Later in the shift the nurses assume care of a 58-year-old patient admitted to the oncology floor. They have a known history of Small Cell Lung Cancer (SCLC). The patient states,”I feel incredibly weak, nauseous, and my head is pounding. I feel like I gained 5 pounds overnight, but my ankles aren’t swollen.” Initial Vitals: BP 130/70, HR 90, RR 18, SpO2 95% on room air. Temp 37.0°C.The nurse suspects the patient is developing SIADH, and reviews the lab results, and notes a sodium level of 124 mEq/L. Which trend regarding the urine sodium levels would support the diagnosis of SIADH?

The patient is being discharged. They admit they skipped insulin because they “felt too sick to eat.” The nurse determines the patient needs education regarding insulin administration at home. The nurse reviews trigger events for the patient’s DKA. The patient admitted they often skip insulin because they want to lose weight. How should the nurse educate the patient regarding this topic?

The next day the nurse is evaluating the effectiveness of the desmopressin (DDAVP) and fluid replacement. Which finding indicates that the treatment is successful and the DI is resolving?

The client is now 24 hours post-op. He is hypotensive (BP 88/50) and his urine output has been 15 mL/hr for the last 4 hours, and complaining of pain at 7/10. Laboratory analysis shows Creatinine: 2.1 mg/dL (Baseline 0.8), Lactate: 4.5 mmol/ and WBC: 22,000/mm³. The nurse recognizes the patient is likely progressing from Peritonitis to Septic Shock. Which order should the nurse question?

Scenario 4 A college freshman living in a dorm, reports high stress due to finals week. The patient states, “My roommate brought me in because I passed out. My stomach hurts really bad.” The patient is drowsy but arousable (GCS 13), and is hyperventilating. The skin is flushed and dry, with poor turgor. Vitals include 92/54 mmHg, HR: 128 bpm,RR: 36/min, deep and labored, Temp: 37.1°C (98.8°F), and O2 Sat: 95% on room air. Weight is 60 kg. The nurse observes the patient’s respiratory status. The type of respiratory pattern the nurse would expect to see if the patient is compensating for their current condition is respirations.

The nurse is monitoring the patient for signs of hypocalcemia. Which of the following assessment findings would indicate neuromuscular irritability associated with low calcium? (Select all that apply)

Based on the current sodium results, the nurse initiates seizure precautions due to the high risk for seizures. Which action by the nursing student requires immediate correction by the precepting nurse?

The patient’s potassium level is currently 3.0 mEq/L. The nurse receives an order for potassium replacement prior to starting the protocol. The nurse looks at the cardiac monitor, and expects to see the presence of a after the T-wave. Conversely, if the patient had presented with hyperkalemia (high potassium), the nurse would likely see T-waves.

Based on the initial vital signs (BP 92/54, HR 128), the patient is displaying signs of significant volume depletion. Which physiological factor is a primary contributor to severe dehydration in the patient?

The patient is actively seizing. After stopping the seizure with benzodiazepines, the provider orders Hypertonic Saline (3% NaCl). Which safety parameter is most critical for the nurse to monitor during this infusion?