A nurse is planning care for a client in acute Addisonian crisis. Which nursing diagnosis should receive the highest priority?

Impaired physical mobility

Imbalanced nutrition: Less than body requirements

Risk for infection

Decreased cardiac output

Answer and Explanation

The Correct Answer is D

Reasoning:

Choice A reason: Impaired physical mobility is a concern in Addisonian crisis due to weakness from cortisol deficiency, but it is not the highest priority. Acute crisis causes severe hypovolemia and hypotension, which threaten cardiac output and organ perfusion, making mobility a secondary issue compared to life-threatening cardiovascular instability.

Choice B reason: Imbalanced nutrition is relevant in chronic Addison’s disease due to weight loss and poor appetite, but in acute crisis, it is not the priority. Severe hypotension and electrolyte imbalances from adrenal insufficiency pose immediate threats to life, requiring urgent correction before addressing nutritional deficits.

Choice C reason: Risk for infection is a concern in Addison’s disease due to cortisol’s role in immune function, but it is not the primary issue in acute crisis. Hypovolemia, hypotension, and electrolyte imbalances drive life-threatening cardiovascular collapse, making infection risk secondary to stabilizing cardiac output and fluid status.

Choice D reason: Decreased cardiac output is the highest priority in Addisonian crisis, as adrenal insufficiency causes severe hypotension and hypovolemia due to aldosterone and cortisol deficiencies. This leads to reduced cardiac preload and shock, requiring urgent fluid and steroid replacement to restore perfusion and prevent organ failure.

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Correct Answer is B

Explanation

Reasoning:

Choice A reason: Pale thick skin is not a typical effect of long-term corticosteroid use. Corticosteroids cause skin thinning due to reduced collagen production, leading to fragile, atrophic skin prone to bruising. Thick skin is more associated with conditions like scleroderma, not the catabolic effects of corticosteroids on skin tissue.

Choice B reason: Moon face is a classic sign of long-term corticosteroid use, resulting from fat redistribution to the face due to glucocorticoid-induced lipolysis and lipogenesis. Excess cortisol promotes fat deposition in the face and trunk, creating a rounded facial appearance, a hallmark of Cushing syndrome or iatrogenic corticosteroid effects.

Choice C reason: Weight loss is not expected with long-term corticosteroid use. Corticosteroids increase appetite and promote fat redistribution, leading to weight gain, particularly in the trunk and face. Weight loss may occur in conditions like Addison’s disease, where cortisol is deficient, not in hypercortisolism states.

Choice D reason: Hypotension is not a common effect of corticosteroids. They can cause fluid retention and increased blood volume due to mineralocorticoid activity, potentially leading to hypertension. Hypotension is more associated with adrenal insufficiency, where cortisol and aldosterone deficiencies reduce vascular tone and fluid balance.

A. Risk for injury B. Ineffective coping C. Noncompliance D. Diarrhea

Correct Answer is A

Explanation

Reasoning:

Choice A reason: Risk for injury is the priority for a client with left-sided hemiparesis post-stroke. Weakness on one side impairs mobility and balance, increasing fall risk. Home environment assessment ensures removal of hazards like rugs or clutter, promoting safety and preventing injuries, critical for stroke recovery.

Choice B reason: Ineffective coping may occur post-stroke due to emotional or functional challenges, but it is not the primary focus during home environment assessment. Physical safety from falls due to hemiparesis is more immediate, as coping issues are addressed through counseling, not environmental modifications.

Choice C reason: Noncompliance with treatment may affect stroke recovery but is not directly addressed by home environment assessment. Ensuring a safe environment to prevent falls due to hemiparesis takes precedence, as physical safety is critical before addressing behavioral or adherence issues in discharge planning.

Choice D reason: Diarrhea is unrelated to hemiparesis or home environment assessment post-stroke. It may occur from medications or other causes but does not pose an immediate risk like falls. The focus is on preventing injuries due to mobility issues, not gastrointestinal symptoms, in this context.

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A nurse is planning care for a client in acute Addisonian crisis. Which nursing diagnosis should receive the highest priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client receiving long-term treatment with high-dose corticosteroids is expected to exhibit which of the following?

Correct Answer is B

Explanation

A nurse is completing discharge teaching for the client who has left-sided hemiparesis following a stroke. When investigating the client’s home environment, the nurse should focus on which nursing diagnosis?

Correct Answer is A

Explanation

The nurse observes a co-worker who always seems to be eating a cup of ice. The nurse encourages the co-worker to have an examination and diagnostic workup with the health care provider. What type of anemia is the nurse concerned that the co-worker may have?

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A client has been diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following manifestations would be expected in this client?

Which type of hemolytic anemia is categorized as an inherited disorder?

A nurse is caring for a client with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which finding would indicate that the client has developed fluid overload?

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