A nurse is assessing a patient with long-standing Addison's crisis presenting with hyponatremia and hyperkalemia. Which additional finding is most suggestive of this condition?

1. A

   Hypernatremia

2. B

   Hypoglycemia

3. C

   Hyperglycemia

4. D

   Hypokalemia

Appeared in: NORCET-11 Prelims

Explanation

• Hypoglycemia is a hallmark of Addisonian crisis due to cortisol deficiency.
• Cortisol is required for gluconeogenesis; its absence leads to low blood sugar.
• Addisonian crisis presents with hyponatremia, hyperkalemia, hypotension, and hypoglycemia.
• Recognizing hypoglycemia is critical for timely intervention in adrenal insufficiency.

Why Other Options Were Wrong

• Option A: Addison's disease causes sodium loss, resulting in hyponatremia, not hypernatremia.
• Option C: Cortisol deficiency impairs gluconeogenesis, leading to hypoglycemia, not hyperglycemia.
• Option D: Aldosterone deficiency in Addison's disease leads to potassium retention and hyperkalemia, not hypokalemia.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Classic metabolic and electrolyte findings in Addisonian crisis to guide bedside assessment, documentation, and the next nursing action.
• Nurses must monitor for hypoglycemia in Addisonian crisis to prevent complications.
• Prompt correction of hypoglycemia is essential to avoid neurological damage.
• What if? If hyperglycemia was present, consider Cushing's syndrome or steroid excess instead of Addison's disease.

How to Approach the Question

• Identify the underlying endocrine disorder and recall its hormonal deficiencies.
• Recall the classic metabolic and electrolyte disturbances associated with Addisonian crisis.
• Eliminate options that contradict the known pathophysiology.
• Select the finding that best fits the clinical scenario.

Concept Tested & Keywords

• Concept Tested: Classic metabolic and electrolyte findings in Addisonian crisis
• Stem keywords: Addison's crisis, hyponatremia, hyperkalemia, long-standing, nurse assessment
• Lead-in keywords: most suggestive
• Clinical cues: Electrolyte abnormalities (hyponatremia, hyperkalemia) point to adrenal insufficiency

Question ID

Q8SraQKVbKttObM6XKaez7

Copy ID

Reference Book

E6 Medicine Davidson Principles Practice 24e p. 691-693

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1262-1264

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 4 p. 35-37