The nurse is caring for a client with diabetes insipidus who is receiving vasopressin (ADH) therapy.
Which of the following assessments should the nurse prioritize to determine if the client has had a therapeutic response to this medication? The client's
The nurse is caring for a client with diabetes insipidus who is receiving vasopressin (ADH) therapy.
Which of the following assessments should the nurse prioritize to determine if the client has had a therapeutic response to this medication? The client's
A. serum blood glucose level.
[6%]
B. serum sodium level.
[22%]
C. urine output.
[58%]
D. heart rate.
[14%]
Statistics
Subject/Lesson
Subject
Critical Care
Lesson
Critical Care Concepts
Client Need
Test Plan
Pharmacological and Parenteral Therapies
Related Topic
Expected Actions/Outcomes
Item Type
Item Type
Analysis
Explanation
Choice C is correct. Urine output is the most direct and immediate indicator of vasopressin's effectiveness in reducing polyuria, a characteristic symptom of diabetes insipidus. Monitoring urine output allows the nurse to assess whether vasopressin therapy is effectively promoting water reabsorption in the kidneys, leading to a decrease in urine volume.
Choice A is incorrect. Vasopressin therapy can affect blood glucose levels indirectly by influencing water reabsorption in the kidneys however, it is not a primary concern when monitoring a client's response to vasopressin therapy for diabetes insipidus.
Choice B is incorrect. Excessive vasopressin can lead to hyponatremia, while inadequate vasopressin may result in hypernatremia. Monitoring serum sodium levels is important for assessing the client's fluid and electrolyte balance, but it is not the highest priority when initially evaluating the client's response to vasopressin therapy.
Choice D is incorrect. While vasopressin can indirectly affect cardiovascular function through its vasoconstrictive effects, monitoring heart rate is not the most immediate concern when assessing a client's response to vasopressin therapy for diabetes insipidus. Other vital signs and cardiovascular parameters, such as blood pressure, may be more relevant in this context.
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Additional Info
✓ Vasopressin, also known as antidiuretic hormone (ADH), is a hormone produced by the hypothalamus and released from the posterior pituitary gland. It plays a key role in regulating water balance and blood pressure by promoting water reabsorption in the kidneys, reducing urine output, and constricting blood vessels to increase blood pressure. In medical practice, vasopressin is used therapeutically to treat conditions such as diabetes insipidus and septic shock.
✓ Diabetes insipidus is a rare condition characterized by excessive urination and extreme thirst. It occurs when the body cannot properly regulate fluid balance due to a deficiency of antidiuretic hormone
✓ Vasopressin binds to vasopressin receptors located on the cells of the kidney's collecting ducts. This binding triggers a series of intracellular signaling pathways that result in increased water reabsorption.
