Addison's disease is an endocrine disorder that develops when the adrenal glands are not able to produce enough cortisol. A client with Addison's disease is receiving fludrocortisone acetate. The nurse knows that the therapeutic effect of this is to _______.

1. A

   Maintain electrolyte balance.

2. B

   Activate parathyroid production.

3. C

   Activate the immune response.

4. D

   Stimulate thyroid gland production.

Appeared in: UPUMS Nsg.Officer-2024

Explanation

• Fludrocortisone is a synthetic mineralocorticoid used as replacement therapy in Addison's disease.
• It mimics the action of aldosterone, the body's natural mineralocorticoid, which is deficient in this condition.
• Its primary function is to act on the kidneys to increase sodium and water reabsorption while promoting potassium excretion.
• This action directly corrects the electrolyte imbalances (hyponatremia, hyperkalemia) and fluid loss characteristic of adrenal insufficiency, thus maintaining electrolyte balance.

Why Other Options Were Wrong

• Option B: Fludrocortisone has no effect on the parathyroid glands or their hormone production.
• Option C: Corticosteroids, including fludrocortisone, generally have immunosuppressive properties, not immune-activating effects.
• Option D: Fludrocortisone does not influence the thyroid gland or the production of thyroid hormones.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Pharmacology: Mineralocorticoid Replacement Therapy in Addison's Disease to guide bedside assessment, documentation, and the next nursing action.
• Nurses must meticulously monitor patients on fludrocortisone for signs of incorrect dosing. Hypotension, weight loss, and hyperkalemia suggest an insufficient dose, while hypertension, edema, weight gain, and hypokalemia indicate an excessive dose.
• Patient education is critical. Patients must understand that fludrocortisone is a lifelong replacement therapy and that abrupt cessation can trigger a life-threatening Addisonian crisis (severe hypotension, shock, coma).
• What if? If a patient on fludrocortisone presents with new-onset hypertension, peripheral edema, and muscle weakness, the nurse should suspect the dose is too high. The priority action is to notify the provider, as the dose needs to be decreased to prevent complications like heart failure and severe hypokalemia.

How to Approach the Question

• First, identify the key elements in the question: the patient has Addison's disease and is being treated with fludrocortisone acetate.
• Recall the pathophysiology of Addison's disease, which is adrenal insufficiency leading to a lack of both glucocorticoids (cortisol) and mineralocorticoids (aldosterone).
• Identify the drug class of fludrocortisone. Recognize it as a synthetic mineralocorticoid, meaning it replaces the function of aldosterone.
• Consider the primary function of aldosterone/mineralocorticoids: to regulate salt and water by retaining sodium and excreting potassium.
• Evaluate the options based on this function. 'Maintain electrolyte balance' directly corresponds to the primary action of a mineralocorticoid.
• Eliminate the other options by recognizing they relate to different endocrine glands (parathyroid, thyroid) or a different physiological process (immune activation), which are not the target of fludrocortisone.

Concept Tested & Keywords

• Concept Tested: Pharmacology: Mineralocorticoid Replacement Therapy in Addison's Disease
• Stem keywords: Addison's disease, fludrocortisone acetate, therapeutic effect
• Lead-in keywords: is to
• Clinical cues: Client with Addison's disease receiving fludrocortisone
• Negative lead-in flag: false

Question ID

QJmi4mJ3igsHOxEdjnK1hu

Copy ID

Reference Book

E6 Pharmacology Nursing Lilley 11e Part 2 pp. 221-223, 223-225

E6 Pharmacology Katzung 16e p. 1112-1114