A nurse reviews the chart of a 22-year-old female who complains of severe right lower quadrant abdominal pain that started this morning around her navel. The patient has had diarrhea since yesterday and no appetite. The nurse expects imaging to be ordered to confirm which likely acute abdominal diagnosis?

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.

Choice A reason: DIC is not caused by the immune system attacking platelets. This describes conditions like immune thrombocytopenic purpura (ITP). In DIC, widespread clotting consumes platelets and clotting factors, leading to bleeding. The immune system is not the primary driver; rather, it’s triggered by conditions like sepsis or trauma.

Choice B reason: DIC results from abnormal activation of the clotting cascade, often triggered by sepsis, trauma, or malignancy. This causes microclots to form in small vessels, consuming clotting factors and platelets, leading to bleeding. Organ damage occurs from microthrombi, and depletion of coagulation components causes hemorrhage, accurately describing DIC’s pathophysiology.

Choice C reason: Hemolytic processes destroying erythrocytes describe hemolytic anemia, not DIC. While hemolysis may occur in DIC due to microangiopathic changes, it is not the primary cause. DIC involves widespread clotting and factor consumption, not primarily red cell destruction, making this an inaccurate explanation of its etiology.

Choice D reason: DIC is not primarily a complication of autoimmune diseases attacking cells. It is triggered by conditions like sepsis, cancer, or obstetric complications, activating the clotting cascade. Autoimmune diseases like lupus may rarely contribute, but DIC’s hallmark is coagulopathy from external triggers, not autoimmunity, making this explanation incorrect.