The nurse provides care for a client immediately after a motor vehicle accident. The nurse notes BP 90/52 mmHg, absent breath sounds over the right lung, shallow RR 28 breaths/minute, and displacement of the trachea to the left side. Which explanation is correct for these findings?

Choice A reason: Serum glucose 158 mg/dL (8.77 mmol/L) is not the most significant observation for an acute adrenal crisis, but a mild elevation of blood sugar. A mild elevation of blood sugar may occur due to stress, infection, medication, or diet, among other factors. It does not indicate a severe deficiency of adrenal hormones, which is the cause of an acute adrenal crisis.

Choice B reason: Blood pressure 98/52 mm Hg is the most significant observation for an acute adrenal crisis, as it indicates a condition called hypotension. Hypotension is a low blood pressure that may cause dizziness, fainting, shock, or organ failure. It is a sign of an acute adrenal crisis, which is a life-threatening emergency that occurs when the adrenal glands fail to produce enough cortisol and aldosterone. Cortisol and aldosterone are hormones that regulate blood pressure, blood sugar, and electrolyte balance.

Choice C reason: Weight gain 3 pounds (1.36 kg) in 24 hours is not the most significant observation for an acute adrenal crisis, but a possible sign of fluid retention. Fluid retention may occur due to heart failure, kidney disease, liver disease, or medication, among other causes. It does not indicate a severe deficiency of adrenal hormones, which is the cause of an acute adrenal crisis.

Choice D reason: Insomnia and restlessness are not the most significant observations for an acute adrenal crisis, but possible symptoms of anxiety, stress, or hyperthyroidism. Anxiety, stress, and hyperthyroidism may cause difficulty sleeping, nervousness, or agitation, among other effects. They do not indicate a severe deficiency of adrenal hormones, which is the cause of an acute adrenal crisis.

Choice A reason: Formation of a clot in the middle cerebral artery is not the most likely cause of death because it is a condition that affects the brain, not the heart. A clot in the middle cerebral artery can cause a stroke, which is a sudden interruption of blood flow to the brain, resulting in brain damage and neurological deficits. A stroke can be fatal, but it does not usually cause cardiopulmonary arrest, which is a sudden cessation of heart and lung function.

Choice B reason: Obstruction of left ventricular blood flow and cardiac dysrhythmias is the most likely cause of death because it is a condition that affects the heart, which is the organ responsible for pumping blood throughout the body. Obstruction of left ventricular blood flow can be caused by hypertrophic cardiomyopathy, which is a genetic disorder that causes the heart muscle to become abnormally thick and stiff, reducing the amount of blood that the heart can pump. Cardiac dysrhythmias are abnormal heart rhythms that can interfere with the electrical signals that control the heart's contractions. Both conditions can lead to sudden cardiac death, which is a sudden and unexpected loss of heart function, resulting in cardiopulmonary arrest.

Choice C reason: Fluid volume overload and decreased serum potassium levels are not the most likely cause of death because they are conditions that affect the fluid and electrolyte balance of the body, not the heart. Fluid volume overload is a condition where the body retains too much fluid, which can cause edema, hypertension, and heart failure. Decreased serum potassium levels are a condition where the blood has too little potassium, which is an electrolyte that helps regulate the nerve and muscle function, including the heart. Both conditions can affect the heart function, but they are not usually the direct cause of cardiopulmonary arrest.

Choice D reason: Diffuse atherosclerosis in the left main coronary artery circulation is not the most likely cause of death because it is a condition that affects the blood vessels, not the heart. Atherosclerosis is a disease that causes the buildup of plaque, which is a fatty substance, in the walls of the arteries, which are the blood vessels that carry oxygen-rich blood to the organs. Diffuse atherosclerosis in the left main coronary artery circulation means that the plaque affects the entire length of the artery that supplies blood to the left side of the heart, which is the side that pumps blood to the rest of the body. Atherosclerosis can cause coronary artery disease, which is a condition where the heart does not receive enough blood and oxygen, leading to chest pain, angina, or heart attack. A heart attack can cause cardiopulmonary arrest, but it is not as common as sudden cardiac death in young adults.