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: Megaloblastic anemia, caused by vitamin B12 or folate deficiency, leads to macrocytic red blood cells and symptoms like fatigue and neurological issues. Ice eating (pica) is not a hallmark; it is more associated with iron deficiency, which drives unusual cravings, making this less likely.

Choice B reason: Iron deficiency anemia is associated with pica, including ice eating (pagophagia), a common symptom. Low iron impairs hemoglobin synthesis, causing microcytic anemia, fatigue, and cravings for non-nutritive substances like ice, likely due to neurological or metabolic effects of iron deficiency, matching the co-worker’s behavior.

Choice C reason: Sickle cell anemia, an inherited hemolytic anemia, causes vaso-occlusive crises and fatigue but is not linked to ice eating. Pica is specific to iron deficiency, not hemoglobinopathies like sickle cell, which involves sickled red blood cells, not iron store depletion.

Choice D reason: Aplastic anemia, due to bone marrow failure, causes pancytopenia, leading to fatigue and infections but not pica or ice eating. This behavior is characteristic of iron deficiency, not the generalized blood cell deficiency seen in aplastic anemia, making it an unlikely diagnosis.

A. An increased number of erythrocytes B. Erythrocytes that are microcytic and hypochromic C. Clustering of platelets with sickled red blood cells D. Erythrocytes that are macrocytic and hyperchromic

Correct Answer is B

Explanation

Reasoning:

Choice A reason: An increased number of erythrocytes is not indicative of iron-deficiency anemia, which is characterized by reduced red blood cell production due to low iron availability for hemoglobin synthesis. Increased erythrocytes suggest compensatory mechanisms or polycythemia, not the reduced erythropoiesis seen in iron deficiency.

Choice B reason: Microcytic and hypochromic erythrocytes are hallmarks of iron-deficiency anemia. Low iron impairs hemoglobin synthesis, leading to smaller (microcytic) and paler (hypochromic) red blood cells. This matches the client’s low hemoglobin and hematocrit, confirming iron deficiency as the cause of the anemia.

Choice C reason: Clustering of platelets with sickled red blood cells is specific to sickle cell anemia, not iron-deficiency anemia. Sickle cell disease involves hemoglobin S, causing cell deformation, not iron deficiency. Platelet clustering is unrelated to the microcytic, hypochromic cells of iron deficiency.

Choice D reason: Macrocytic and hyperchromic erythrocytes suggest megaloblastic anemia, typically from vitamin B12 or folate deficiency, not iron deficiency. Iron-deficiency anemia produces microcytic, hypochromic cells due to impaired hemoglobin synthesis, making macrocytic, hyperchromic cells inconsistent with the client’s laboratory findings.

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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

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?

Correct Answer is B

Explanation

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia?

Correct Answer is B

Explanation

A client has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia?

A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the health care provider to order?

A client has been receiving a continuous infusion of weight-based heparin for more than 4 days. The client’s PTT is at a level that requires an increase of heparin by 100 units per hour. The client has the laboratory findings shown above. What is the most important action for the nurse to take?

The nurse providing care for a client with Cushing syndrome has identified the nursing diagnosis of risk for injury related to weakness. How should the nurse best reduce this risk?

The nurse is caring for a 13-year-old diagnosed with sickle cell anemia. The client asks the nurse what they can do to help prevent sickle cell crisis. What would be an appropriate answer to this client?

Which outcome indicates that treatment of a client with diabetes insipidus has been effective?

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

A nurse suspects that a client may have aplastic anemia based on clinical manifestations and assessment. Which one of the following lab results would be consistent with this diagnosis?