A client is brought by ambulance to the ED after experiencing what the family thinks is a stroke. The nurse caring for this client is aware that which is an absolute contraindication for thrombolytic therapy?

Reasoning:

Choice A reason: Addison disease results from adrenal insufficiency, causing deficient cortisol and aldosterone production. This leads to symptoms like hypotension, hyponatremia, and hyperkalemia, opposite to the cortisol excess seen in Cushing syndrome, which involves weight gain, hypertension, and hyperglycemia due to elevated adrenal cortex activity.

Choice B reason: Hashimoto disease is an autoimmune thyroiditis causing hypothyroidism, with low thyroid hormone levels leading to fatigue, weight gain, and cold intolerance. It does not involve adrenal cortex cortisol excess, unlike Cushing syndrome, which is characterized by hypercortisolism and distinct metabolic and physical symptoms.

Choice C reason: Cushing syndrome is defined by excess free circulating cortisol from the adrenal cortex, due to pituitary tumors, adrenal hyperplasia, or exogenous steroids. This causes weight gain, moon face, hypertension, and hyperglycemia, reflecting cortisol’s effects on metabolism, fat distribution, and fluid balance, making it the correct disorder.

Choice D reason: Graves disease is an autoimmune condition causing hyperthyroidism, with excess thyroid hormone leading to weight loss, tachycardia, and heat intolerance. It does not involve adrenal cortex cortisol production, unlike Cushing syndrome, which is specifically related to hypercortisolism and its systemic metabolic effects.

Reasoning:

Choice A reason: Defective production of erythrocytes is a key classification of anemia, as seen in conditions like aplastic anemia or iron deficiency anemia. Impaired bone marrow function or nutrient deficiencies reduce red blood cell synthesis, leading to decreased hemoglobin and oxygen-carrying capacity, a common mechanism in various anemias.

Choice B reason: Destruction of erythrocytes, or hemolysis, is a major anemia classification. Conditions like hemolytic anemia cause premature red blood cell breakdown due to immune-mediated destruction, membrane defects, or hemoglobinopathies, reducing circulating erythrocytes and causing anemia despite normal or increased bone marrow production.

Choice C reason: Loss of erythrocytes through bleeding is a primary anemia classification. Chronic or acute blood loss from gastrointestinal, genitourinary, or traumatic sources depletes red blood cells and iron stores, leading to iron deficiency anemia, a common cause, particularly in older adults or those with chronic bleeding.

Choice D reason: Shape of erythrocytes is not a primary classification for anemia. While abnormal shapes, like sickle cells, contribute to specific anemias (e.g., sickle cell anemia), classification focuses on mechanisms like production, destruction, or loss. Shape is a characteristic, not a primary cause of anemia.

Choice E reason: Quantity of erythrocytes is a consequence, not a classification, of anemia. All anemias involve reduced erythrocyte counts, but the classification is based on underlying causes—defective production, destruction, or loss—not the resulting low quantity, which is a defining feature rather than a mechanistic category.