Walkthrough: Physiological Adaptation Q14 – NCLEX-RN®

00:00 A nurse is reviewing the history and laboratory data for several clients with abnormal specific gravity results. Which client is most likely to have a diagnosis of diabetes insipidus? Sweet, I love this question. Okay, let's tear it up. So, a nurse is reviewing the history and laboratory data for several clients. Okay. That means we're going to see more than one. And what is specific about these clients? They have abnormal specific gravity results. Hey, when they spell it out for you and say abnormal, pay attention. Right? That's a big deal. So, we know that their specific gravity is not within normal range. Which client is most likely to have a diagnosis of diabetes insipidus? Okay, that's a diagnosis. So, what do I have to do before I look at these answer choices? Think back in your brain what do you know? Well, in order to recognize abnormal specific gravity results, you'd have to try and think.

01:02 Can you remember what normal is? And then think about diabetes insipidus. What is that? We know they all have abnormal specific gravity results. So which one is most likely to have this problem? Okay, now when you look at your answer choices, you're going to have 4 options. So I want you to go through each one thinking "Okay, is there a connection with this and diabetes insipidus or the hormone involved in diabetes insipidus?" So ask yourself that 4 times. Do not get worked up that it's an endocrine question. You got this. We've prepared you for it.

01:43 If you're feeling a little anxious about it, stop, just do your best, work through the question, and we'll walk through it. If there's some content that you're missing, you'll have it by the time you walk through with us. Okay, so see you in a few minutes, use your scratch paper with the numbers 1, 2, 3, and 4 on it. Make sure you eliminate those answer choices and say why to come up with your best answer then come on back. Welcome back. Hey, let me break down a little bit of the patho for you when we're looking at this. Right? When you got here, there were no numbers for a specific gravity. So, normal, just for fun, urine specific gravity would be 1.010 to 1.030. That is an example, keep in mind every lab can have a little bit difference sometimes but that should be pretty consistent throughout labs.

02:35 So, they told us they have abnormal specific gravity but they weren't asking us to pick which value would indicate diabetes insipidus. So, okay, that wasn't an option but it's asking us to see which is most likely to have a diagnosis of diabetes insipidus? Well, what is diabetes insipidus? Right? Actually, I think that this is the most weirdly named diagnosis because when you say diabetes to me I usually think of the kind of insulin and blood sugars and maybe that's what you thought when you first started learning about it too. It's not that. Diabetes insipidus is a lack of the hormone ADH. Remember, ADH is antidiuretic hormone. So, anti means against; diuretic, diuresing, peeing out fluids; and then hormone means it's just a chemical messenger. So, somebody with diabetes insipidus does not have enough ADH so instead of having the hormone that says "Hey, we're against diuresing, hang on to all that fluid. They're gonna pee out large volumes of fluid." And it's going to be looking like kind of tap water. The opposite problem of diabetes insipidus is SIADH, Syndrome of Inappropriate Antidiuretic Hormone. That means someone who has excessive ADH and they do this, they blow up like the blueberry girl and Willy Wonka because they don't put any urine out and what they do looks really dark and nasty and they hang on to all that fluid because they're like mine, mine, mine, mine, mine, mine. They don't pee fluid out. That's why they swell up and get really edematous. So, those are opposites of each other. Diabetes insipidus, not enough ADH. Syndrome of Inappropriate Antidiuretic Hormone, SIADH, way too much ADH. So, they're going to look exactly opposite to each other. Now when you look at the answer choices, you have to say "Huh, is the client with the UTI, is there a connection to somebody with a UTI and diabetes insipidus?" I don't think so, but let's look. Number 2, a client with a diagnosis of type 1 diabetes, haha, not today elves. You may have caught me when I was a brand new student, but not anymore. Because I know that diabetes insipidus has nothing to do with type 1 diabetes or type 2 diabetes. So, number 2, you are out. That's not most likely to have that diagnosis. Now, you may be thinking when you look through this, "Hey somebody could have DI and some of these other things too." Yeah, but what they're asking when they say most likely which one has the strongest connection to diabetes insipidus. Now number 3, a history of a brain tumor. Huh, okay. Now, you're messing around with the brain. You got a brain tumor, that's tissue that wasn't supposed to be there. It can start really doing some damage to your brain.

05:55 I'm going to leave that one in for now. So I've left number 1 and number 3 in.

06:00 Number 4, a client with only 1 adrenal gland. Okay, well, you can function with an adrenal gland but you're wondering like maybe they don't have enough. Well, we're talking about fluid control when we're talking about diabetes insipidus. And is the hormone that's connected to diabetes insipidus, is it produced by the adrenal gland? Nope, it's not. Right? The hormone that is produced by the adrenal gland that helps you or messes with your fluid volume is aldosterone. Remember, aldosterone and don't ever call a physician and say that that way, I just say that because that's how I say that to help you remember. Is a hormone that tells your body to reabsorb or hang on to sodium and then when you hang on to sodium, water follows. But diabetes insipidus is not a problem with aldosterone. It's a problem with ADH.

06:58 That's what we're dealing with. Now, if the brain tumor happens to damage the hypothalamus, the hypothalamus plays a role in producing ADH. So, even though they didn't tell us their hypothalamus was damaged, when you look at these 4 answer choices, that's the one of these 4 that has the closest connection to ADH.

07:19 So, I can hear you saying "Nothing up there said they had problems with their hypothalamus." You're right. That is true, but remember how the game is played.

07:27 This is what the elves are looking for. Can you put it together that no UTI isn't going to be a cause or connected to diabetes insipidus when compared to a brain tumor. Number 2 plays no role and number 4 that's not even the right hormone.

07:45 That's what they're looking for you to know. Number 3 is brain tumor is the only thing up there that could have a potential impact on ADH and if that brain tumors happen to mess with the hypothalamus, that's why you would not have enough ADH. So that's why it's number 3. Okay, so lots of cool stuff to take with you your other question. Content things. How comfortable do you feel with SIADH in diabetes insipidus? Do you recognize the differences in what urine output would look like? What their blood pressure would be? Remember, somebody was putting out a lot of fluid volume is likely going to have a lower blood pressure and a faster heart rate responding to that hypovolemia. Somebody who has too much ADH is going to be hanging on to fluid, have lower nastier looking urine output, and their blood pressure is likely to be higher because they've got so much fluid onboard.

08:40 Are you thinking about where hormones come from? What hormones come from the adrenal gland? These are all things I encourage you, don't rush through the questions, sit with them for a bit. See what information you want to remember to write in your notebook because well I know that you can't know everything, totally get that and I have to remind myself with that like "Hey, I'm enough. I have worked as hard as I can to be prepared for the test. There may be something on here that I don't know and that's okay." Because just controlling your thoughts is key. But this is how you learn more things and you're more prepared for the test.

09:17 When you sit with these questions and you reflect on them, just clicking through them doesn't do what you need to do. In fact, I'm not a huge fan of telling students "You need to do 3000 questions this semester and then you'll be ready for the NCLEX." I would rather you do a lower number of questions but do them well, think through them, and reflect on them. I guarantee you, you'll have a better result than somebody who just clicked answers and worked all the way through because they had to. So, encourage, I want you to be encouraged because you are doing the work that it takes to become a better critical thinker, a better test taker, and in the end the best nurse that you can be.