Med Surg 2 Test 3: Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

new book

brunner & suddarth 14th ed

You are caring for a patient who has a diagnosis of syndrome of
inappropriate antidiuretic hormonesecretion (SIADH). Your
patients plan of care includes assessment of specific gravity every 4
hours. Theresults of this test will allow the nurse to assess
what aspect of the patients health?A) Nutritional statusB)
Potassium balanceC) Calcium balanceD) Fluid volume status

Ans: DFeedback:A specific gravity will detect if the
patient has a fluid volume deficit or fluid volume excess.
Nutrition,potassium, and calcium levels are not directly indicated.

The home health nurse is performing a home visit for an oncology
patient discharged 3 days ago aftercompleting treatment for
non-Hodgkin lymphoma. The nurses assessment should include
examinationfor the signs and symptoms of what
complication?A) Tumor lysis syndrome (TLS)B) Syndrome of
inappropriate antiduretic hormone (SIADH)C) Disseminated
intravascular coagulation (DIC)D) Hypercalcemia

Ans: AFeedback:TLS is a potentially fatal complication
that occurs spontaneously or more commonly followingradiation,
biotherapy, or chemotherapy-induced cell destruction of large or
rapidly growing cancers suchas leukemia, lymphoma, and small
cell lung cancer. DIC, SIADH and hypercalcemia are less
likelycomplications following this treatment and diagnosis.

A patient with a diagnosis of syndrome of inappropriate antidiuretic
hormone secretion (SIADH) isbeing cared for on the critical care
unit. The priority nursing diagnosis for a patient with this condition
iswhat?A) Risk for peripheral neurovascular
dysfunctionB) Excess fluid volumeC) HypothermiaD)
Ineffective airway clearance

Ans: BTest Bank - Brunner & Suddarth's Textbook of
Medical-Surgical Nursing 14e (Hinkle 2017) 986Feedback:The
priority nursing diagnosis for a patient with SIADH is excess fluid
volume, as the patient retainsfluids and develops a sodium
deficiency. Restricting fluid intake is a typical intervention for
managingthis syndrome. Temperature imbalances are not associated
with SIADH. The patient is not at risk forneurovascular
dysfunction or a compromised airway.

Diagnostic testing of an adult patient reveals renal glycosuria. The
nurse should recognize the need forTest Bank - Brunner &
Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017)
1007the patient to be assessed for what health problem?A)
Diabetes insipidusB) Syndrome of inappropriate antidiuretic
hormone secretion (SIADH)C) Diabetes mellitusD) Renal carcinoma

Ans: CFeedback:Renal glycosuria can occur on its own as a
benign condition. It also occurs in poorly controlled
diabetes,the most common condition that causes the blood glucose
level to exceed the kidneys reabsorptioncapacity. Glycosuria is
not associated with SIADH, diabetes insipidus, or renal carcinoma.

What should the nurse suspect when hourly assessment of urine output
on a patient postcraniotomyexhibits a urine output from a
catheter of 1,500 mL for two consecutive hours?A) Cushing
syndromeB) Syndrome of inappropriate antidiuretic hormone
(SIADH)C) Adrenal crisisD) Diabetes insipidus

Ans: DTest Bank - Brunner & Suddarth's Textbook of
Medical-Surgical Nursing 14e (Hinkle 2017)
1248Feedback:Diabetes insipidus is an abrupt onset of
extreme polyuria that commonly occurs in patients after
brainsurgery. Cushing syndrome is excessive glucocorticoid
secretion resulting in sodium and waterretention. SIADH is the
result of increased secretion of ADH; the patient becomes
volume-overloaded,urine output diminishes, and serum sodium
concentration becomes dilute. Adrenal crisis isundersecretion of
glucocorticoids resulting in profound hypoglycemia, hypovolemia, and hypotension.

When caring for a patient with increased ICP the nurse knows the
importance of monitoring for possiblesecondary complications,
including syndrome of inappropriate antidiuretic hormone (SIADH).
Whatnursing interventions would the nurse most likely initiate
if the patient developed SIADH?A) Fluid restrictionB)
Transfusion of plateletsC) Transfusion of fresh frozen plasma
(FFP)D) Electrolyte restriction

Ans: AFeedback:The nurse also assesses for complications
of increased ICP, including diabetes insipidus, and SIADH.SIADH
requires fluid restriction and monitoring of serum electrolyte levels.
Transfusions areunnecessary.

After a subarachnoid hemorrhage, the patients laboratory results
indicate a serum sodium level of lessthan 126 mEq/L. What is the
nurses most appropriate action?A) Administer a bolus of normal
saline as ordered.B) Prepare the patient for thrombolytic
therapy as ordered.C) Facilitate testing for hypothalamic
dysfunction.D) Prepare to administer 3% NaCl by IV as ordered.

