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: RAK Nursing Officer - 2019

Explanation

In Addison's disease, the adrenal glands do not produce enough aldosterone, a hormone that helps the kidneys excrete potassium.
Reduced aldosterone leads to potassium retention, causing hyperkalemia (serum potassium greater than 5.0 mEq/L).
Potassium is critical for cardiac muscle function. High levels disrupt the heart's electrical conduction, leading to irritability and arrhythmias.
ECG changes are a hallmark sign, starting with tall, peaked T-waves and progressing to more severe dysrhythmias like ventricular fibrillation or asystole.

Option A: Polyuria (excessive urination) is not a direct sign of hyperkalemia. In fact, severe hyperkalemia can be caused by kidney failure, which often presents with oliguria (decreased urine output).
Option C: Dry mucous membranes are a sign of dehydration (fluid volume deficit). While clients with Addison's disease can become dehydrated due to sodium and water loss, this sign is not specific to the presence of hyperkalemia.
Option D: Prolonged bleeding time indicates a problem with platelet function or the coagulation cascade. It is not related to 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.
Hyperkalemia is a medical emergency due to its potential to cause fatal cardiac arrhythmias. A nurse's ability to recognize the signs, especially in at-risk patients like those with Addison's disease or renal failure, is critical for patient safety.
Immediate intervention for severe hyperkalemia includes placing the patient on a cardiac monitor, restricting potassium intake, and administering medications like calcium gluconate to stabilize the heart, or insulin and glucose to shift potassium into the cells.
What if the client had Cushing's disease instead of Addison's? Cushing's disease involves excess cortisol and often excess aldosterone, which would lead to the opposite problem: hypokalemia (low potassium) due to increased renal potassium excretion.

How to Approach the Question

First, identify the core pathophysiology of the disease mentioned in the stem: Addison's disease involves adrenal insufficiency.
Next, recall the key hormonal change: a lack of aldosterone.
Connect the hormonal change to its effect on electrolytes. A lack of aldosterone means the kidneys retain potassium and excrete sodium.
Therefore, the client is at risk for hyperkalemia.
Finally, review the options and select the one that is a known, critical sign of hyperkalemia. The most life-threatening effect of high potassium is on the heart.

Concept Tested & Keywords

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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

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