A nurse is caring for a client with a urine specific gravity of less than 1.005, polyuria, and nocturia. The nurse recognizes that which of the following physiologic findings is the likely cause?
Increased insulin production
Increased adrenocorticotropic hormone (ACTH)
Low levels of T3, T4
Insufficient antidiuretic hormone (ADH)
The Correct Answer is D
A. Increased insulin production would not cause polyuria and low specific gravity urine; rather, hyperglycemia from lack of insulin can cause high specific gravity due to glucose in urine.
B. Increased ACTH affects cortisol production but is not directly related to urine concentration or polyuria.
C. Low T3 and T4 levels are associated with hypothyroidism, which typically does not cause polyuria or decreased specific gravity.
D. Insufficient ADH, as seen in diabetes insipidus, leads to the inability to concentrate urine, resulting in a low specific gravity, polyuria, and nocturia due to excessive water loss.
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Correct Answer is A
Explanation
A. Mastoiditis often results in inflammation and infection that extend to the middle ear, causing the tympanic membrane to appear red, dull, thickened, and immobile upon examination.
B. A transparent and clear tympanic membrane is typical in a healthy ear, not in cases of mastoiditis.
C. A pearly colored tympanic membrane is also indicative of a normal, healthy ear without infection.
D. A pink-colored tympanic membrane may suggest mild irritation but is not a characteristic finding of mastoiditis.
Correct Answer is A
Explanation
A. Assessing respiratory status and airway patency is the highest priority in this situation due to the risk of respiratory compromise from cervical spinal cord injuries, which can affect the diaphragm and other respiratory muscles.
B. While assessing extremity strength and sensation is important, it comes after ensuring the client’s airway and breathing are stable.
C. Pain management is essential, but addressing immediate life-threatening conditions takes precedence over pain assessment.
D. Assessing the client's level of consciousness is crucial for overall evaluation but does not take priority over ensuring adequate respiratory function in the context of a cervical spinal cord injury.