A nurse is caring for a client with Addison's disease.
When teaching the client, which of the following factors can lead to an adrenal crisis?
Abruptly discontinuing glucocorticoid medications.
Extreme emotional stress.
Surgery or severe illness.
Exercising during medication therapy.
Eating a high-sugar diet.
Correct Answer : A,B,C
Choice A rationale
Glucocorticoids are essential for maintaining vascular tone and metabolic homeostasis. In Addison's disease, the adrenal cortex is unable to produce sufficient cortisol. If exogenous steroid replacement is stopped abruptly, the body cannot mount a physiological response to even minor stressors. This leads to a rapid decline in blood pressure and vascular collapse known as an adrenal crisis. Tapering is required to allow any residual adrenal function to adapt or to maintain systemic stability.
Choice B rationale
Extreme emotional stress triggers the hypothalamic pituitary adrenal axis to demand increased cortisol production. In a client with Addison's disease, the damaged adrenal glands cannot meet this increased demand for glucocorticoids. This deficiency during periods of high psychological or physiological tension leads to acute adrenal insufficiency. Patients are often taught to increase their medication dosage during these times, known as stress dosing, to prevent the onset of life threatening hypotension and electrolyte imbalances.
Choice C rationale
Surgery and severe illness represent profound physiological stressors that require a massive increase in systemic cortisol levels to maintain hemodynamic stability and glucose levels. For a patient with primary adrenal insufficiency, these events quickly exhaust the baseline levels of replaced hormones. Without supplemental intravenous hydrocortisone during the perioperative or acute illness phase, the patient will experience a crisis characterized by profound dehydration, hyperkalemia, and shock due to the lack of mineralocorticoid and glucocorticoid activity.
Choice D rationale
Regular, moderate exercise is generally encouraged for patients with Addison's disease to maintain cardiovascular health and bone density. While extreme physical overexertion could theoretically act as a stressor, standard exercise during consistent medication therapy is not a primary trigger for adrenal crisis. Patients should be monitored for heat exhaustion and salt loss during heavy sweating, but the act of exercising itself is not an indication of imminent adrenal failure if the patient is adequately replaced.
Choice E rationale
Diet does not directly trigger an adrenal crisis, although patients with Addison's disease often require a high sodium intake to compensate for the lack of aldosterone. A high sugar diet may lead to other health complications like obesity or dental caries, but it does not cause the acute hormonal collapse seen in Addison's. Adrenal crisis is primarily a failure of the stress response system rather than a reaction to specific macronutrient ratios or dietary sugar concentrations.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
This statement is incorrect because hyperacute rejection occurs almost immediately, usually within minutes to hours after the graft is vascularized. It does not take several days to develop; that timeframe is more characteristic of acute rejection, which typically occurs within the first few weeks or months. Hyperacute rejection is a rapid and violent immune response that happens while the patient is still in the operating room or very shortly after the surgical procedure is completed.
Choice B rationale
This statement is false because hyperacute rejection is generally irreversible. Once the process begins, the damage to the transplanted organ is so severe and rapid that increasing immunosuppressive medications like corticosteroids or monoclonal antibodies will not save the graft. The only effective treatment for hyperacute rejection is the immediate surgical removal of the transplanted organ to prevent a systemic inflammatory response and further complications for the recipient, who must then return to dialysis.
Choice C rationale
This is the correct statement. Hyperacute rejection is caused by pre-existing recipient antibodies that react against the donor's antigens, specifically the ABO blood group or human leukocyte antigens. This binding triggers the complement system and a massive inflammatory cascade. This leads to widespread endothelial damage, platelet aggregation, and capillary thrombosis within the new organ. The resulting ischemia and necrosis cause the organ to turn blue or mottled almost immediately after blood flow is restored.
Choice D rationale
This statement is inaccurate because the symptoms of hyperacute rejection are immediate rather than occurring within two weeks. While fever and pain at the transplant site can occur, they happen immediately. The two-week timeframe is much more common for acute rejection, which is mediated by T-cells rather than pre-existing antibodies. Hyperacute rejection is now rare due to improved cross-matching techniques that identify these pre-formed antibodies before the transplant surgery is ever performed.
Correct Answer is D
Explanation
Choice A rationale
Radiation therapy for pancreatic cancer typically causes a decrease in appetite, known as anorexia, rather than an increase. The radiation affects the gastric and intestinal mucosa, leading to the release of cytokines that suppress the hunger center in the hypothalamus. Furthermore, the tumor itself and the localized inflammatory response in the abdomen often result in early satiety and nausea, making an increased appetite a highly unlikely finding during this treatment.
Choice B rationale
Weight gain is not expected during radiation for pancreatic cancer; instead, weight loss is a hallmark side effect. The combination of malabsorption due to pancreatic insufficiency and the systemic effects of radiation therapy leads to a catabolic state. Patients often struggle to maintain their caloric intake because of gastrointestinal distress and metabolic changes. Monitoring for weight loss is crucial, as significant drops can impair the patient's ability to tolerate the full course of treatment.
Choice C rationale
Koplik spots are small, white spots on the buccal mucosa that are pathognomonic for measles. They have no physiological connection to radiation therapy or pancreatic cancer. This finding would indicate a viral infection rather than a side effect of localized external beam radiation to the abdomen. The nurse focuses on skin integrity within the radiation field and systemic gastrointestinal symptoms rather than assessing for signs of unrelated infectious childhood diseases like rubeola.
Choice D rationale
External beam radiation to the pancreas involves the delivery of high-energy rays that inevitably pass through the small and large intestines. This causes radiation enteritis, where the rapidly dividing cells of the intestinal lining are damaged, leading to inflammation and impaired fluid absorption. Diarrhea is a frequent and expected adverse effect of this localized treatment. The nurse must monitor stool frequency and consistency while assessing for signs of dehydration and electrolyte imbalances.
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