NCLEX-RNPhysiological AdaptationHard
A client is 6 hours postoperative following a transsphenoidal hypophysectomy. The nurse notes urine output of 350-400 mL/hr for the past 3 hours, urine specific gravity of 1.001, and serum sodium of 150 mEq/L. Which prescribed intervention should the nurse anticipate?
- ARestriction of free water intake to 800 mL/day
- BDemeclocycline administration
- CFurosemide administration
- DDesmopressin (DDAVP) administration
Show answer & explanationAnswer & explanation
Correct answer: D. Desmopressin (DDAVP) administration
This presentation indicates diabetes insipidus, a known complication of pituitary surgery, characterized by massive dilute urine output, low specific gravity, and hypernatremia due to insufficient antidiuretic hormone. Desmopressin, a synthetic ADH analog, is the treatment of choice.
Why the other options are wrong
- A. Fluid restriction is used for SIADH with fluid overload, not for diabetes insipidus with volume depletion.
- B. Demeclocycline is used to treat SIADH by inducing nephrogenic diabetes insipidus, the opposite condition.
- C. Furosemide would worsen fluid loss and hypernatremia, which are already critical problems in this client.
Diabetes Insipidus (Neurogenic)
A deficiency of antidiuretic hormone, often after pituitary surgery or head trauma, causing excretion of large volumes of dilute urine and resulting hypernatremia/dehydration.
- Hallmarks: polyuria (>200 mL/hr), low urine specific gravity (<1.005), hypernatremia
- Common cause: pituitary/hypothalamic surgery or trauma
- Treatment: desmopressin (DDAVP) and fluid replacement
Memory trick: DI = Dry Inside (dilute urine, dehydration); SIADH = Soaked Inside