A client has an acute adrenal (addisonian) crisis. Which observation is the most significant during the nursing assessment?

Serum glucose 158 mg/dL (8.77 mmol/L)

Blood pressure 98/52 mm Hg

Weight gain 3 pounds (1.36 kg) in 24 hours

Insomnia and restlessness

Answer and Explanation

The Correct Answer is B

Choice A reason: Serum glucose 158 mg/dL (8.77 mmol/L) is not the most significant observation for an acute adrenal crisis, but a mild elevation of blood sugar. A mild elevation of blood sugar may occur due to stress, infection, medication, or diet, among other factors. It does not indicate a severe deficiency of adrenal hormones, which is the cause of an acute adrenal crisis.

Choice B reason: Blood pressure 98/52 mm Hg is the most significant observation for an acute adrenal crisis, as it indicates a condition called hypotension. Hypotension is a low blood pressure that may cause dizziness, fainting, shock, or organ failure. It is a sign of an acute adrenal crisis, which is a life-threatening emergency that occurs when the adrenal glands fail to produce enough cortisol and aldosterone. Cortisol and aldosterone are hormones that regulate blood pressure, blood sugar, and electrolyte balance.

Choice C reason: Weight gain 3 pounds (1.36 kg) in 24 hours is not the most significant observation for an acute adrenal crisis, but a possible sign of fluid retention. Fluid retention may occur due to heart failure, kidney disease, liver disease, or medication, among other causes. It does not indicate a severe deficiency of adrenal hormones, which is the cause of an acute adrenal crisis.

Choice D reason: Insomnia and restlessness are not the most significant observations for an acute adrenal crisis, but possible symptoms of anxiety, stress, or hyperthyroidism. Anxiety, stress, and hyperthyroidism may cause difficulty sleeping, nervousness, or agitation, among other effects. They do not indicate a severe deficiency of adrenal hormones, which is the cause of an acute adrenal crisis.

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Correct Answer is A

Explanation

Choice A reason: Infected macrophages and lymphocytes surround the Mycobacterium tuberculosis bacteria and form a tuberculous granuloma is the best explanation for the primary immune response to tuberculosis infection. A granuloma is a collection of immune cells that wall off the bacteria and prevent their spread. It is a protective mechanism that limits the infection and preserves the lung function.

Choice B reason: Tumor necrosis factor is released by T lymphocytes and lyses the Mycobacterium tuberculosis bacteria in the alveoli is not a correct explanation for the primary immune response to tuberculosis infection. Tumor necrosis factor is a cytokine that activates macrophages and induces inflammation, but it does not directly kill the bacteria. It may also have harmful effects by causing tissue damage and weight loss.

Choice C reason: Natural killer cells and neutrophils form a thick purulent debris, which becomes a caseous necrosis is not a correct explanation for the primary immune response to tuberculosis infection. Natural killer cells and neutrophils are part of the innate immune system, which is not very effective against intracellular bacteria like Mycobacterium tuberculosis. Caseous necrosis is a type of tissue death that results from the liquefaction of the granuloma. It is a sign of progressive disease, not primary infection.

Choice D reason: The inflammatory response of cytokines activates the complement system and causes permanent lung tissue damage is not a correct explanation for the primary immune response to tuberculosis infection. The inflammatory response of cytokines and the complement system are part of the innate immune system, which is not very effective against intracellular bacteria like Mycobacterium tuberculosis. Permanent lung tissue damage is a complication of chronic or reactivated tuberculosis, not primary infection.

A. Thrombosis of the small blood vessels in the substantia nigra. B. Increased acetylcholine levels and cholinergic activity in the brain. C. Cell-mediated immune response and muscle fiber damage. D. Increased production of dopamine in the motor cortex.

Correct Answer is A

Explanation

Choice A:
Thrombosis of the small blood vessels in the substantia nigra is the best explanation for the clinical manifestations observed in the patient. The substantia nigra is an area in the brain responsible for producing dopamine, a neurotransmitter involved in motor control. Thrombosis, or the formation of blood clots, in the small blood vessels of the substantia nigra can lead to a decrease in dopamine production, resulting in the symptoms of Parkinson's disease.

Choice B:
Increased acetylcholine levels and cholinergic activity in the brain are not the primary factors causing the manifestations of Parkinson's disease. In fact, Parkinson's disease is characterized by a decrease in dopamine levels, not an increase in acetylcholine.

Choice C:
Cell-mediated immune response and muscle fiber damage are not the main mechanisms underlying the clinical manifestations of Parkinson's disease. While inflammation and immune responses may play a role in the progression of the disease, they are not the primary cause of the symptoms observed.

Choice D:
Increased production of dopamine in the motor cortex is not the cause of the symptoms in Parkinson's disease. In fact, patients with Parkinson's disease experience a decrease in dopamine production due to the degeneration of dopamine-producing neurons in the substantia nigra.

Overall, the most plausible explanation for the patient's clinical manifestations is thrombosis of the small blood vessels in the substantia nigra, leading to a decrease in dopamine production.

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