A nurse is managing the care of a client who is postoperative and has acute adrenal insufficiency. Which of the following actions should the nurse take?

A. Infuse 1 unit of platelet: Platelet transfusion is indicated for thrombocytopenia or active bleeding related to low platelet counts. Acute adrenal insufficiency does not involve platelet depletion or coagulation defects. This intervention does not address the underlying hormonal crisis.

B. Restrict daily fluid intake: Clients with acute adrenal insufficiency are at risk for hypovolemia and hypotension due to aldosterone deficiency. Fluid restriction would worsen dehydration and circulatory collapse. Fluid replacement is typically required rather than restriction.

C. Admin hydrocortisone sodium: Acute adrenal insufficiency requires immediate glucocorticoid replacement to restore cortisol levels. Hydrocortisone sodium provides both glucocorticoid and some mineralocorticoid effects, helping stabilize blood pressure and metabolism. Prompt administration is critical to prevent adrenal crisis complications.

D. Give oral spironolactone: Spironolactone is a potassium-sparing diuretic and aldosterone antagonist. In adrenal insufficiency, aldosterone levels are already low, making this medication inappropriate. Its use could worsen hyperkalemia and hypotension.

A. A 75-year-old man with type 2 diabetes and coronary artery disease who has recently started on insulin injections: Starting insulin may improve glycemic control, but it does not directly increase the risk for hyperosmolar hyperglycemic syndrome (HHS). HHS usually develops in the context of uncontrolled hyperglycemia rather than new insulin therapy.

B. A 45-year-old woman with type 1 diabetes who forgets to take her insulin in the morning: Missing insulin doses in type 1 diabetes is more likely to precipitate diabetic ketoacidosis (DKA) rather than HHS. DKA develops rapidly with ketone formation due to absolute insulin deficiency.

C. A 83-year-old long-term care resident with type 2 diabetes and advanced Alzheimer's disease who recently developed influenza: HHS typically occurs in older adults with type 2 diabetes during periods of acute illness or stress, which can cause severe hyperglycemia, dehydration, and hyperosmolarity without significant ketosis. Infection such as influenza increases risk, making this patient the highest risk.

D. An 18-year-old college student with type 1 diabetes who exercises excessively: Excessive exercise may affect blood glucose levels but is more likely to cause hypoglycemia in type 1 diabetes rather than precipitate HHS, which occurs mainly in type 2 diabetes under stress or illness.