NORCET 3 - 2022 (Shift-1)
Medical & Surgical Nursing
Easy
Which of the following clinical feature seen in a client with Addison disease?
Appeared in: NORCET 3 - 2022 (Shift-1)
Explanation
- Hyper-pigmentation is a classic sign of primary Addison's disease.
- It is caused by low cortisol levels, which leads to a compensatory increase in pituitary secretion of ACTH (adrenocorticotropic hormone).
- The precursor to ACTH, pro-opiomelanocortin (POMC), is also a precursor to melanocyte-stimulating hormone (MSH).
- Elevated ACTH levels lead to increased MSH, which stimulates melanin production, causing darkening of the skin, especially in sun-exposed areas, skin folds, and mucous membranes.
Why Other Options Were Wrong
- Option A: A puffy face, or 'moon facies', is a characteristic sign of Cushing's syndrome, not Addison's disease. It results from the redistribution of fat due to excess cortisol.
- Option C: A generalized rash is not a specific feature of Addison's disease. While autoimmune conditions can be associated with Addison's, a rash is not a primary symptom.
- Option D: Weight gain is contrary to the typical presentation of Addison's disease. The disease usually causes anorexia, nausea, and gastrointestinal disturbances that lead to weight loss.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Clinical Manifestations of Addison's Disease to guide bedside assessment, documentation, and the next nursing action.
- Nurses must be able to recognize the signs of Addison's disease, as early diagnosis and treatment are crucial to prevent a life-threatening Addisonian crisis.
- Patient education is a key nursing role, focusing on the importance of lifelong hormone replacement therapy, stress management, and wearing a medical alert bracelet.
- What if? If a patient with known Addison's disease presents with fever, vomiting, and severe hypotension, the nurse must recognize these as signs of an impending Addisonian crisis, a medical emergency requiring immediate IV hydrocortisone, fluids, and glucose.
How to Approach the Question
- First, identify the core concept of the question, which is the clinical features of 'Addison disease'.
- Recall the pathophysiology of Addison's disease: it is primary adrenal insufficiency, meaning the adrenal glands produce too little cortisol and aldosterone.
- Think about the body's compensatory mechanism. Low cortisol triggers the pituitary to produce more ACTH.
- Connect the high ACTH level to its effect on skin pigmentation. Remember that the precursor molecule for ACTH also stimulates melanocytes, causing hyperpigmentation.
- Evaluate the other options by contrasting them with the known pathophysiology. Puffy face and weight gain are signs of excess cortisol (Cushing's syndrome), the opposite of Addison's. Rashes are non-specific.
- Select 'Hyper-pigmentation' as the only option that directly results from the pathophysiology of primary Addison's disease.
Concept Tested & Keywords
- Concept Tested: Clinical Manifestations of Addison's Disease
- Stem keywords: Addison disease, clinical feature
- Lead-in keywords: Which
- Negative lead-in flag: false
Question ID
QCS3uQ2bpBIqrBW2nF2R_I
Reference Book
E6 Physiology Essentials Sembulingam 10e Part 2 p. 81-83
E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 1123-1125
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 7497-7499
Practise the full NORCET 3 - 2022 (Shift-1)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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