. A patient with central diabetes insipidus is being treated with desmopressin (DDAVP) and fluid replacement. Which of the following lab values should the nurse monitor closely?
Serum sodium levels
Serum magnesium levels
Serum potassium levels
Serum calcium levels
The Correct Answer is A
A. Serum sodium levels: Desmopressin can lead to water retention and potentially hyponatremia. Monitoring serum sodium is crucial to prevent electrolyte imbalance.
B. Serum magnesium levels: Magnesium is not typically impacted by desmopressin treatment in central diabetes insipidus.
C. Serum potassium levels: Desmopressin does not generally affect potassium levels in patients with diabetes insipidus.
D. Serum calcium levels: Calcium levels are not directly influenced by desmopressin or diabetes insipidus.
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Correct Answer is A
Explanation
A. Hypovolemia leading to decreased renal perfusion. Hypovolemia from dehydration and low blood pressure reduces blood flow to the kidneys, resulting in pre-renal AKI, characterized by elevated BUN and creatinine.
B. Acute tubular necrosis. Acute tubular necrosis may cause AKI but is often due to prolonged hypoperfusion, nephrotoxic drugs, or ischemia, not the immediate presentation seen here.
C. Urinary tract obstruction. A urinary tract obstruction leads to post-renal AKI, often with symptoms like flank pain or difficulty urinating, not dehydration and low blood pressure.
D. Chronic kidney disease. Chronic kidney disease is a long-term condition and would not cause the acute symptoms or sudden onset of AKI as seen in this patient.
Correct Answer is D
Explanation
A. Warfarin. Warfarin (Coumadin) is an anticoagulant used to prevent blood clots, but it typically requires several days to achieve a therapeutic effect and needs close monitoring of INR (International Normalized Ratio) levels. While it can be used for long-term prevention of DVT, it's not the immediate choice for post-operative prophylaxis.
B. Alteplase (tPA). Alteplase is a thrombolytic agent, used to break down existing clots, not prevent their formation. It is typically used in emergency situations, such as for treating ischemic stroke.
C. Clopidogrel. Clopidogrel is an antiplatelet agent, often used to prevent arterial clots, not DVTs. It is more commonly used in conditions like stroke and heart disease.
D. Enoxaparin. Enoxaparin, a low molecular weight heparin, is commonly used to prevent DVT after surgery by inhibiting specific clotting factors. It’s frequently prescribed for DVT prevention in orthopedic surgery patients.