A nurse is assessing a client with Addison's disease for signs of hyperkalemia. The nurse expects to note which of the following if hyperkalemia is present?

Appeared in: DHS 2018 shift 1st

Explanation

In Addison's disease, the adrenal glands do not produce enough aldosterone, a hormone that helps regulate sodium and potassium balance.
A lack of aldosterone leads to the retention of potassium in the blood, a condition known as hyperkalemia (serum potassium greater than 5.0 mEq/L).
High potassium levels are particularly dangerous for the heart, as they interfere with its electrical conduction system, leading to potentially fatal cardiac dysrhythmias.
ECG changes associated with hyperkalemia include peaked T waves, widened QRS complexes, and eventually, ventricular fibrillation or asystole.

Option A: Polyuria, or excessive urination, is a symptom more commonly associated with hypokalemia (low potassium) or conditions like diabetes mellitus, not hyperkalemia.
Option C: This is a sign of dehydration (fluid volume deficit). While patients with Addison's can be dehydrated due to sodium and water loss, it is not a direct sign of hyperkalemia itself.
Option D: This indicates a problem with blood clotting, related to platelets or coagulation factors. It is not affected by serum potassium levels.

Clinical Relevance

Nursing practice connection: Use the key finding related to Clinical manifestations of hyperkalemia in Addison's disease to guide bedside assessment, documentation, and the next nursing action.
Recognizing the signs of hyperkalemia is a critical nursing responsibility, as it is a medical emergency that can lead to cardiac arrest.
For a patient with Addison's disease, nurses must monitor serum potassium levels closely and be prepared to intervene immediately if signs of hyperkalemia appear.
What if? If the patient had Cushing's syndrome instead of Addison's, the nurse would be monitoring for signs of hypokalemia (low potassium), such as muscle weakness, fatigue, and flat T waves on the ECG, due to excess aldosterone.

How to Approach the Question

First, identify the core pathophysiology of the disease mentioned: Addison's disease involves adrenal insufficiency.
Next, connect the pathophysiology to the specific complication: Lack of aldosterone in Addison's causes potassium retention (hyperkalemia).
Then, recall the primary and most life-threatening effects of that complication. For hyperkalemia, the most critical effects are on the heart.
Evaluate each option based on this understanding. 'Cardiac dysrhythmias' is a direct and severe consequence of hyperkalemia.
Eliminate the other options by linking them to different conditions (Polyuria -> hypokalemia; Dry mucous membranes -> dehydration; Prolonged bleeding -> clotting disorders).

Concept Tested & Keywords

Concept Tested: Clinical manifestations of hyperkalemia in Addison's disease
Stem keywords: Addison's disease, hyperkalemia, signs
Lead-in keywords: expects to note
Clinical cues: A patient with Addison's disease is a key cue for potential electrolyte imbalances, particularly hyperkalemia due to aldosterone deficiency.
Negative lead-in flag: NOT changes the reasoning strategy; look for the exception or incorrect statement rather than the true statement.

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 149-151

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 542-544

E6 Medicine Harrison 22e Part 1 p. 400-402

Practise the full DHS 2018 shift 1st

Attempt every question from this paper in a timed mock, then review the full solution for each one.