The nurse is creating a plan of care to prevent venous thrombosis for a patient after orthopedic surgery. Which appropriate nursing intervention will the nurse include in the plan of care?

Choice A reason: Administering 25 mL of dextrose 50% IVP would rapidly elevate blood glucose by delivering concentrated glucose, critical for severe hypoglycemia. However, an infiltrated IV line prevents effective delivery, risking extravasation and tissue damage. This action is ineffective without a functional IV, delaying treatment for the patient’s life-threatening low glucose state, which can lead to seizures or coma.

Choice B reason: Encouraging orange juice intake is inappropriate for a patient with altered consciousness, responding only to a sternal rub. Severe hypoglycemia impairs swallowing, increasing aspiration risk. Oral glucose is too slow to correct critical hypoglycemia, requiring immediate parenteral intervention to restore glucose levels and prevent neurological damage or death in this emergency.

Choice C reason: Inserting a new intravenous access line is the priority because the current line is infiltrated, preventing delivery of medications or fluids. A functional IV ensures rapid administration of dextrose to correct severe hypoglycemia. This action addresses the immediate barrier to treatment, enabling life-saving interventions to stabilize the patient’s critically low blood glucose levels effectively.

Choice D reason: Administering 1 mg of IM glucagon stimulates glycogenolysis to release stored glucose, a viable option when IV access is unavailable. However, it is slower than IV dextrose and less effective in patients with depleted glycogen stores, common in severe hypoglycemia. Establishing IV access is prioritized for faster, more reliable glucose delivery in this critical situation.

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.