The patient is returning to the unit after undergoing a bilateral adrenalectomy. Which clinical manifestation would indicate that the client is experiencing an Addisonian crisis?

Pain 7/10 at the surgical site

Hyperglycemia

Blood pressure 92/50

Sodium 152 mEq/L

Answer and Explanation

The Correct Answer is C

A. Pain 7/10 at the surgical site: This level of pain is expected following major surgery, such as a bilateral adrenalectomy, and does not specifically indicate an Addisonian crisis.
B. Hyperglycemia: Although hyperglycemia can be associated with stress or corticosteroid treatment, it is not a hallmark of Addisonian crisis. Addisonian crisis is more related to adrenal insufficiency rather than hyperglycemia.
C. Blood pressure 92/50: Low blood pressure is a critical sign of an Addisonian crisis. This condition results from severe adrenal insufficiency where the body cannot maintain adequate blood pressure.
D. Sodium 152 mEq/L: High sodium levels are not characteristic of an Addisonian crisis. Addisonian crisis typically leads to hyponatremia (low sodium levels) due to inadequate aldosterone production.

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Correct Answer is B

Explanation

A. Hypercalcemia and hyperkalemia: These are not typical indicators of parathyroid damage. Hypercalcemia usually results from overactive parathyroid glands, while hyperkalemia is not a common result of parathyroid damage.
B. Muscle twitching and tingling around the mouth: These symptoms are indicative of hypoparathyroidism, a condition that can occur if the parathyroid glands are damaged during thyroid surgery. This results in hypocalcemia (low calcium levels), which causes neuromuscular symptoms like muscle twitching and tingling.
C. Harsh, vibratory breath sounds: These are not related to parathyroid damage. They may suggest respiratory issues, not problems with calcium regulation.
D. Hyperthermia and hypertension: These are not associated with parathyroid damage. They may be related to other post-surgical complications but not specifically to parathyroid gland injury.

A. A 40-year-old patient with Cushing syndrome and gynecomastia. B. A 58-year-old patient with Addison's disease who is exhibiting confusion. C. A 45-year-old patient with Graves' disease and exophthalmos. D. A 47-year-old patient with hypothyroidism who is asking for a warm blanket. E. A 47-year-old patient with hypothyroidism who is asking for a warm blanket.

Correct Answer is B

Explanation

A. A 40-year-old patient with Cushing syndrome and gynecomastia: While Cushing syndrome requires ongoing management and monitoring, gynecomastia alone is not an urgent concern compared to the symptoms described in option B.
B. A 58-year-old patient with Addison's disease who is exhibiting confusion: Addison's disease can lead to adrenal insufficiency, and confusion could indicate an adrenal crisis or severe electrolyte imbalance. This is a critical situation requiring immediate assessment to prevent severe complications.
C. A 45-year-old patient with Graves' disease and exophthalmos: Graves' disease with exophthalmos is significant but does not typically represent an immediate life-threatening condition compared to the symptoms associated with Addison's disease.
D. A 47-year-old patient with hypothyroidism who is asking for a warm blanket: This patient’s request for a warm blanket suggests they might be experiencing symptoms related to hypothyroidism, such as feeling cold. However, this is less urgent compared to the confusion and potential crisis in option B.

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The patient is returning to the unit after undergoing a bilateral adrenalectomy. Which clinical manifestation would indicate that the client is experiencing an Addisonian crisis?

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