Ans: DFeedback:The patient may be experiencing syndrome
of inappropriate antidiuretic hormone (SIADH) or
cerebralsalt-wasting syndrome. The treatment most often is the
use of IV hypertonic 3% saline. A normal salinebolus would
exacerbate the problem and there is no indication for tests of
hypothalamic function orthrombolytic therapy.

A patient is admitted through the ED with suspected St. Louis
encephalitis. The unique clinical featureof St. Louis
encephalitis will make what nursing action a priority?A) Serial
assessments of hemoglobin levelsB) Blood glucose
monitoringC) Close monitoring of fluid balanceD)
Assessment of pain along dermatomes

Ans: CFeedback:A unique clinical feature of St. Louis
encephalitis is SIADH with hyponatremia. As such, it is
importantto monitor the patients intake and output closely.

new book

giddens 2nd ed

The nurse is caring for a patient diagnosed with syndrome of
inappropriate antidiuretic hormone (SIADH). What is the nurse�s
best action?
a. Encourage increased fluid and water intake
b. Teach about risk for malignancies
c. Monitor for changes in level of consciousness
d. Assess labwork for potassium level changes

ANS: C
As the name suggests, SIADH is a condition in which antidiuretic
hormone (ADH) is secreted despite normal or low plasma osmolarity,
resulting in water retention and dilutional hyponatremia. In response
to increased plasma volume, aldosterone secretion increases and
further contributes to sodium loss. Hyponatremia frequently
manifests with changes in level of consciousness from confusion to
coma. A large number of clinical conditions can cause SIADH including
malignancies, pulmonary disorders, injury to the brain, and certain
pharmacologic agents. Malignancies often lead to SIADH versus SIADH
causing malignant conditions. Water intoxication can lead to
hyponatremia, therefore water intake is restricted. The most affected
electrolyte from SIADH is sodium versus potassium.
REF: Page 132
OBJ: NCLEX� Client Needs Category: Physiological Integrity:
Reduction of Risk Potential

new book

ignatavicius 9th ed

A nurse is caring for a client with meningitis. Which laboratory
values should the nurse monitor to identifypotential
complications of this disorder? (Select all that apply.)a.
Sodium levelb. Liver enzymesc. Clotting factorsd.
Cardiac enzymese. Creatinine level

ANS: A, CInflammation associated with meningitis can stimulate
the hypothalamus and result in excessive production
ofantidiuretic hormone. The nurse should monitor sodium levels
for early identification of syndrome ofinappropriate
antidiuretic hormone. A systemic inflammatory response (SIR) can also
occur with meningitis. ASIR can result in a coagulopathy that
leads to disseminated intravascular coagulation. The nurse
shouldmonitor clotting factors to identify this complication.
The other laboratory values are not specific tocomplications of
meningitis.DIF: Applying/Application REF: 868KEY:
Meningitis| assessment/diagnostic examinationMSC: Integrated
Process: Nursing Process: AssessmentNOT: Client Needs Category:
Physiological Integrity: Reduction of Risk Potential

A nurse cares for a client who possibly has syndrome of inappropriate
antidiuretic hormone (SIADH). Theclients serum sodium level is
114 mEq/L. Which action should the nurse take first?a. Consult
with the dietitian about increased dietary sodium.b. Restrict
the clients fluid intake to 600 mL/day.c. Handle the client
gently by using turn sheets for re-positioning.d. Instruct
unlicensed assistive personnel to measure intake and output.

ANS: BWith SIADH, clients often have dilutional hyponatremia.
The client needs a fluid restriction, sometimes to aslittle as
500 to 600 mL/24 hr. Adding sodium to the clients diet will not help
if he or she is retaining fluid anddiluting the sodium. The
client is not at increased risk for fracture, so gentle handling is
not an issue. The clientshould be on intake and output; however,
this will monitor only the clients intake, so it is not the best
answer.Reducing intake will help increase the clients
sodium.DIF: Applying/Application REF: 1251KEY: Pituitary
disorder| electrolyte imbalanceMSC: Integrated Process: Nursing
Process: ImplementationNOT: Client Needs Category: Physiological
Integrity: Physiological Adaptation

A nurse assesses clients with potential endocrine disorders. Which
clients are at high risk forhypopituitarism? (Select all that
apply.)a. A 20-year-old female with benign pituitary
tumorsb. A 32-year-old male with diplopiac. A 41-year-old
female with anorexia nervosad. A 55-year-old male with
hypertensione. A 60-year-old female who is experiencing
shockf. A 68-year-old male who has gained weight recently

