A nurse is assessing a client who has adrenal insufficiency. Which of the following findings should the nurse expect?

Increased body hair

Decreased blood urea nitrogen level

Hyperpigmentation of the skin

Hypocalcemia

Answer and Explanation

The Correct Answer is C

A. Increased body hair: Adrenal insufficiency leads to decreased androgen production, which may cause hair thinning rather than increased body hair. Hypertrichosis (excessive hair growth) is not a typical finding in adrenal insufficiency.

B. Decreased blood urea nitrogen level: Adrenal insufficiency is often associated with dehydration due to aldosterone deficiency, leading to reduced sodium retention and increased fluid loss. This can result in elevated blood urea nitrogen (BUN) levels rather than a decrease.

C. Hyperpigmentation of the skin: Increased melanocyte-stimulating hormone (MSH) activity, triggered by elevated adrenocorticotropic hormone (ACTH) levels, causes darkening of the skin, especially in sun-exposed areas, skin folds, and mucous membranes. This is a hallmark feature of primary adrenal insufficiency (Addison’s disease).

D. Hypocalcemia: Adrenal insufficiency is more commonly associated with hypercalcemia rather than hypocalcemia. Decreased cortisol levels can lead to reduced renal calcium excretion, contributing to elevated serum calcium levels.

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Correct Answer is D

Explanation

A. Infuse the unit of blood to the client over 6 hr: Blood transfusions should be completed within 4 hours to reduce the risk of bacterial growth and hemolysis. Prolonged infusion times increase the likelihood of complications such as infection or reduced efficacy of the transfused blood.

B. Prime the blood administration IV tubing with lactated Ringer’s: Blood products should only be primed and infused with normal saline (0.9% sodium chloride) to prevent hemolysis and clot formation. Lactated Ringer’s contains calcium, which can cause clotting in the blood product, increasing the risk of complications.

C. Check the first set of vital signs 30 min after the blood infusion is started: The nurse should check the client’s vital signs before initiating the transfusion, then again within the first 15 minutes. The highest risk of transfusion reactions occurs within this period, requiring close monitoring for signs such as fever, chills, or hypotension.

D. Document the donation number of the unit of blood on the client’s electronic medical record: Accurate documentation of the blood unit’s donation number ensures traceability and accountability. This information is essential for tracking in case of transfusion reactions or recalls and is a standard safety practice in blood transfusion protocols.

A. Hypertension B. 2+ edema C. Tachycardia D. Crackles in lungs

Correct Answer is C

Explanation

A. Hypertension: Elevated blood pressure is not a typical sign of bleeding. In cases of significant blood loss, compensatory mechanisms usually lead to hypotension rather than hypertension due to reduced circulating volume. A hypertensive response may occur due to pain or stress but does not indicate hemorrhage.

B. 2+ edema: Postoperative edema can occur from fluid shifts, inflammation, or IV fluid administration but is not a direct indicator of active bleeding. Bleeding is more likely to cause signs of hypovolemia, such as tachycardia or hypotension, rather than localized swelling.

C. Tachycardia: A common early sign of bleeding, as the body compensates for decreased blood volume by increasing heart rate to maintain oxygen delivery. Persistent tachycardia in a postoperative client should raise suspicion for internal bleeding, especially if accompanied by hypotension or pallor.

D. Crackles in lungs: Crackles are usually linked to fluid overload, pneumonia, or heart failure rather than bleeding. Pulmonary congestion may develop after aggressive IV fluid resuscitation, but bleeding primarily manifests with hemodynamic instability rather than respiratory symptoms.

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A nurse is assessing a client who has adrenal insufficiency. Which of the following findings should the nurse expect?

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