A male client informs the nurse he has suddenly stopped taking the glucocorticoid medication without consulting the healthcare provider. The nurse should recognize the client is at risk for developing which condition?

Phenylketonuria.

Adrenal insufficiency.

Hypercortisolism.

Diabetes mellitus.

Answer and Explanation

The Correct Answer is B

Rationale:
A. Phenylketonuria: Phenylketonuria is a genetic metabolic disorder present from birth where the body cannot break down the amino acid phenylalanine, unrelated to glucocorticoid therapy or abrupt discontinuation. It is not a risk in this scenario.

B. Adrenal insufficiency: Abrupt cessation of glucocorticoids can suppress the hypothalamic-pituitary-adrenal (HPA) axis. Without tapering, the adrenal glands may not produce adequate endogenous cortisol, leading to adrenal insufficiency. Symptoms can include fatigue, hypotension, nausea, and risk of adrenal crisis.

C. Hypercortisolism: Hypercortisolism, or Cushing’s syndrome, results from prolonged high levels of cortisol. Stopping glucocorticoids would not cause hypercortisolism; rather, it creates a deficiency state.

D. Diabetes mellitus: While glucocorticoids can induce hyperglycemia, abrupt discontinuation does not directly cause diabetes. The client’s main risk is insufficient cortisol production rather than elevated blood glucose.

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Correct Answer is []

Explanation

Rationale:

• Hyperosmotic hyperglycemic syndrome (HHS): The client presents with severe hyperglycemia (glucose 642 mg/dL), hyperosmolality (osmolality 315 mOsm/kg), and dehydration without significant ketones in the urine. Neurological changes such as confusion and drowsiness are consistent with HHS. This condition is common in older adults with type 2 diabetes and often triggered by infection, illness, or poor oral intake.

• Worsening peripheral neuropathy: Although the client has a history of peripheral neuropathy, the acute presentation of confusion, extreme hyperglycemia, and dehydration indicates a systemic metabolic emergency rather than neuropathic progression. Neuropathy does not explain the neurological changes or laboratory findings.

• Diabetic ketoacidosis (DKA): DKA is characterized by hyperglycemia, metabolic acidosis, and significant ketonuria. This client has negligible ketones and a relatively normal serum pH, making DKA unlikely. The absence of ketones differentiates HHS from DKA. Treatment strategies differ, particularly regarding fluid replacement rates and insulin dosing.

• Ischemic stroke: Neurological symptoms could suggest a stroke, but CT imaging was negative for acute findings. The drowsiness and confusion are better explained by hyperosmolarity and dehydration. Blood glucose of 642 mg/dL and high osmolality indicate a metabolic rather than vascular cause.

• Begin insulin drip: Continuous IV insulin is indicated to gradually reduce hyperglycemia while avoiding rapid fluid shifts. Insulin therapy helps move glucose into cells and corrects the hyperosmolar state. Careful titration is necessary because overly aggressive insulin can cause hypoglycemia or worsen electrolyte imbalances. This is a central intervention in managing HHS.

• Administer IV bolus: IV fluid resuscitation with 0.9% sodium chloride addresses the profound dehydration and hyperosmolarity. The client exhibits signs of volume depletion including tachypnea, hypotension (BP 102/61 mmHg), and concentrated urine (specific gravity 1.040). Fluid replacement restores perfusion, improves renal function, and reduces serum osmolality.

• Insert urinary catheter: While monitoring output is important, catheterization is not immediately indicated unless precise measurement is critical or the client is unable to void. Noninvasive monitoring of urine output is sufficient initially. Routine catheter placement can increase infection risk and is not the first-line action.

• Place client on oxygen: Oxygen saturation is 97% on room air, indicating adequate oxygenation. Supplemental oxygen is not needed at this time. Respiratory compromise is not a feature of HHS unless complications develop. Oxygen therapy does not address the underlying hyperosmolar state.

• Restrict fluids: Fluid restriction is contraindicated in HHS because the client is severely dehydrated. Aggressive fluid replacement is needed to correct hyperosmolarity and improve renal perfusion. Restricting fluids would worsen dehydration, electrolyte imbalance, and overall perfusion status.

• Frequent blood glucose measurements: Monitoring blood glucose frequently allows the healthcare team to titrate insulin appropriately and prevent rapid drops that could lead to cerebral edema or hypoglycemia. This is essential in the acute management of HHS where glucose levels are extremely elevated. Close monitoring ensures safe and effective glycemic control.

• Intake and output: Tracking fluid balance is vital because the client is severely dehydrated and receiving IV fluids. Monitoring urine output and fluid intake helps assess renal perfusion and the effectiveness of fluid resuscitation. It also aids in detecting early signs of fluid overload or worsening kidney function during treatment.

A. Explain to the parents that anger is a common response to grief. B. Refer the parents to the chaplain to provide grief counseling. C. Assure the parents that a terminal diagnosis was inevitable. D. Tell the parents that blaming each other will not change the situation.

Correct Answer is A

Explanation

Rationale:
A. Explain to the parents that anger is a common response to grief: Anger is a normal stage of grief and often occurs when families are processing shock, fear, and helplessness after a terminal diagnosis. Providing education and normalization helps reduce guilt, facilitates emotional expression, and supports healthy coping.

B. Refer the parents to the chaplain to provide grief counseling: Chaplaincy support can be helpful for spiritual and emotional needs, but immediate intervention involves addressing the parents’ acute emotional response. Referral alone does not provide timely support for the anger being expressed.

C. Assure the parents that a terminal diagnosis was inevitable: Telling parents the outcome was inevitable may be perceived as dismissive or minimizing their feelings. It does not validate their emotions or help them process grief constructively.

D. Tell the parents that blaming each other will not change the situation: Confronting blame without acknowledging emotions may increase defensiveness and conflict. Immediate support should focus on understanding and normalizing grief reactions rather than correcting behavior.

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A male client informs the nurse he has suddenly stopped taking the glucocorticoid medication without consulting the healthcare provider. The nurse should recognize the client is at risk for developing which condition?

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Naxlex Comprehensive Predictor Exams

Patient Data

Correct Answer is []

Explanation

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Correct Answer is A

Explanation

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A male client informs the nurse he has suddenly stopped taking the glucocorticoid medication without consulting the healthcare provider. The nurse should recognize the client is at risk for developing which condition?