A patient with a history of Addison’s disease and flulike symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The patient’s blood pressure is 90/58 mmHg, his pulse is 116 beats/minute, and his temperature is 101 °F (38.3 °C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by IV infusion?

Potassium

Hypotonic saline

Insulin

Hydrocortisone

Answer and Explanation

The Correct Answer is D

Choice A reason: Potassium 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. Treatment focuses on cortisol replacement and fluids to correct hypotension and hyponatremia, not potassium, which is already elevated.

Choice B reason: Hypotonic saline is not appropriate for Addisonian crisis. Patients have hyponatremia and hypotension due to aldosterone deficiency, requiring isotonic saline (e.g., 0.9% NaCl) to restore sodium and volume. Hypotonic fluids could worsen hyponatremia by further diluting serum sodium, exacerbating neurological symptoms like confusion.

Choice C reason: Insulin is irrelevant in Addisonian crisis, which involves cortisol and aldosterone deficiency, not hyperglycemia. Hypoglycemia may occur due to low cortisol, but glucose is administered if needed, not insulin. The focus is on hydrocortisone to replace deficient glucocorticoids, addressing the underlying adrenal insufficiency and stabilizing the patient.

Choice D reason: Hydrocortisone IV is the cornerstone of Addisonian crisis treatment, replacing deficient glucocorticoids due to adrenal insufficiency. It corrects hypoglycemia, hypotension, and metabolic dysfunction, improving symptoms like weakness and confusion. Rapid administration restores stress response and stabilizes hemodynamics, critical for reversing the life-threatening crisis and preventing shock.

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Correct Answer is A

Explanation

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.

A. Appendicitis B. Pancreatitis C. Peritonitis D. Mechanical bowel obstruction

Correct Answer is A

Explanation

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.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a patient with deep vein thrombosis. The nurse would expect all of the following orders to be on the care plan, except:

Correct Answer is A

Explanation

Correct Answer is A

Explanation

A nurse is caring for a patient who has type 2 diabetes mellitus and their glucose levels are rising. Which of the following would indicate the patient is in a hyperosmolar hyperglycemic state (HHS)?

A patient has symptoms suspicious of deep vein thrombosis. Which lab test would be helpful to see if higher-than-normal amounts of protein fragments secondary to fibrinolysis are present in the blood?

A nurse cares for a patient experiencing diabetic ketoacidosis who presents with Kussmaul respirations. What action would the nurse take?

A nurse is caring for a patient in Addisonian crisis. Which medication order should the nurse question?

A nurse plans care for a patient with acute pancreatitis. Which intervention would the nurse include in the patient’s plan of care to promote healing?

A patient with sickle cell disease is brought to the emergency department by a parent. The patient has a fever of 101.6 °F, a heart rate of 116, and a respiratory rate of 32. The nurse auscultates bilateral wheezes in both lung fields. What does the nurse suspect this patient is experiencing?

The nurse is caring for a patient with gastroenteritis. He not only has diarrhea and dehydration but also complains of feeling very warm. What systemic response may the patient experience with this inflammatory infection?

A nurse is caring for a patient who is in a myxedema coma. Which of the following actions should the nurse take?