Which intervention should be implemented for a client with diabetes insipidus?
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Objectives of theraphy are to ensure adequate fluid replacement, to replace vasopressin, and to search for and correct the underlying intracranial pathology. Treatment for diabetes insipidus of nephrogenic origin involves using thiazide, diuretics, mild salt depletion, and prostaglandin inhibitors (eg., ibuprofen, indomethacin, and aspirin). Show
Nursing Interventions
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ExamMSN Exam for Diabetes Insipidus (PM)Please wait while the activity loads. If loading fails, click here to try again Choose the letter of the correct answer. Good luck! Start Congratulations - you have completed MSN Exam for Diabetes Insipidus (PM). You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%% Your answers are highlighted below. Question 1 The nurse is assessing a postcraniotomy client and finds the urine output from a catheter is 1500 ml for the 1st hour and the same for the 2nd hour. The nurse should suspect: A Diabetes mellitus B Diabetes insipidus C Adrenal crisis D Cushing’s syndrome Question 1 Explanation: Diabetes insipidus is an abrupt onset of extreme polyuria that commonly occurs in clients after brain surgery. Cushing’s syndrome is excessive glucocorticoid secretion resulting in sodium and water retention. Diabetes mellitus is a hyperglycemic state marked by polyuria, polydipsia, and polyphagia. Adrenal crisis is undersecretion of glucocorticoids resulting in profound hypoglycemia, hypovolemia, and hypotension. Question 2 The drug of choice for central diabetes insipidus is desmopressin (DDAVP). What isthis drug’s mechanism of action? A Blocks vasopressin and increases kidney water reabsorption B Mimics vasopressin and increases kidney water reabsorption C Mimics vasopressin and increases kidney salt excretion D Blocks vasopressin and increases kidney salt excretion Question 3 A client is suspected of developing diabetes insipidus. Which of the following is the most effective assessment? A Taking vital signs every 4 hours B Assessing ABG values every other day C Monitoring blood glucose D Measuring urine output hourly Question 3 Explanation: Measuring the urine output to detect excess amount and checking the specific gravity of urine samples to determine urine concentration are appropriate measures to determine the onset of diabetes insipidus. Question 4 What drugs antagonize the effects of ADH on the renal tubules, and thus could causenephrogenic diabetes insipidus? A Lithium and demeclocycline B Acetaminophen and isoniazid C Bromocryptine and cabergoline D Cimetidine and verapamil E Hydrochlorothiazide and furosemide Question 5 A 67-year-old male client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, nurse Richard would suspect which of the following disorders? A Diabetes mellitus B Hypoparathyroidism C Hyperparathyroidism D Diabetes insipidus Question 5 Explanation: Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone (PTH). Clients also exhibit hypercaliuria-causing polyuria. While clients with diabetes mellitus and diabetes insipidus also have polyuria, they don’t have bone pain and increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather than polyuria. Question 6 Cyrill with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirty-six hours later, the client's urine output suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse's suspicion of diabetes insipidus? A Above-normal urine osmolality level, below-normal serum osmolality level B Below-normal urine and serum osmolality levels C Above-normal urine and serum osmolality levels D Below-normal urine osmolality level, above-normal serum osmolality level Question 6 Explanation: In diabetes insipidus, excessive polyuria causes dilute urine, resulting in a below-normal urine osmolality level. At the same time, polyuria depletes the body of water, causing dehydration that leads to an above-normal serum osmolality level. For the same reasons, diabetes insipidus doesn't cause above-normal urine osmolality or below-normal serum osmolality levels. Question 7 A priority nursing diagnostic for a client admitted to the hospital with a diagnosis of diabetes insipidus is: A Sleep pattern deprivation related nocturia B Risk for impaired skin integrity r/t generalized edema C Activity intolerance r/t muscle weakness D Fluid volume excess r/t intake greater that output Question 8 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 luteinizing hormone (LH). B thyroid-stimulating hormone (TSH). C follicle-stimulating hormone (FSH). D antidiuretic hormone (ADH). Question 8 Explanation: ADH is the hormone clients with diabetes insipidus lack. The client’s TSH, FSH, and LH levels won’t be affected. Question 9 You are preparing a 24-year-old patient with diabetes insipidus (DI) for discharge from the hospital. Which statement indicates that the patient needs additional teaching? A “I will drink fluids equal to the amount of my urine output.” B “I will weigh myself every day using the same scale.” C “I will gradually wean myself off the vasopressin.” D “I will wear my medical alert bracelet at all times.” Question 9 Explanation: The patient with permanent DI requires life-long vasopressin therapy. All of the other statements are appropriate to the home care of this patient. Focus: Prioritization Question 10 What electrolyte abnormalities can cause diabetes insipidus? A Hypocalcemia and hypokalemia B Hypocalcemia and hyperkalemia C Hypercalcemia and hypokalemia D Hypercalcemia and hyperkalemia Question 11 To confirm central diabetes insipidus, post-injection (desmopressin) urine osmolarityshould be what percentage of pre-injection osmolarity? A > 125% B > 150% C 100% (equal) D < 50% E < 75% Question 12 A client with diabetes insipidus is taking Desmopressin acetate (DDAVP). To determine if the drug is effective, the nurse should monitor the client’s: A Intake and output B Pulse rate C Arterial blood pH D Serum glucose Question 12 Explanation: DDAVP replaces the ADH, facilitating reabsorption of water and consequent return of normal urine output and thirst. Question 13 Damage to what organ would cause central diabetes insipidus? A Hypothalamus B Kidneys C Parathyroid D Thyroid E Pituitary Question 14 Which of the following is most suggestive of psychogenic polydipsia, not diabetesinsipidus? A 24-hour urine output > 18L B Constant symptoms C Plasma osmolarity > 295mOsm/kg D Nocturia E Plasma osmolarity < 280mOsm/kg after a water deprivation test Question 15 Which outcome indicates that treatment of a male client with diabetes insipidus has been effective? A Urine output measures more than 200 ml/hour. B The heart rate is 126 beats/minute. C Blood pressure is 90/50 mm Hg. D Fluid intake is less than 2,500 ml/day. Question 15 Explanation: 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. Question 16 Adequate fluid replacement and vasopressin replacement are objectives of therapy for which of the following disease processes? A Diabetes insipidus. B Diabetes mellitus. C Diabetic ketoacidosis. D Syndrome of inappropriate antidiuretic hormone secretion (SIADH). Question 16 Explanation: Maintaining adequate fluid and replacing vasopressin are the main objectives in treating diabetes insipidus. An excess of antidiuretic hormone leads to SIADH, causing the patient to retain fluid. Diabetic ketoacidosis is a result of severe insulin insufficiency. Question 17 When caring for a male client with diabetes insipidus, nurse Juliet expects to administer: A 10% dextrose. B regular insulin. C furosemide (Lasix). D vasopressin (Pitressin Synthetic). Question 17 Explanation: 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. Question 18 The client with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is: A Encourage increased fluid intake B Check the vital signs C Weigh the client D Measure the urinary output Question 18 Explanation: The large amount of fluid loss can cause fluid and electrolyte imbalance that should be corrected. The loss of electrolytes would be reflected in the vital signs. Measuring the urinary output is important, but the stem already says that the client has polyuria. Encouraging fluid intake will not correct the problem, .Weighing the client is not necessary at this time. Question 19 What are the typical presenting signs of diabetes insipidus? A Weight gain and malaise B Periorbital ecchymosis and blurred vision C Hyperglycemia and polyuria D Polyuria and polydipsia E Oliguria and hypoglycemia Question 20 A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should nurse Lina provide? A “You may not be able to use desmopressin nasally if you have nasal discharge or blockage.” B “Administer desmopressin while the suspension is cold.” C “Your condition isn’t chronic, so you won’t need to wear a medical identification bracelet.” D “You won’t need to monitor your fluid intake and output after you start taking desmopressin.” Question 20 Explanation: 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. Once you are finished, click the button below. Any items you have not completed will be marked incorrect. Get Results There are 20 questions to complete. ← List → Return Shaded items are complete. 1234567891011121314151617181920EndReturn You have completed questions question Your score is Correct Wrong Partial-Credit You have not finished your quiz. If you leave this page, your progress will be lost. Correct Answer You Selected Not Attempted Final Score on Quiz Attempted Questions Correct Attempted Questions Wrong Questions Not Attempted Total Questions on Quiz Question Details Results Date Score Hint Time allowed minutes seconds Time used Answer Choice(s) Selected Question Text All done Need more practice! Keep trying! Not bad! Good work! Perfect! Nursing Care PlanNursing Diagnosis
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Nursing Interventions
Administer intravenous (IV) fluids:IV fluids are indicated if the patient cannot take in sufficient fluids orally. Which nursing intervention should be implemented for a patient diagnosed with diabetes insipidus?Nursing Interventions
Monitor intake and output, weight, and specific gravity of urine. Maintain the intake of adequate fluids, and monitor for signs of dehydration. Instruct the client to avoid foods or liquids that produce diuresis. Administer chlorpropamide (Diabinese) if prescribed for mild diabetes insipidus.
What is the best treatment for diabetes insipidus?Central diabetes insipidus.
Typically, this form is treated with a synthetic hormone called desmopressin (DDAVP, Nocdurna). This medication replaces the missing anti-diuretic hormone (ADH) and decreases urination. You can take desmopressin in a tablet, as a nasal spray or by injection.
What should I monitor with diabetes insipidus?If you have diabetes insipidus, you'll continue to pee large amounts of dilute urine when normally you'd only pee a small amount of concentrated urine. During the test, the amount of urine you produce will be measured. You may also need a blood test to assess the levels of antidiuretic hormone (ADH) in your blood.
Which priority intervention should the nurse implement for the client diagnosed with syndrome of inappropriate antidiuretic hormone?The most commonly prescribed treatment for SIADH is fluid and water restriction. If the condition is chronic, fluid restriction may need to be permanent.
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