UPUMS Nsg.Officer-2024
Medical & Surgical Nursing
Medium
Which client will most likely experience a serum sodium concentration of 127 mEq/L (127 mmol/L)?
Appeared in: UPUMS Nsg.Officer-2024
Explanation
- A serum sodium level of 127 mEq/L is defined as hyponatremia, as it is below the normal range of 135-145 mEq/L.
- Thiazide diuretics (e.g., hydrochlorothiazide) are a common cause of hyponatremia, especially in older adults.
- They work by inhibiting the sodium-chloride cotransporter in the distal convoluted tubule of the kidneys, which leads to increased excretion of sodium and water.
- This loss of sodium in the urine lowers the concentration of sodium in the blood, causing hyponatremia.
Why Other Options Were Wrong
- Option B: Hyperaldosteronism involves excessive production of the hormone aldosterone.
- Option C: Corticosteroids possess mineralocorticoid properties that mimic the action of aldosterone.
- Option D: Cushing's syndrome is characterized by an excess of the hormone cortisol, which also has mineralocorticoid effects.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pathophysiological causes of hyponatremia, focusing on medication side effects and endocrine disorders as background academic context rather than a clinical decision trigger.
- Nurses must closely monitor serum electrolyte levels, especially sodium, for clients taking diuretics. This is a critical patient safety measure to prevent adverse outcomes.
- Key signs and symptoms of hyponatremia that a nurse should assess for include headache, confusion, nausea, muscle cramps, and in severe cases, seizures and coma due to cerebral edema.
- What if the client's sodium level was 150 mEq/L? This would indicate hypernatremia, and the most likely cause among the options would be hyperaldosteronism, corticosteroid use, or Cushing's syndrome, as these conditions all lead to sodium retention.
How to Approach the Question
- First, identify the clinical significance of the lab value provided. A serum sodium of 127 mEq/L is below the normal range (135-145 mEq/L), indicating hyponatremia.
- The question asks for the most likely cause of this hyponatremia among the given options.
- Analyze each option's effect on sodium balance by recalling its physiological or pharmacological mechanism.
- Recall that thiazide diuretics promote sodium excretion.
- Recall that conditions with excess mineralocorticoid activity (hyperaldosteronism, Cushing's syndrome, corticosteroid use) cause sodium retention.
- Select the option that aligns with causing sodium loss (hyponatremia).
Concept Tested & Keywords
- Concept Tested: Pathophysiological causes of hyponatremia, focusing on medication side effects and endocrine disorders.
- Stem keywords: serum sodium concentration, 127 mEq/L
- Lead-in keywords: most likely
- Clinical cues: Serum sodium of 127 mEq/L indicates moderate hyponatremia (Normal: 135-145 mEq/L).
Question ID
QUS-DUIuN5sCOmDI3-wYx_
Reference Book
E6 Textbook of Biochemistry for medical StudentsDM Vasudevan Part 2 — Subpart A (pp 1-239 of 478) p. 92-94
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 565-567
Practise the full UPUMS Nsg.Officer-2024
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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