A patient went on a cruise and forgot his steroid medication. After he abruptly stopped his medication, he went into Addisonian crisis. In addition to serum sodium, which of the following labs is known to decrease in an Addisonian crisis?

Choice A reason: Placing the affected extremity in a dependent position is contraindicated in DVT, as it promotes blood pooling, worsening clot formation and risking embolism. Elevation reduces swelling and improves venous return, preventing further thrombosis. This action contradicts standard DVT management, which prioritizes reducing stasis and promoting circulation to prevent complications.

Choice B reason: Graduated compression stockings are standard in DVT management, as they improve venous return, reduce edema, and prevent clot progression. By applying external pressure, they counteract venous stasis, a key factor in DVT. This intervention is appropriate and expected to support circulation and reduce complications in affected limbs.

Choice C reason: Avoiding massage of the affected limb is critical in DVT care. Massage can dislodge a clot, leading to pulmonary embolism, a life-threatening complication. This precaution is a standard order to ensure patient safety, as mechanical manipulation of the clot risks embolization and severe cardiovascular consequences.

Choice D reason: Analgesic agents are appropriate for DVT to manage pain caused by inflammation and swelling in the affected limb. Pain relief improves patient comfort and mobility, supporting recovery. Nonsteroidal anti-inflammatory drugs or other analgesics are commonly prescribed, making this an expected and appropriate part of the care plan.

Choice A reason: Appendicitis is likely, as severe right lower quadrant pain migrating from the periumbilical area, accompanied by diarrhea and anorexia, is classic. Inflammation of the appendix causes localized pain, nausea, and gastrointestinal symptoms. Imaging (e.g., CT scan) confirms appendicitis, which requires urgent surgical intervention to prevent rupture and peritonitis.

Choice B reason: Pancreatitis typically presents with epigastric or left upper quadrant pain radiating to the back, often with nausea and vomiting, not right lower quadrant pain. Diarrhea and anorexia are less specific to pancreatitis. The pain’s location and migration pattern make appendicitis more likely than pancreatic inflammation in this case.

Choice C reason: Peritonitis causes diffuse abdominal pain, fever, and rigidity, not localized right lower quadrant pain. It often results from appendicitis rupture but is not the primary diagnosis here. The patient’s symptoms suggest early appendicitis, not secondary peritonitis, which would show more systemic signs like high fever and rebound tenderness.

Choice D reason: Mechanical bowel obstruction causes crampy, diffuse abdominal pain, distension, and vomiting, with constipation more common than diarrhea. The localized right lower quadrant pain and migration from the navel align with appendicitis, not obstruction. Imaging would differentiate, but the symptom pattern strongly supports appendicitis over bowel obstruction.