NCLEX-RNPhysiological AdaptationMedium
A client with a history of Addison disease is admitted after abruptly stopping oral hydrocortisone 2 days ago. The client is lethargic, hypotensive, and reports severe abdominal pain. Which prescription should the nurse anticipate as the priority?
- AIV insulin and dextrose infusion
- BIV hydrocortisone and normal saline bolus
- COral fludrocortisone and potassium supplement
- DIV vasopressin and fluid restriction
Show answer & explanationAnswer & explanation
Correct answer: B. IV hydrocortisone and normal saline bolus
This presentation is an Addisonian (adrenal) crisis caused by abrupt corticosteroid withdrawal, resulting in life-threatening hypotension and shock from cortisol deficiency. Priority treatment is immediate IV corticosteroid replacement (hydrocortisone) along with aggressive isotonic fluid resuscitation to correct hypovolemia and hypotension.
Why the other options are wrong
- A. Insulin/dextrose is used for hyperkalemia treatment, not the primary problem here.
- C. Oral medications are inappropriate for an unstable client in shock.
- D. Vasopressin and fluid restriction are used for SIADH, not adrenal crisis.
Addisonian Crisis
A life-threatening exacerbation of adrenal insufficiency causing severe hypotension, hyponatremia, hyperkalemia, and hypoglycemia, often triggered by abrupt steroid withdrawal or stress.
- Triggered by infection, stress, or abrupt corticosteroid discontinuation
- Treatment: IV hydrocortisone + isotonic fluids + glucose as needed
- Untreated leads to vascular collapse and death
Memory trick: Stop steroids suddenly = Shock strikes suddenly