The nurse assesses a client who has been diagnosed with Addison's disease. Which of the following is a diagnostic sign of this disease?

Sodium of 140 mEq/L (range 135-145 mEq/L)

Glucose of 100 mg/dL (range 60-100 mg/dL)

A blood pressure reading of 135/90 mm Hg

Potassium of 6.0 mEq/L (range 3.5-5 mEq/L)

Answer and Explanation

The Correct Answer is D

Reasoning:

Choice A reason: A sodium level of 140 mEq/L is within the normal range and not diagnostic of Addison’s disease. This condition, caused by adrenal insufficiency, typically leads to hyponatremia due to reduced aldosterone, which decreases sodium reabsorption, making a normal sodium level uncharacteristic of the disease.

Choice B reason: A glucose level of 100 mg/dL is normal and not specific to Addison’s disease. Hypoglycemia is more common due to cortisol deficiency, which impairs gluconeogenesis. A normal glucose level does not support the diagnosis, as it does not reflect the metabolic disruptions of adrenal insufficiency.

Choice C reason: A blood pressure of 135/90 mm Hg is elevated but not diagnostic of Addison’s disease. The condition typically causes hypotension due to reduced aldosterone and cortisol, leading to low blood volume and vascular tone. Hypertension suggests another etiology, not adrenal insufficiency.

Choice D reason: A potassium level of 6.0 mEq/L indicates hyperkalemia, a diagnostic sign of Addison’s disease. Aldosterone deficiency reduces potassium excretion in the kidneys, leading to elevated serum potassium. This, combined with hyponatremia and hypotension, is a hallmark of adrenal insufficiency, making hyperkalemia a key diagnostic finding.

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Correct Answer is D

Explanation

Reasoning:

Choice A reason: Encouraging increased oral intake is inappropriate for SIADH, as it exacerbates water retention caused by excessive ADH. This would worsen dilutional hyponatremia and fluid overload, potentially leading to severe complications like cerebral edema, making fluid restriction the preferred approach to manage this condition.

Choice B reason: Infusing IV fluids rapidly is contraindicated in SIADH, as it increases fluid overload. Excessive ADH already causes water retention, diluting serum sodium. Rapid IV fluid administration could worsen hyponatremia and lead to neurological complications, such as seizures, due to further dilution of electrolytes.

Choice C reason: Administering glucose-containing IV fluids is not appropriate for SIADH, as it adds to the fluid volume, worsening water retention and hyponatremia. Glucose fluids do not address the underlying ADH excess and may exacerbate dilutional effects, increasing the risk of cerebral edema or other complications.

Choice D reason: Restricting fluids is the appropriate intervention for SIADH, as excessive ADH causes water retention, leading to hyponatremia. Limiting fluid intake helps correct the dilutional effect, increasing serum sodium concentration and reducing the risk of complications like cerebral edema, aligning with the goal of restoring fluid balance.

A. The client’s urinary catheter became occluded B. The client’s analgesia regimen was recently changed C. The client was not repositioned during the night shift D. The client received a blood transfusion

Correct Answer is A

Explanation

Reasoning:

Choice A reason: An occluded urinary catheter is the most likely trigger for autonomic dysreflexia in spinal cord injury above T6. Bladder distension stimulates sympathetic overactivity, causing hypertension and bradycardia. This noxious stimulus below the injury level disrupts autonomic regulation, making catheter occlusion a common precipitant of this condition.

Choice B reason: A changed analgesia regimen is unlikely to cause autonomic dysreflexia. Pain may contribute to discomfort, but dysreflexia typically results from visceral stimuli like bladder or bowel distension. Analgesia changes do not directly trigger the sympathetic overresponse characteristic of this life-threatening condition.

Choice C reason: Failure to reposition may cause pressure injuries but is less likely to precipitate autonomic dysreflexia. While discomfort from immobility can contribute, visceral stimuli like catheter occlusion are more direct triggers, as they strongly activate the sympathetic nervous system below the spinal injury level.

Choice D reason: A blood transfusion is not a common cause of autonomic dysreflexia. Transfusions may cause reactions like fever, but dysreflexia results from stimuli like bladder distension. Transfusion-related complications do not typically trigger the autonomic overresponse seen in spinal cord injury patients with dysreflexia.

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The nurse assesses a client who has been diagnosed with Addison's disease. Which of the following is a diagnostic sign of this disease?

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