ANS: A, C, D, EPituitary tumors, anorexia nervosa,
hypertension, and shock are all conditions that can cause
hypopituitarism.Diplopia is a manifestation of hypopituitarism,
and weight gain is a manifestation of Cushings disease
andsyndrome of inappropriate antidiuretic hormone. They are not
risk factors for hypopituitarism.DIF: Remembering/Knowledge REF:
1246KEY: Pituitary disorder| health screeningMSC:
Integrated Process: Nursing Process: AssessmentNOT: Client Needs
Category: Safe and Effective Care Environment: Management of Care

A nurse assesses clients with potential endocrine disorders. Which
clients are at high risk for adrenalinsufficiency? (Select all
that apply.)a. A 22-year-old female with metastatic
cancerb. A 43-year-old male with tuberculosisc. A
51-year-old female with asthmad. A 65-year-old male with
gram-negative sepsise. A 70-year-old female with hypertension

ANS: A, B, DMetastatic cancer, tuberculosis, and gram-negative
sepsis are primary causes of adrenal insufficiency.
Activetuberculosis is a contributing factor for syndrome of
inappropriate antidiuretic hormone. Hypertension is a
keymanifestation of Cushings disease. These are not risk factors
for adrenal insufficiency.DIF: Remembering/Knowledge REF:
1248KEY: Adrenal gland disorder| health screeningMSC:
Integrated Process: Nursing Process: AssessmentNOT: Client Needs
Category: Safe and Effective Care Environment: Management of Care

new book

lewis 7th- ch50

A patient with an antidiuretic hormone (ADH)-secreting small-cell
cancer of the lung is treated with demeclocycline (Declomycin) to
control the symptoms of syndrome of inappropriate secretion of
antidiuretic hormone (SIADH). The nurse determines that the
demeclocycline is effective upon finding that the
a. patient�s daily weight is stable.
b. urine specific gravity is increased.
c. patient�s urinary output is increased.
d. peripheral edema is decreased.


Correct Answer: C

Rationale: Demeclocycline blocks the action of ADH on
the renal tubules and increases urine output. A stable body weight and
an increase in urine specific gravity indicate 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.

Cognitive Level: Application Text
Reference: p. 1295

Nursing Process: Evaluation NCLEX:
Physiological Integrity

When teaching a patient with chronic SIADH about long-term management
of the disorder, the nurse determines that additional instruction is
needed when the patient says,
a. �I need to shop for foods that are low in sodium and avoid
adding salt to foods.�
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 the diuretics cause
potassium loss.�


Correct Answer: A

Rationale: 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.

Cognitive Level: Application Text
Reference: p. 1296

Nursing Process: Evaluation

NCLEX: Health Promotion and Maintenance

A patient is hospitalized with possible SIADH. The patient is
confused and reports a headache, muscle cramps, and twitching. The
nurse would expect the initial laboratory results to include a
a. serum sodium of 125 mEq/L (125 mmol/L).
b. hematocrit of 52%.
c. blood urea nitrogen (BUN) of 22 mg/dl (11.5 mmol/L).
d. serum chloride of 110 mEq/L (110 mmol/L).


Correct Answer: A

Rationale: 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. The BUN is not helpful in
diagnosis of SIADH and this BUN value is increased. The serum chloride
level will usually decrease along with the sodium level. This chloride
value is elevated.

Cognitive Level: Application Text
Reference: p. 1295

Nursing Process: Assessment NCLEX:
Physiological Integrity

A patient is admitted with possible SIADH. Which information obtained
by the nurse is most important to communicate rapidly to the health
care provider?
a. The patient complains of a severe headache.
b. The patient complains of severe thirst.
c. The patient has a urine specific gravity of 1.025.
d. The patient has a serum sodium level of 119 mEq/L.


Correct Answer: D

Rationale: 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.

Cognitive Level: Application Text
Reference: p. 1295

Nursing Process: Assessment NCLEX:
Physiological Integrity

When developing a plan of care for a patient with SIADH, which
interventions will the nurse include?
a. Encourage fluids to 2000 ml/day.
b. Offer patient hard candies to suck on.
c. Monitor for increased peripheral edema.
d. Keep head of bed elevated to 30 degrees.


Correct Answer: B

Rationale: Sucking on hard candies decreases thirst
for patient on a 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 ADH release.

Cognitive Level: Application Text
Reference: p. 1296

Nursing Process: Planning NCLEX:
Physiological Integrity

After receiving change-of-shift report about these four patients,
which patient should the nurse assess first?
a. A 22-year-old admitted with SIADH who has a serum sodium level
of 130 mEq/L.
b. A 31-year-old who has iatrogenic Cushing�s syndrome with a
capillary blood glucose level of 244 mg/dl.
c. A 53-year-old who has Addison�s disease and is due for a
scheduled dose of hydrocortisone (Solu-Cortef).
d. A 70-year-old who recently started levothyroxine (Synthroid) to
treat hypothyroidism and has an irregular pulse of 134.


