A nurse in the provider's office is caring for a child who has a history of tonic-clonic seizure disorder. Three months ago, the neurologist changed the child's antiepileptic medications to include Phenytoin due to increasing number of seizures per guardian. The child has a 1-year history of mild exercise-induced asthma for which they were prescribed a rescue inhaler of albuterol prn.

The client is at risk for developing

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Choice A reason: A low-sodium diet is not recommended for a child who has Addison's disease, as they need more sodium to maintain their blood pressure and fluid balance. A high-sodium diet may be advised instead. ¹

Choice B reason: Hyperglycemia, or high blood sugar, is not a common manifestation of Addison's disease, as the condition causes low levels of cortisol, which normally raises blood sugar. Hypoglycemia, or low blood sugar, is more likely to occur and should be monitored and treated. ²

Choice C reason: Fluid volume excess, or edema, is not a common complication of Addison's disease, as the condition causes low levels of aldosterone, which normally retains sodium and water in the body. Fluid volume deficit, or dehydration, is more likely to occur and should be prevented and corrected. ³

Choice D reason: Cortisol replacement therapy is the main treatment for Addison's disease, as it helps restore the normal function of the adrenal glands and prevent adrenal crisis. The parents should be taught about the dosage, timing, and side effects of the medication, as well as the signs and symptoms of underdose and overdose. They should also be instructed to increase the dose during times of stress, illness, or injury, and to carry an emergency injection kit. ⁴.

Choice A reason: Asking the parents what caused the bruises is not the best action, as it may not elicit truthful or accurate information. The parents may be the perpetrators of the abuse, or they may be unaware or in denial of the abuse. The nurse should not confront or accuse the parents without sufficient evidence or support.

Choice B reason: Notifying social services is an important action, but not the first one. The nurse should first gather more information and document the findings before making a report. The nurse should also follow the policies and procedures of the health care facility regarding child abuse reporting.

Choice C reason: Asking the toddler what caused the bruises is the best action, as it may provide valuable clues about the source and nature of the injuries. The nurse should use a gentle and nonjudgmental approach, and ask open-ended questions, such as "How did you get these bruises?" or "Who hurt you?" The nurse should also observe the child's behavior and body language, and reassure the child that they are not in trouble.

Choice D reason: Notifying the provider is a necessary action, but not the first one. The nurse should first assess and interview the child, and document the findings. The nurse should also consult with the provider about the appropriate medical care and follow-up for the child. The provider may also assist the nurse in making a report to social services.