A nurse is caring for a patient in Addisonian crisis. Which medication order should the nurse question?

Fludrocortisone (Florinef)

Hydrocortisone (Cortef)

Potassium chloride

Normal saline solution

Answer and Explanation

The Correct Answer is C

Choice A reason: Fludrocortisone is appropriate in Addisonian crisis to replace aldosterone, which is deficient in adrenal insufficiency. It promotes sodium retention and potassium excretion, correcting hyponatremia and hyperkalemia. This medication is a standard part of treatment, addressing the mineralocorticoid deficiency critical to stabilizing the patient’s electrolyte and fluid balance.

Choice B reason: Hydrocortisone is essential in Addisonian crisis, replacing deficient glucocorticoids. It corrects hypoglycemia, hypotension, and metabolic dysfunction, improving symptoms like weakness and shock. IV hydrocortisone is a cornerstone of treatment, rapidly restoring stress response and preventing life-threatening complications, making it an appropriate and expected medication order.

Choice C reason: Potassium chloride is contraindicated in Addisonian crisis, as adrenal insufficiency causes hyperkalemia due to aldosterone deficiency, impairing potassium excretion. Administering potassium would worsen hyperkalemia, risking cardiac arrhythmias or arrest. The nurse should question this order, as it could exacerbate the patient’s already elevated potassium levels.

Choice D reason: Normal saline solution is appropriate for Addisonian crisis to correct hypotension and hyponatremia caused by aldosterone deficiency and fluid loss. Isotonic saline restores volume and sodium levels, stabilizing hemodynamics. It is a standard intervention, supporting blood pressure and electrolyte balance, making it an expected part of the treatment plan.

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Correct Answer is B

Explanation

Choice A reason: Morphine sulfate IV is controversial in pancreatitis, as it may cause sphincter of Oddi spasm, potentially worsening pancreatic duct obstruction and pain. Alternative analgesics like meperidine are preferred. Morphine does not directly promote healing and may complicate pancreatitis management, making it an inappropriate choice for this care plan.

Choice B reason: Maintaining NPO status and administering IV fluids is critical in acute pancreatitis to rest the pancreas, reducing enzyme secretion that exacerbates inflammation. IV fluids correct dehydration from vomiting or third-spacing, supporting hemodynamic stability and promoting healing by minimizing pancreatic stimulation and maintaining perfusion to vital organs.

Choice C reason: Semi-Fowler’s position improves respiratory comfort and reduces abdominal pressure, but it is not the primary intervention for healing in pancreatitis. It aids symptom management, not pancreatic recovery. NPO status and IV fluids directly address the inflammatory process and dehydration, making them more critical for promoting healing in this condition.

Choice D reason: Small, frequent feedings are contraindicated in acute pancreatitis, as oral intake stimulates pancreatic enzyme secretion, worsening inflammation and pain. Patients are kept NPO to rest the pancreas. Feedings may be introduced later in recovery, but during acute phases, this intervention hinders healing and is not included in the care plan.

A. Red blood cells that are microcytic and hypochromic B. Decreased reticulocyte count C. Elevated hemoglobin level D. Elevated red blood cell count

Correct Answer is A

Explanation

Choice A reason: Iron deficiency anemia causes microcytic, hypochromic red blood cells due to impaired hemoglobin synthesis. Lack of iron reduces heme production, leading to smaller (microcytic) and paler (hypochromic) RBCs. This is a hallmark finding on blood smear, confirmed by low MCV and MCHC, diagnostic of iron deficiency anemia.

Choice B reason: Decreased reticulocyte count is not typical in iron deficiency anemia. Reticulocytes may be normal or slightly elevated as the bone marrow attempts to compensate for anemia. A low count suggests bone marrow failure, not iron deficiency, which primarily affects hemoglobin production, not RBC production rate.

Choice C reason: Elevated hemoglobin level is inconsistent with iron deficiency anemia, which causes low hemoglobin due to reduced heme synthesis from iron lack. Hemoglobin typically falls below 12 g/dL in females or 13 g/dL in males, reflecting anemia severity, making this an incorrect indicator for this condition.

Choice D reason: Elevated red blood cell count is not seen in iron deficiency anemia. RBC count is typically low or normal, as iron deficiency impairs hemoglobin production, reducing RBC size and color, not number. Elevated RBC counts occur in conditions like polycythemia, not anemia, making this an incorrect choice.

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A nurse is caring for a patient in Addisonian crisis. Which medication order should the nurse question?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse plans care for a patient with acute pancreatitis. Which intervention would the nurse include in the patient’s plan of care to promote healing?

Correct Answer is B

Explanation

The nurse is taking care of a patient suspected to have iron deficiency anemia. Laboratory studies are performed. The nurse reviews the results, knowing that which result indicates this type of anemia?

Correct Answer is A

Explanation

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