MSN Exam for Diabetes Insipidus

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

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

18) Adequate fluid replacement and vasopressin replacement are objectives of therapy for which of the following disease processes?

1. Diabetes mellitus.
2. Diabetes insipidus.
3. Diabetic ketoacidosis.
4. Syndrome of inappropriate antidiuretic hormone secretion (SIADH).

19) The client with a history of diabetes insipidus is admitted with polyuria, polydipsia, and mental confusion. The priority intervention for this client is:

1. Measure the urinary output
2. Check the vital signs
3. Encourage increased fluid intake
4. Weigh the client

20) When caring for a male client with diabetes insipidus, nurse Juliet expects to administer:

1. vasopressin (Pitressin Synthetic).
2. furosemide (Lasix).
3. regular insulin.
4. 10% dextrose.

1. D. Below-normal urine osmolality level, above-normal serum osmolality level. 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.
   
2. A. Mimics vasopressin and increases kidney water reabsorption 
3. D. Diabetes insipidus. 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.
4. D. Hyperparathyroidism. 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.
5. D. Lithium and demeclocycline 
6. E. Pituitary
7. E. > 150%
8. B. Activity intolerance r/t muscle weakness 
9. A. Hyperglycemia and polyuria 
10. B. Hypercalcemia and hypokalemia 
11. 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.
12. C. “You may not be able to use desmopressin nasally if you have nasal discharge or blockage.” 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.
13. D. “I will gradually wean myself off the vasopressin.” 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
14. C. 24-hour urine output > 18L 
15. D. Measuring urine output hourly. 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.
16. D. Intake and output . DDAVP replaces the ADH, facilitating reabsorption of water and consequent return of normal urine output and thirst.
17. 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.
18. B. Diabetes insipidus. 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.
19. B. Check the vital signs . 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.
20. 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.