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Addison's Disease
A client with Addison's disease is prescribed fludrocortisone. The nurse understands that this medication is given to:
Correct Answer:
b) balance sodium and potassium
Rationale:
Fludrocortisone is a synthetic corticosteroid that mimics aldosterone to help balance sodium and potassium levels, which are often disrupted in Addison's disease. Cortisol levels are typically addressed by hydrocortisone. Addison's disease does not commonly lead to calcium imbalances, and while it may affect glucose levels, fludrocortisone is not primarily used for glucose control (Barrett et al., 2019).
A client with Addison's disease is experiencing an adrenal crisis. What is the priority nursing intervention?
Correct Answer:
c) give iv hydrocortisone
Rationale:
In an adrenal crisis, there is a severe deficiency of cortisol, requiring immediate administration of IV hydrocortisone to replace the hormone and stabilize the client. Administering IV potassium is contraindicated as hyperkalemia is often present. Oral fluids are not sufficient for the level of dehydration and electrolyte imbalance in adrenal crisis. The client should be positioned in a supine position to promote perfusion, not prone (Bornstein et al., 2016).
Which of the following manifestations would the nurse most likely observe in a client with Addison's disease?
Correct Answer:
c) hyperpigmentation and hypotension
Rationale:
Clients with Addison's disease often present with hyperpigmentation (bronze-like skin) due to increased ACTH levels and hypotension resulting from aldosterone deficiency, which leads to fluid and electrolyte imbalance. The "moon face" and "buffalo hump" are characteristic of Cushing's syndrome. Hypertension and bradycardia are not common features of Addison’s disease (Barrow & Clouse, 2017).
A nurse is teaching a client with Addison's disease about corticosteroid therapy. Which statement indicates that the client understands the instructions?
Correct Answer:
b) "i need to carry an emergency supply of medication with me at all times."
Rationale:
Clients with Addison’s disease need to carry an emergency supply of corticosteroid medication to manage potential adrenal crises. Corticosteroids must be taken regularly, not only when symptoms arise. Clients should not skip doses, even if experiencing nausea, and they are often advised to increase their salt intake due to aldosterone deficiency (Grossman & Porth, 2014).
The nurse is monitoring a client with Addison's disease for signs of an impending adrenal crisis. Which symptom is most concerning?
Correct Answer:
c) severe hypotension
Rationale:
Severe hypotension is a critical sign of an adrenal crisis, requiring immediate intervention. Fatigue is common in Addison's disease but not as concerning as severe hypotension. Hypertension and weight gain are more associated with Cushing's syndrome, not Addison's disease (Barrett et al., 2019).
A client with Addison's disease asks why they have developed darkened skin. What is the nurse’s best response?
Correct Answer:
b) "your body is producing excess melanin due to hormone imbalances."
Rationale:
In Addison’s disease, increased levels of ACTH lead to stimulation of melanocytes, causing hyperpigmentation or darkened skin. This change is not directly related to kidney function, potassium levels, or medication side effects (Bornstein et al., 2016).
Which of the following is the most appropriate action by the nurse when caring for a client with Addison's disease during times of stress?
Correct Answer:
b) increase corticosteroid dosage
Rationale:
During times of stress, clients with Addison’s disease require increased doses of corticosteroids to manage the body's increased demand. Fluid restriction is inappropriate due to the risk of dehydration. Potassium supplements are contraindicated as hyperkalemia is common. Avoiding all physical activity is not necessary; proper medication adjustment is key (Grossman & Porth, 2014).
The nurse is educating a client with Addison’s disease on recognizing the signs of an adrenal crisis. Which of the following symptoms should be included?
Correct Answer:
b) sudden pain in the lower back, vomiting, and severe diarrhea
Rationale:
Symptoms of an adrenal crisis include sudden, severe pain (often in the lower back or abdomen), vomiting, and diarrhea, which can quickly lead to dehydration and shock. Fever, confusion, and hyperglycemia are not typical signs of adrenal crisis. Bradycardia and decreased urine output are not primary symptoms of adrenal crisis, and muscle weakness with tingling fingers and joint swelling do not indicate a crisis (Barrett et al., 2019).
A client is newly diagnosed with Addison's disease and is concerned about maintaining a balanced lifestyle. What is the best advice for the nurse to provide?
Correct Answer:
b) "take your medication regularly and monitor for signs of crisis."
Rationale:
The cornerstone of managing Addison's disease is consistent corticosteroid replacement and monitoring for signs of adrenal crisis. High-intensity workouts can exacerbate stress on the body. Clients with Addison's often require a higher salt intake, not a restriction. Completely avoiding physical activities and stress is not necessary; instead, medication management and regular monitoring are key (Bornstein et al., 2016).
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