The nurse is preparing a female client with Addison’s disease for self-care after discharge. Which is the pathophysiological basis to support the need for the client to carry a cortisol kit at all times?

Choice A reason: Insulin reduces serum glucose in diabetes mellitus, not water loss in diabetes insipidus (DI). DI results from vasopressin deficiency, causing excessive urination. Insulin is irrelevant, as DI is a fluid balance disorder, not a glucose metabolism issue, making this response incorrect and misleading for the client.

Choice B reason: Assessing dietary habits and glucose levels pertains to diabetes mellitus, not diabetes insipidus. DI involves water loss due to vasopressin deficiency, not glucose dysregulation. This response misaligns with DI’s pathophysiology, as insulin or glucose monitoring is unnecessary, and vasopressin therapy is the standard treatment.

Choice C reason: Maintaining normal serum glucose is a goal for diabetes mellitus, not diabetes insipidus, which involves water loss from vasopressin deficiency. DI treatment focuses on fluid balance via vasopressin, not glucose control. This response is incorrect, as it conflates DI with an unrelated metabolic condition.

Choice D reason: Diabetes insipidus is managed with vasopressin (ADH) therapy to reduce excessive urination and conserve water, addressing the underlying deficiency. This response accurately explains DI’s treatment, distinguishing it from diabetes mellitus and clarifying that insulin is not needed, aligning with evidence-based endocrinology practice for fluid balance.

Choice A reason: Hypertensive crisis is not a feature of Addison’s disease, which causes hypotension due to cortisol and aldosterone deficiency. Cortisol kits address adrenal insufficiency during stress, not hypertension. This choice is incorrect, as it misaligns with Addison’s pathophysiology and cortisol’s role.

Choice B reason: Cortisol is not used for systemic allergic reactions, which require antihistamines or epinephrine. Addison’s patients need cortisol for adrenal insufficiency during stress, as their bodies cannot produce it. This choice is incorrect, as cortisol kits address hypoadrenalism, not anaphylaxis.

Choice C reason: Addison’s disease involves adrenal insufficiency, impairing cortisol production. Stress increases cortisol demand, which the patient cannot meet, risking adrenal crisis. Carrying a cortisol kit allows rapid administration during stress, preventing life-threatening hypotension or shock, aligning with endocrinology evidence for Addison’s management.

Choice D reason: Hyperglycemia is unrelated to Addison’s disease, which does not typically affect glucose metabolism. Cortisol kits address adrenal insufficiency, not blood glucose. This choice is incorrect, as cortisol replacement is for stress-induced hypoadrenalism, not glycemic control, per Addison’s pathophysiological basis.