Correct Answer: D

Rationale: Initiation of thyroid replacement in older
adults may cause angina and cardiac dysrhythmias. The patient�s high
pulse rate needs rapid investigation by the nurse to assess for and
intervene with any cardiac problems. The other patients also require
nursing assessment and/or actions but are not at risk for
life-threatening complications.

Cognitive Level: Application Text
Reference: p. 1306

Nursing Process: Planning NCLEX:
Physiological Integrity

new book

lewis 9th ed

The nurse determines that demeclocycline (Declomycin) is effective
for a patient withsyndrome of inappropriate antidiuretic hormone
(SIADH) based on finding that the patient�sa. weight has
increased.b. urinary output is increased.c. peripheral
edema is decreased.d. urine specific gravity is increased.

ANS: BDemeclocycline blocks the action of antidiuretic hormone
(ADH) on the renal tubules and increases urineoutput. An
increase in weight or an increase in urine specific gravity indicates
that the SIADH is notcorrected. Peripheral edema does not occur
with SIADH. A sudden weight gain without edema is acommon
clinical manifestation of this disorder.DIF: Cognitive Level:
Apply (application) REF: 1193-1194TOP: Nursing Process:
Evaluation MSC: NCLEX: Physiological Integrity

The nurse determines that additional instruction is needed for a
60-year-old patient withchronic syndrome of inappropriate
antidiuretic hormone (SIADH) when the patient says which ofthe
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.�

ANS: APatients with SIADH are at risk for hyponatremia, and a
sodium supplement may be prescribed. The otherpatient statements
are correct and indicate successful teaching has occurred.DIF:
Cognitive Level: Apply (application) REF: 1194TOP: Nursing
Process: Evaluation MSC: NCLEX: Physiological Integrity

A 56-year-old patient who is disoriented and reports a headache and
muscle cramps ishospitalized with possible syndrome of
inappropriate antidiuretic hormone (SIADH). The nursewould
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.

ANS: BWhen water is retained, the serum sodium level will drop
below normal, causing the clinicalmanifestations reported by the
patient. The hematocrit will decrease because of the dilution caused
bywater retention. Urine will be more concentrated with a higher
specific gravity. The serum chloride levelwill usually decrease
along with the sodium level.DIF: Cognitive Level: Understand
(comprehension) REF: 1193TOP: Nursing Process: Assessment MSC:
NCLEX: Physiological Integrity

Which intervention will the nurse include in the plan of care for a
52-year-old malepatient 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.

ANS: BSucking on hard candies decreases thirst for a patient on
fluid restriction. Patients with SIADH are onfluid restrictions
of 800 to 1000 mL/day. Peripheral edema is not seen with SIADH. The
head of the bedis elevated no more than 10 degrees to increase
left atrial filling pressure and decrease antidiuretichormone
(ADH) release.DIF: Cognitive Level: Apply (application) REF:
1194TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

Which information is most important for the nurse to communicate
rapidly to thehealth care provider about a patient admitted with
possible syndrome of inappropriate antidiuretichormone
(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.

ANS: DA serum sodium of less than 120 mEq/L increases the risk
for complications such as seizures and needsrapid correction.
The other data are not unusual for a patient with SIADH and do not
indicate the need forrapid action.DIF: Cognitive Level:
Apply (application) REF: 1193OBJ: Special Questions:
Prioritization TOP: Nursing Process: AssessmentMSC: NCLEX:
Physiological Integrity

After receiving change-of-shift report about the following four
patients, which patientshould the nurse assess first?a. A
31-year-old female with Cushing syndrome and a blood glucose level of
244mg/dLb. A 70-year-old female taking levothyroxine
(Synthroid) who has an irregular pulseof 134c. A
53-year-old male who has Addison�s disease and is due for a scheduled
dose ofhydrocortisone (Solu-Cortef).d. A 22-year-old male
admitted with syndrome of inappropriate antidiuretic
hormone(SIADH) who has a serum sodium level of 130 mEq/L

ANS: BInitiation of thyroid replacement in older adults may
cause angina and cardiac dysrhythmias. Thepatient�s high pulse
rate needs rapid investigation by the nurse to assess for and
intervene with anycardiac problems. The other patients also
require nursing assessment and/or actions but are not at risk
forlife-threatening complications.DIF: Cognitive Level:
Analyze (analysis) REF: 1203OBJ: Special Questions:
Prioritization; Multiple PatientsTOP: Nursing Process:
Assessment MSC: NCLEX: Safe and Effective Care Environment