MSN Exam for Diabetes Insipidus

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1) 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?

  1. Above-normal urine and serum osmolality levels
  2. Below-normal urine and serum osmolality levels
  3. Above-normal urine osmolality level, below-normal serum osmolality level
  4. Below-normal urine osmolality level, above-normal serum osmolality level

2) The drug of choice for central diabetes insipidus is desmopressin (DDAVP). What isthis drug’s mechanism of action?

  1. Mimics vasopressin and increases kidney water reabsorption
  2. Blocks vasopressin and increases kidney water reabsorption
  3. Mimics vasopressin and increases kidney salt excretion
  4. Blocks vasopressin and increases kidney salt excretion

3) 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:

  1. Cushing’s syndrome
  2. Diabetes mellitus
  3. Adrenal crisis
  4. Diabetes insipidus

4) 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?

  1. Diabetes mellitus
  2. Diabetes insipidus
  3. Hypoparathyroidism
  4. Hyperparathyroidism

5) What drugs antagonize the effects of ADH on the renal tubules, and thus could causenephrogenic diabetes insipidus?

  1. Bromocryptine and cabergoline
  2. Hydrochlorothiazide and furosemide
  3. Cimetidine and verapamil
  4. Lithium and demeclocycline
  5. Acetaminophen and isoniazid

6) Damage to what organ would cause central diabetes insipidus?

  1. Kidneys
  2. Hypothalamus
  3. Thyroid
  4. Parathyroid
  5. Pituitary

7) To confirm central diabetes insipidus, post-injection (desmopressin) urine osmolarityshould be what percentage of pre-injection osmolarity?

  1. < 50%
  2. < 75%
  3. 100% (equal)
  4. > 125%
  5. > 150%

8) A priority nursing diagnostic for a client admitted to the hospital with a diagnosis of diabetes insipidus is:

  1. Sleep pattern deprivation related nocturia
  2. Activity intolerance r/t muscle weakness
  3. Fluid volume excess r/t intake greater that output
  4. Risk for impaired skin integrity r/t generalized edema

9) What are the typical presenting signs of diabetes insipidus?

  1. Hyperglycemia and polyuria
  2. Periorbital ecchymosis and blurred vision
  3. Polyuria and polydipsia
  4. Oliguria and hypoglycemia
  5. Weight gain and malaise

10) What electrolyte abnormalities can cause diabetes insipidus?

  1. Hypercalcemia and hyperkalemia
  2. Hypercalcemia and hypokalemia
  3. Hypocalcemia and hyperkalemia
  4. Hypocalcemia and hypokalemia

11) 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?

  1. antidiuretic hormone (ADH).
  2. thyroid-stimulating hormone (TSH).
  3. follicle-stimulating hormone (FSH).
  4. luteinizing hormone (LH).

12) A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should nurse Lina provide?

  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.”

13) 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?

  1. “I will drink fluids equal to the amount of my urine output.”
  2. “I will weigh myself every day using the same scale.”
  3. “I will wear my medical alert bracelet at all times.”
  4. “I will gradually wean myself off the vasopressin.”

14) Which of the following is most suggestive of psychogenic polydipsia, not diabetesinsipidus?

  1. Nocturia
  2. Constant symptoms
  3. 24-hour urine output > 18L
  4. Plasma osmolarity > 295mOsm/kg
  5. Plasma osmolarity < 280mOsm/kg after a water deprivation test

15) A client is suspected of developing diabetes insipidus. Which of the following is the most effective assessment?

  1. Taking vital signs every 4 hours
  2. Monitoring blood glucose
  3. Assessing ABG values every other day
  4. Measuring urine output hourly

16) A client with diabetes insipidus is taking Desmopressin acetate (DDAVP). To determine if the drug is effective, the nurse should monitor the client’s:

  1. Arterial blood pH
  2. Pulse rate
  3. Serum glucose
  4. Intake and output

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.
Answers and Rationales
  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.