Question

A client with a history of Addison's disease and flu-like symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101°F (38.3°C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by I.V. infusion?

Answer 1

Correct Answers:

Methylprednisolone (Solu-medrol)

Rationale :

♦️Acute adrenal insufficiency (Addisonian crisis) is a life-threatening emergency that occurs when there is a sudden drop in cortisol levels.

♦️It is typical in response to stress or illness in clients with Addison’s disease.

♦️The most urgent treatment involves administration of IV corticosteroids, such as methylprednisolone, to replace the critical cortisol deficit.

♦️This reverses symptoms like hypotension, confusion, weakness, and fever.

♦️Delayed or inadequate corticosteroid therapy may result in shock and death, making this the first-line intervention.

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Answer 2

Correct Answers:

The need for life-long steroid replacement

Rationale :

🔸Clients with Addison’s disease have permanent adrenal cortex dysfunction, leading to lifelong cortisol and aldosterone deficiency.

🔸This requires daily hormone replacement therapy, typically with hydrocortisone or prednisone, to maintain homeostasis.

🔸Stopping therapy or adjusting it without medical supervision can precipitate a crisis.

🔸Patient education should emphasize adherence and stress dosing to manage physical or emotional stressors.

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Answer 3

Correct Answers:

Respiratory Alkalosis

Rationale :

💎Hyperventilation leads to excessive exhalation of CO₂, which causes a decrease in carbonic acid levels in the blood, resulting in increased pH—the hallmark of respiratory alkalosis.

💎 It is frequently triggered by anxiety, fear, or pain, especially in clients with generalized anxiety disorder.

💎Symptoms may include lightheadedness, tingling, and dizziness.

💎Treatment often involves reassurance and breathing control, such as rebreathing into a paper bag.

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Answer 4

Correct Answers:

Inform the primary care provider that the patient may have an infection.

Rationale :

✨ In clients with sickle cell crisis, a new fever and lung crackles raise concern for acute chest syndrome, a severe and potentially fatal complication.

✨ Prompt notification of the primary provider is critical to initiate antibiotics, imaging, and possibly transfusions.

✨ Early intervention can prevent respiratory failure or sepsis.

✨ Oxygen and respiratory therapy may follow, but recognition and medical response are the first steps.

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Answer 5

Correct Answers:

Erythropoietin (Epogen)

Rationale :

✔️ Clients with chronic kidney disease (CKD) often experience anemia due to impaired erythropoietin production by the kidneys.

✔️ Epogen (epoetin alfa) is a recombinant form of erythropoietin that stimulates red blood cell production in the bone marrow.

✔️ It reduces the need for blood transfusions and improves energy levels and oxygenation.

✔️ It is usually given subcutaneously or intravenously and monitored with hemoglobin levels.

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Answer 6

Correct Answers:

"I can cook soup using canned vegetables"

Rationale :

✓ Clients with Cushing’s syndrome often have fluid retention and hypertension due to excess cortisol and therefore must limit sodium intake.

✓ Canned vegetables and soups are typically high in sodium, making them inappropriate dietary choices.

✓ This response indicates a knowledge gap that requires further education.

✓ Sodium restriction helps control edema and blood pressure, critical in this condition.

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Answer 7

Correct Answers:

Hemolytic anemia

Rationale :

🔸Hemolytic anemia involves the destruction of red blood cells, which leads to elevated levels of bilirubin and increased reticulocyte count as the body tries to replace lost RBCs.

🔸Symptoms often include fatigue, pallor, and jaundice.

🔸These lab values clearly point toward accelerated RBC turnover, not production failure.

🔸Differentiating between types of anemia is crucial for treatment planning.

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Answer 8

Correct Answers:

Iron will cause the stools to darken in color.

Rationale :

🔹Oral iron supplements commonly cause dark green or black stools, a harmless side effect resulting from unabsorbed iron.

🔹This can alarm patients, so preemptive education helps avoid unnecessary concern.

🔹 Other common effects may include constipation or mild nausea, which can be managed through dosage adjustment or food intake.

🔹Iron should not be taken with dairy, as calcium inhibits its absorption.

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Answer 9

Correct Answers:

"l have difficulty breathing when walking 30 feet."

Rationale :

✅ Shortness of breath on exertion is a classic subjective symptom of iron-deficiency anemia, caused by reduced oxygen-carrying capacity of the blood.

✅ Clients may also report fatigue, palpitations, and dizziness with minimal activity.

✅ This finding supports the nurse’s assessment of functional impairment due to anemia.

✅ It highlights the need for intervention and energy conservation strategies.

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Answer 10

Correct Answers:

hyponatremia
decreased glucose level
Craving for salt

Rationale :

✅ Hyponatremia:

Clients with Addison’s disease experience aldosterone deficiency, which impairs sodium reabsorption in the kidneys.
As a result, sodium is lost in the urine, leading to hyponatremia.
Symptoms may include fatigue, confusion, and hypotension.
Monitoring sodium levels is critical to prevent adrenal crisis.

✅ Decreased glucose level:

Cortisol plays a key role in maintaining blood glucose levels through gluconeogenesis.
In Addison’s disease, the lack of cortisol causes hypoglycemia, especially during stress or fasting.
Clients may present with dizziness, sweating, or confusion.
Routine glucose monitoring is essential in these patients.

✅ Craving for salt:

Due to sodium depletion, the body triggers a strong craving for salty foods as a compensatory mechanism.
This is a common, early symptom of Addison’s disease. Salt cravings are linked to the loss of aldosterone’s mineralocorticoid effect.
Addressing electrolyte balance is part of routine management.

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RN ATI Medsurg Exam 8

No.

2 : The nurse is caring for a patient with Addison's disease who is scheduled for discharge. When teaching the patient about hormone replacement therapy, the nurse should address what topic?

3 : A patient with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon an assessment that the patient is hyperventilating. The triage nurse is aware that hyperventilation is the MOST common cause of which acid-base imbalance?

4 : A client is being treated on the medical unit for a sickle cell crisis. The nurse's most recent assessment reveals an oral temperature of 100.50F and a new onset of fine crackles on lung auscultation. What is the nurse's most appropriate action?

5 : A client with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this patient?

6 : A client with Cushing's syndrome is receiving education about dietary changes from the nurse. Which statement by the patient demonstrates the need for further teaching?

7 : A client comes into the clinic complaining of fatigue. Blood work shows an increased bilirubin concentration and an increased reticulocyte count. What would the nurse suspect the patient has?

8 : A nurse is providing education to a client with iron deficiency anemia who has been prescribed iron supplements. What should the nurse include in health education?

9 : The nurse is collecting data for a client who has been diagnosed with iron-deficiency anemia. What subjective findings does the nurse recognize as symptoms related to this type of anemia?

10 : A nurse is caring for a patient with Addison's Disease. Which of the following clinical manifestations should the nurse expect to observe? (SELECT ALL THAT APPLY)

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