Which of the following are common manifestations of primary adrenal insufficiency (Addison's disease)? Select all that apply.
Hypertension.
Hyperpigmentation of the skin.
Increased sweating.
Hyperkalemia.
Weight loss.
Bradycardia.
Correct Answer : B,D,E
Choice A rationale
Hypertension is not a manifestation of this disease; instead, patients typically exhibit hypotension. The deficiency of mineralocorticoids, specifically aldosterone, leads to decreased sodium reabsorption and increased water excretion by the kidneys. This results in a reduction in extracellular fluid volume and cardiac output. Normal blood pressure is maintained by these hormones; without them, patients often experience chronic low blood pressure and orthostatic changes, which can lead to syncope or dizziness.
Choice B rationale
Hyperpigmentation is a classic sign of primary adrenal insufficiency due to elevated levels of adrenocorticotropic hormone. When the adrenal glands fail, the pituitary gland increases production of this hormone to stimulate them. Since it shares a precursor with melanocyte-stimulating hormone, the excess levels lead to increased melanin production. This is most visible in skin creases, pressure points, and mucous membranes, giving the skin a bronzed appearance even in areas not exposed to sunlight.
Choice C rationale
Increased sweating is not a typical finding in this condition. In fact, patients may have decreased sweating or dry skin due to chronic dehydration and electrolyte imbalances. Excessive sweating is more commonly associated with conditions of sympathetic overactivity, such as hyperthyroidism or pheochromocytoma. In adrenal insufficiency, the metabolic rate is generally low, and the body's focus is on conserving what little fluid and salt remain, rather than expending them through thermoregulatory sweating.
Choice D rationale
Hyperkalemia occurs because of the lack of aldosterone, which normally promotes the excretion of potassium in exchange for sodium in the distal renal tubules. Without sufficient aldosterone, the kidneys retain potassium, leading to serum levels above the normal range of 3.5 to 5.0 mEq/L. High potassium can cause dangerous cardiac arrhythmias and muscle weakness. Monitoring electrolyte levels is critical in managing these patients to prevent life-threatening complications related to cardiac conduction abnormalities.
Choice E rationale
Weight loss is a common and often early manifestation of this disorder. It results from a combination of anorexia, nausea, and the loss of body fluids due to sodium wasting. Additionally, the deficiency of glucocorticoids like cortisol leads to impaired metabolism of carbohydrates, proteins, and fats, contributing to the depletion of body mass. Patients often report a significant and unintentional reduction in weight over weeks or months as the adrenal function progressively declines.
Choice F rationale
Bradycardia is not a standard sign of this condition; instead, patients often present with tachycardia. The rapid heart rate is a compensatory mechanism by the body to maintain cardiac output in the face of low blood volume and hypotension. While severe hyperkalemia can eventually cause heart blocks or slow rhythms, the initial and more common response to the fluid volume deficit in adrenal insufficiency is an increased heart rate to ensure tissue perfusion.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Extravasation of vesicant chemotherapy agents triggers immediate cellular damage and localized inflammatory responses. Stopping the infusion prevents further tissue exposure to toxic compounds that cause necrosis. Notification of the provider is essential to initiate specific antidote protocols or surgical consultation. Physical assessment determines the extent of the injury, which is critical for documentation and intervention planning. This priority action minimizes long term morbidity and functional loss at the peripheral or central venous access site.
Choice B rationale
Antiemetics are pharmacological agents used to manage chemotherapy induced nausea and vomiting by blocking neurotransmitters like serotonin or dopamine in the chemoreceptor trigger zone. While supportive care is important during oncological treatment, administering these medications does not address the acute mechanical or chemical injury occurring at the intravenous site. Continuing the infusion while the patient reports pain and swelling would exacerbate tissue destruction and potentially lead to compartment syndrome or permanent nerve damage.
Choice C rationale
Continuing a chemotherapy infusion when signs of infiltration or extravasation are present violates safety standards and increases the volume of vesicant in the interstitial space. Warm compresses are contraindicated for certain chemotherapeutic agents, such as vinca alkaloids, because heat can increase local blood flow and spread the toxic drug further into surrounding tissues. Initial management must prioritize cessation of the causative agent rather than symptom masking through thermal applications which might worsen the chemical burn.
Choice D rationale
Aspiration of residual drug from the cannula is a recognized component of extravasation management, but it must never be performed while the infusion is active. Attempting to aspirate without stopping the pump allows the machine to continue forcing fluid into the subcutaneous tissue under pressure. The sequence of nursing actions must always begin with stopping the flow of the hazardous substance to limit the radius of the injury before attempting to remove the fluid.
Correct Answer is A
Explanation
Choice A rationale
This antimalarial medication is a cornerstone in managing systemic lupus erythematosus by inhibiting the stimulation of toll-like receptors and reducing the production of inflammatory cytokines. It is primarily used to control skin rashes, joint pain, and fatigue while significantly reducing the frequency of disease flares. Clinical evidence suggests it also provides a long-term survival benefit and prevents organ damage accrual in patients with chronic autoimmune responses.
Choice B rationale
This monoclonal antibody specifically targets B-lymphocyte stimulator proteins to reduce the activity of B cells contributing to the autoimmune response in lupus. While it is an approved adjunct treatment for active, autoantibody-positive systemic lupus erythematosus, it is generally reserved for patients who do not respond adequately to standard therapies. It is not considered the most common first-line systemic agent compared to the widespread and foundational use of antimalarial drugs in this population.
Choice C rationale
Nonsteroidal anti-inflammatory drugs are frequently utilized in lupus management to alleviate musculoskeletal pain, pleurisy, and fever by inhibiting cyclooxygenase enzymes and prostaglandin synthesis. However, these medications only provide symptomatic relief for minor manifestations and do not modify the underlying disease course or prevent major organ exacerbations. Their use is often limited by potential side effects including gastrointestinal irritation, renal impairment, and increased cardiovascular risk in patients with systemic inflammation.
Choice D rationale
This folate antimetabolite acts as a potent immunosuppressant by interfering with DNA synthesis and cellular proliferation, particularly in rapidly dividing immune cells. It is often employed in lupus cases involving significant arthritis or skin disease that remains refractory to antimalarials. While effective for controlling inflammation, it carries a higher risk profile than first-line agents, necessitating frequent monitoring of liver function tests and complete blood counts to detect potential hepatotoxicity or bone marrow suppression.
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