The nurse is caring for a patient who was treated for Addisonian crisis.
What clinical change indicates to the nurse that the prescribed therapy was effective?

Increase of 25 mmHg in the patient's systolic blood pressure.

An increase in the serum potassium level from 3.5 to 5.6 mEq/dL.

Patient complains of headache and is showing signs of restlessness.

The patient has normal temperature with pallor to the skin.

Answer and Explanation

The Correct Answer is A

Choice A rationale

An increase in systolic blood pressure by 25 mmHg indicates a positive response to therapy for Addisonian crisis. Addisonian crisis involves severe hypotension due to low levels of cortisol and aldosterone, which regulate blood pressure. Cortisol replacement therapy helps to increase blood pressure by enhancing the responsiveness of blood vessels to catecholamines and promoting sodium and water retention. This improvement is critical for stabilizing the patient and restoring hemodynamic balance.

Choice B rationale

An increase in serum potassium level from 3.5 to 5.6 mEq/dL suggests hyperkalemia, which is a sign of worsening condition, not improvement. Addisonian crisis is characterized by hyperkalemia due to aldosterone deficiency, which impairs potassium excretion. Effective treatment would normalize potassium levels rather than increase them.

Choice C rationale

Complaints of headache and signs of restlessness may indicate adverse effects or complications, rather than therapeutic efficacy. These symptoms could result from inadequate or excessive dosing of corticosteroids or other underlying issues. Monitoring patient response and adjusting treatment is essential.

Choice D rationale

Normal temperature with pallor to the skin does not indicate effective therapy for Addisonian crisis. Pallor may reflect ongoing hypoperfusion or anemia. The absence of fever is not a definitive marker of therapeutic success. Key indicators include hemodynamic stability and normalized electrolytes.

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Correct Answer is D

Explanation

Choice A rationale

Tumor lysis syndrome (TLS) results from the rapid breakdown of cancer cells, leading to metabolic imbalances such as hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Symptoms can include nausea, vomiting, diarrhea, muscle cramps, and arrhythmias. TLS is a metabolic emergency seen in high-turnover cancers like leukemia or lymphoma and is not associated with symptoms like jugular venous distention or edema in the face, neck, and arms.

Choice B rationale

Hypercalcemia, often due to bone metastasis or certain paraneoplastic syndromes, presents with symptoms such as confusion, lethargy, constipation, nausea, polyuria, and polydipsia. It is not related to the symptoms described in the question, which are indicative of a different oncologic emergency.

Choice C rationale

Spinal cord compression occurs when a tumor compresses the spinal cord, leading to symptoms like severe back pain, weakness, sensory changes, and autonomic dysfunction. It does not explain the symptoms of jugular venous distention, facial, neck, and arm edema.

Choice D rationale

Superior vena cava syndrome (SVCS) occurs when a tumor compresses the superior vena cava, leading to decreased venous return from the upper body. Symptoms include shortness of breath, jugular venous distention, and edema of the face, neck, and arms due to impaired blood flow. This is an oncologic emergency requiring prompt intervention to reduce the obstruction.

A. Notify the provider that the patient is exhibiting signs of hypercalcemia and draw blood to obtain ionized calcium level. B. Notify the provider that the patient is exhibiting signs of tumor lysis syndrome and draw blood to obtain uric acid level. C. Notify the provider that the patient is exhibiting signs of infection and request an order for blood cultures. D. Notify the provider that the patient is exhibiting signs of bleeding and request an order for a packed red blood cell transfusion.

Correct Answer is A

Explanation

Choice A rationale

Hypercalcemia is common in patients with bone metastasis. Symptoms include weakness, fatigue, confusion, and excessive thirst. The nurse should notify the provider and draw blood to obtain the ionized calcium level for proper diagnosis and treatment.

Choice B rationale

Tumor lysis syndrome typically occurs in patients with rapidly proliferating tumors undergoing treatment, leading to the release of intracellular contents. Symptoms include hyperuricemia, not excessive thirst. This choice does not match the patient's presentation.

Choice C rationale

While infection can cause weakness and confusion, it does not typically cause extreme thirst. The patient's symptoms are more indicative of hypercalcemia, making this choice less relevant.

Choice D rationale

Bleeding can cause weakness and confusion due to anemia, but it does not cause extreme thirst. The symptoms of the patient are more aligned with hypercalcemia than bleeding.

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The nurse is caring for a patient who was treated for Addisonian crisis.What clinical change indicates to the nurse that the prescribed therapy was effective?

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The nurse is caring for a patient who was treated for Addisonian crisis.
What clinical change indicates to the nurse that the prescribed therapy was effective?