A nurse assesses the following patients for potential endocrine dysfunction.
Which patient is at greatest risk for a deficiency of gonadotropin-releasing hormone?

Choice A rationale

Hyperactive bowel sounds would not be expected in a patient with peritonitis. Peritonitis is an inflammation of the peritoneum, which often results in paralytic ileus due to the inflammatory response and chemical irritation. This leads to decreased or absent bowel motility, and therefore, the nurse would expect to find hypoactive or absent bowel sounds upon auscultation.

Choice B rationale

Increased urinary output is an unlikely finding in a patient with peritonitis. The inflammatory response and fluid shifts into the third space can lead to hypovolemia, decreased renal perfusion, and reduced urine output. A patient with peritonitis is more likely to experience oliguria or even anuria as a result of the body's compensatory mechanisms to maintain circulating blood volume.

Choice C rationale

Rigid abdomen is a classic and significant finding in a patient with peritonitis. This is due to the involuntary guarding of the abdominal muscles, which contract as a protective response to the irritation of the parietal peritoneum. This board-like rigidity is a critical indicator of severe abdominal inflammation and requires immediate medical attention.

Choice D rationale

Frequent bowel movements are not expected. Peritonitis causes decreased or absent bowel motility due to paralytic ileus. This condition, combined with the pain and inflammation, would likely lead to constipation or the absence of bowel sounds, rather than frequent bowel movements, which are more characteristic of conditions like gastroenteritis.

Choice A rationale

High-dose corticosteroid therapy, such as with prednisone, can cause hypokalemia by increasing potassium excretion in the kidneys. These steroids mimic the action of aldosterone, which promotes sodium reabsorption and potassium excretion in the distal convoluted tubules and collecting ducts. This process leads to increased urinary loss of potassium, potentially causing a serum potassium level below the normal range of 3.5 to 5.0 mEq/L.

Choice B rationale

Hypermagnesemia is not a typical side effect of corticosteroid therapy. Corticosteroids primarily affect sodium and potassium balance. Hypermagnesemia is more commonly associated with kidney failure or excessive intake of magnesium-containing medications. The kidneys are highly efficient at excreting magnesium, so elevated levels (normal range 1.5 to 2.5 mEq/L) are rare unless renal function is compromised.

Choice C rationale

Corticosteroid therapy actually increases the excretion of potassium from the body, leading to a decrease in serum potassium levels, not an increase. The mineralocorticoid effects of these drugs cause increased activity of the sodium-potassium pump in renal tubules, leading to the exchange of potassium for sodium, resulting in increased urinary potassium loss and a risk for hypokalemia.

Choice D rationale

While some electrolyte imbalances can occur, hypomagnesemia is not a primary concern directly linked to high-dose corticosteroid therapy. Corticosteroids' main effect on electrolytes is their mineralocorticoid activity, which primarily targets sodium and potassium regulation. Hypomagnesemia is more commonly associated with conditions like chronic alcoholism, malnutrition, or gastrointestinal losses.