A nurse is monitoring a patient with Addison's disease who has just been prescribed hydrocortisone.
Which of the following signs should the nurse monitor for to detect acute adrenal insufficiency?

Choice A rationale

This statement is incorrect because hot, dry skin is a hallmark characteristic of heat stroke rather than heat exhaustion. In heat stroke, the body's thermoregulatory mechanisms fail entirely, and the person stops sweating, leading to a dangerous rise in core body temperature, often exceeding 104 degrees Fahrenheit or 40 degrees Celsius. In contrast, patients experiencing heat exhaustion are typically still able to sweat profusely as their body attempts to dissipate heat through the process of evaporation.

Choice B rationale

Heat exhaustion often involves hypotension and tachycardia as the body attempts to compensate for significant fluid and electrolyte loss. Excessive sweating leads to a decrease in intravascular volume, which lowers blood pressure. The heart rate increases as a compensatory mechanism to maintain cardiac output and perfusion to vital organs. These clinical findings are essential for differentiating exhaustion from simpler heat cramps. Understanding these hemodynamics helps the nurse prioritize fluid resuscitation to prevent the progression to life-threatening heat stroke.

Choice C rationale

Altered mental status, confusion, seizures, or coma are definitive characteristics of heat stroke that distinguish it from heat exhaustion. As the core body temperature rises to critical levels, the central nervous system becomes impaired due to thermal injury and cerebral edema. While a person with heat exhaustion may feel weak or dizzy, they generally remain cognitively intact. The presence of neurological dysfunction signifies a medical emergency requiring immediate and aggressive cooling measures to prevent permanent brain damage or multi-organ failure.

Choice D rationale

Excessive sweating and clammy, pale skin are classic signs of heat exhaustion. During this stage, the thermoregulatory system is still functioning but is overwhelmed by the heat load and fluid depletion. The skin feels cool and moist because the body is still pushing blood to the periphery to encourage cooling through sweat. Normal lab parameters for sodium are 135 to 145 mEq/L, and these levels can fluctuate significantly during heat-related illnesses, requiring careful monitoring and replacement during treatment. .

Choice A rationale

Tumor lysis syndrome is an oncologic emergency characterized by the rapid release of intracellular contents, including potassium, phosphate, and nucleic acids, into the bloodstream. These nucleic acids are metabolized into uric acid, which can precipitate in the renal tubules, leading to obstructive uropathy and acute kidney injury. Aggressive hydration, typically 3 liters or more daily, is the primary intervention to increase urine flow, dilute the concentration of these substances, and promote their renal excretion.

Choice B rationale

The semi-Fowler's position is primarily utilized to improve lung expansion and decrease the work of breathing in patients with respiratory distress or to prevent aspiration. While comfortable, it does not directly address the underlying pathophysiology of tumor lysis syndrome or the prevention of acute kidney injury. The priority in this metabolic emergency is maintaining high intravascular volume and renal perfusion to clear the excessive load of electrolytes and uric acid produced by the rapidly lysing malignant cells.

Choice C rationale

Obtaining blood cultures is a standard intervention for suspected sepsis or systemic infection but is not a primary treatment for tumor lysis syndrome. While oncology patients are often immunocompromised and at risk for infection, the immediate threat in tumor lysis syndrome is metabolic derangement and renal failure. Nurses should focus on monitoring electrolyte levels, such as potassium (normal 3.5 to 5.0 mEq/L) and phosphorus (normal 2.5 to 4.5 mg/dL), and ensuring aggressive fluid resuscitation rather than diagnostic tests for infection.

Choice D rationale

High-dose intravenous corticosteroids are not the standard treatment for preventing acute kidney injury in the context of tumor lysis syndrome. While steroids may be part of the chemotherapy regimen that initially triggered the cell lysis, the management of the resulting syndrome involves hydration, allopurinol or rasburicase to lower uric acid levels, and the management of electrolyte imbalances. Corticosteroids do not assist in the clearance of uric acid or the protection of renal tubules from metabolic crystalline deposits. .