A nurse is caring for a child who has Addison's disease.
Which of the following actions should the nurse take?
Discuss the manifestations of hyperglycemia with the parents.
Teach the parents about cortisol replacement therapy.
Place the child on a low-sodium diet.
Monitor the child for fluid volume excess.
The Correct Answer is B
Choice A rationale
Discussing hyperglycemia manifestations is not specific to Addison's disease, as Addison's is characterized by hypoglycemia due to cortisol deficiency.
Choice B rationale
Teaching the parents about cortisol replacement therapy is essential in Addison's disease management. Cortisol deficiency is the primary issue, so educating on proper administration and monitoring is crucial.
Choice C rationale
Placing the child on a low-sodium diet is not recommended because Addison's disease often involves salt wasting, so adequate sodium intake is necessary.
Choice D rationale
Monitoring for fluid volume excess is more applicable to conditions like heart failure, not Addison's disease, which is associated with dehydration and hypovolemia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Withholding oral fluids and food is the priority because it reduces pancreatic stimulation and decreases the secretion of pancreatic enzymes, preventing further autodigestion and inflammation of the pancreas.
Choice B rationale
Auscultating the client's lungs is important to check for complications such as pleural effusion or atelectasis, but it is not the immediate priority after pain management.
Choice C rationale
Assisting the client to a side-lying position can help with comfort and may ease breathing, but it does not directly address the underlying issue of pancreatic inflammation.
Choice D rationale
Providing oral hygiene is essential for overall care but does not impact the acute management of pancreatitis.
Correct Answer is D
Explanation
Choice A rationale
Decreased serum lipase is not expected in acute pancreatitis; rather, lipase levels are typically elevated due to pancreatic enzyme leakage into the bloodstream.
Choice B rationale
Increased serum calcium is not a typical finding in acute pancreatitis; instead, hypocalcemia can occur due to fat necrosis and soap formation.
Choice C rationale
Decreased WBC is not expected; an elevated WBC count is common due to the inflammatory response associated with pancreatitis.
Choice D rationale
Increased serum amylase is a hallmark of acute pancreatitis as the damaged pancreas releases more amylase into the blood.
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