrict caffeinated beverages.
3. Check urine ketones if blood glucose is >250.
4. Assess tissue turgor every four (4) hours.

Answer: 4

The client is excreting large amounts of dilute urine. If the client is unable to drink enough fluids, the client will quickly become dehydrated, so tissue turgor should be assessed frequently.

1. Diabetes insipidus is not diabetes mellitus; sliding-scale insulin is not administered to the client.
2. There is no caffeine restriction for DI.
3. Checking urine ketones is not indicated.

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Question: The unlicensed assistive personnel (UAP) complains to the nurse she has filled the water pitcher four (4) times during the shift for a client diagnosed with a closed head injury and the client has asked for the pitcher to be filled again. Which intervention should the nurse implement first?

1. Tell the UAP to fill the pitcher with ice cold water.
2. Instruct the UAP to start measuring the client's I & O.
3. Assess the client for polyuria and polydipsia.
4. Check the client's BUN and creatinine levels.

Answer: 3

The first action should be to determine if the client is experiencing polyuria
and polydipsia as a result of developing diabetes insipidus, a complication of the head trauma.

1. The client should have the water pitcher filled, but this is not the first action.
2. This should be done but not before assessing the problem.
4. This could be done, but it will not give the nurse information about DI.

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Question: The nurse is admitting a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which clinical manifestations should be reported to the health-care provider?

1. Serum sodium of 112 mEq/L and a headache.
2. Serum potassium of 5.0 mEq/L and a heightened awareness.
3. Serum calcium of 10 mg/dL and tented tissue turgor.
4. Serum magnesium of 1.2 mg/dL and large urinary output.

Answer: 1

A serum sodium level of 112 mEq/L is dangerously low, and the client is at risk for seizures. A headache is a symptom of a low sodium level.

2. This is a normal potassium level, and a heightened level of awareness indicates drug usage.
3. This is a normal calcium level and the client is fluid overloaded, not dehydrated, so there would not be tented tissue turgor.
4. This is a normal magnesium level, and a large urinary output is desired.

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Question: The male client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) secondary to cancer of the lung tells the nurse he wants to discontinue the fluid restriction and does not care if he dies. Which action by the nurse is an example of the ethical principle of autonomy?

1. Discuss the information the client told the nurse with the health-care provider and significant other.
2. Explain it is possible the client could have a seizure if he drank fluid beyond the restrictions.
3. Notify the health-care provider of the client's wishes and give the client fluids as desired.
4. Allow the client an extra drink of water and explain the nurse could get into trouble if the client tells the health-care provider.

Answer: 3

This is an example of autonomy (the client has the right to decide for himself).

1. Discussing the information with others is not allowing the client to decide what is best for himself.
2. This could be an example of beneficence (to do good) if the nurse did this so the client has information on which to base a decision on whether to continue the fluid restriction.
4. This is an example of dishonesty and should never be tolerated in a health-care setting.

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Question: The nurse determines that demeclocycline (Declomycin) is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) based on finding that the patient's
A. weight has increased.
B. urinary output is increased.
C. peripheral edema is decreased.
D. urine specific gravity is increased.

Answer: B

Demeclocycline blocks the action of antidiuretic hormone (ADH) on the renal tubules and increases urine output. An increase in weight or an increase in urine specific gravity indicates that the SIADH is not corrected. Peripheral edema does not occur with SIADH. A sudden weight gain without edema is a common clinical manifestation of this disorder.

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Question: The nurse determines that additional instruction is needed for a 60-year-old patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) when the patient says which of the following?
A. "I need to shop for foods low in sodium and avoid adding salt to food."
B. "I should weigh myself daily and report any sudden weight loss or gain."
C. "I need to limit my fluid intake to no more than 1 quart of liquids a day."
D. "I will eat foods high in potassium because diuretics cause potassium loss."

Answer: A

Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other patient statements are correct and indicate successful teaching has occurred.

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Question: A 56-year-old patient who is disoriented and reports a headache and muscle cramps is hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The nurse would expect the initial laboratory results to include a(n)
A. elevated hematocrit.
B. decreased serum sodium.
C. low urine specific gravity.
D. increased serum chloride.

Answer: B

When water is retained, the serum sodium level will drop below normal, causing the clinical manifestations reported by the patient. The hematocrit will decrease because of the dilution caused by water retention. Urine will be more concentrated with a higher specific gravity. The serum chloride level will usually decrease along with the sodium level.

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Question: An expected nursing diagnosis for a 30-year-old patient admitted to the hospital with symptoms of diabetes insipidus is
A. excess fluid volume related to intake greater than output.
B. impaired gas exchange related to fluid retention in lungs.
C. sleep pattern disturbance related to frequent waking to void.
D. risk for impaired skin integrity related to generalized edema.

Answer: C

Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected.

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Question: Which intervention will the nurse include in the plan of care for a 52-year-old male patient with syndrome of inappropriate antidiuretic hormone (SIADH)?
A. Monitor for peripheral edema.
B. Offer patient hard candies to suck on.
C. Encourage fluids to 2 to 3 liters per day.
D. Keep head of bed elevated to 30 degrees.

Answer: B

Sucking on hard candies decreases thirst for a patient on fluid restriction. Patients with SIADH are on fluid restrictions of 800 to 1000 mL/day. Peripheral edema is not seen with SIADH. The head of the bed is elevated no more than 10 degrees to increase left atrial filling pressure and decrease antidiuretic hormone (ADH) release.

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Question: The nurse is caring for a patient admitted with diabetes insipidus (DI). Which information is most important to report to the health care provider?
A. The patient is confused and lethargic.
B. The patient reports a recent head injury.
C. The patient has a urine output of 400 mL/hr.
D. The patient's urine specific gravity is 1.003.

Answer: A

The patient's confusion and lethargy may indicate hypernatremia and should be addressed quickly. In addition, patients with DI compensate for fluid losses by drinking copious amounts of fluids, but a patient who is lethargic will be unable to drink enough fluids and will become hypovolemic. A high urine output, low urine specific gravity, and history of a recent head injury are consistent with diabetes insipidus, but they do not require immediate nursing action to avoid life-threatening complications.

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Question: A 23-year-old patient is admitted with diabetes insipidus. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)?
A. Titrate the infusion of 5% dextrose in water.
B. Teach the patient how to use desmopressin (DDAVP) nasal spray.
C. Assess the patient's hydration status every 8 hours.
D. Administer subcutaneous DDAVP.

Answer: D

Administration of medications is included in LPN/LVN education and scope of practice. Assessments, patient teaching, and titrating fluid infusions are more complex skills and should be done by the RN.

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Question: Which information is most important for the nurse to communicate rapidly to the health care provider about a patient admitted with possible syndrome of inappropriate antidiuretic hormone (SIADH)?
A. The patient has a recent weight gain of 9 lb.
B. The patient complains of dyspnea with activity.
C. The patient has a urine specific gravity of 1.025.
D. The patient has a serum sodium level of 118 mEq/L.

Answer: D

A serum sodium of less than 120 mEq/L increases the risk for complications such as seizures and needs rapid correction. The other data are not unusual for a patient with SIADH and do not indicate the need for rapid action

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