Nursing Multiple Choice Question - Practice!

Question

A client has been admitted with a medical diagnosis of addisonian crisis. When completing the admisison assessment, the nurse expects this client to exhibit which clinical manifestations?

A. Thin, fragile skin, ecchymoses, and complains of weight gain

B. Palpitations and diaphoresis

C. Hypotension, rapid weak pulse, and rapid respiratory rate

Abrupt onset of hyperpyrexia, extreme tachycardia, and delirium

Answer 1

The correct answer is C. Hypotension, rapid weak pulse, and rapid respiratory rate.

Rationale:

Addisonian crisis, also known as acute adrenal insufficiency, is a life-threatening condition that occurs when the body does not produce enough cortisol and aldosterone due to adrenal gland dysfunction or damage. The main clinical manifestations of Addisonian crisis are related to the loss of fluid volume and electrolytes, which result in hypotension, rapid weak pulse, and rapid respiratory rate. Other common clinical manifestations include nausea, vomiting, abdominal pain, fever, and altered mental status.

Option A is incorrect because thin, fragile skin and ecchymoses are clinical manifestations of chronic adrenal insufficiency, not Addisonian crisis. Weight loss, not weight gain, is also a common manifestation of Addisonian crisis due to decreased appetite and catabolism.

Option B is incorrect because palpitations and diaphoresis are not typical clinical manifestations of Addisonian crisis.

Option D is incorrect because abrupt onset of hyperpyrexia (high fever), extreme tachycardia (fast heart rate), and delirium are not clinical manifestations of Addisonian crisis, but rather suggest a different medical condition, such as sepsis or hyperthyroidism.

Answer 2

An Addisonian crisis is a life-threatening situation that results in low blood pressure, low blood levels of sugar, and high blood levels of potassium. This occurs as a result of an acute insufficiency of adrenal hormones (aldosterone and cortisol). Deficient levels of aldosterone cause increased renal sodium loss and potassium reabsorption, resulting in decreased intravascular volume, vascular tone, cardiac output, and renal perfusion. This, in turn, lowers arterial blood pressure, which may lead to hypotension, tachycardia, and eventual vascular collapse. 

Therefore, option C best fits the clinical presentation of a patient being admitted for an Addisonian crisis.

Answer 3

A. describes symptoms/sign of Cushing's disease. This is unlikely to be seen in Addisonian crisis UNLESS, the patient has been on chronic high dose steroids (hence the Cushingoid appearance) then suddenly stopped

B. is more consistent with the hyper-adrenaline state of pheochromocytoma.HOWEVER, the Addisonian patients may also cause sweating along with palpitations due to tachycardia from intravascular volume depletion

C.This a more classic presentation with hypotension due to volume depletion, rapid pulse due to compensatory tachycardia and rapid respiration due to the development of a non-anion gap acidosis

D. This presentation could be seen in thyroid storm, BUT ALSO severe Addisonianism. Hyperpyrexia is common.

suggest reviewing https://www.ncbi.nlm.nih.gov/books/NBK441933/