The nurse determines that this client’s priority problem is:

Choice A reason: I will always need to take hydrocortisone pills is a correct statement. Hydrocortisone is a synthetic form of cortisol, a hormone that is normally produced by the adrenal glands. After a bilateral adrenalectomy, the patient will have no adrenal glands and will need to take hydrocortisone pills for life to replace the missing hormone.

Choice B reason: I have a way to inject hydrocortisone in case of emergency is also a correct statement. Hydrocortisone injections are used to treat acute adrenal crisis, a life-threatening condition that can occur when the patient has low cortisol levels due to stress, illness, injury, or surgery. The patient should have an emergency kit with hydrocortisone injections and instructions on how to use them.

Choice C reason: I will stop taking hydrocortisone when I feel better is an incorrect statement. This indicates a need for further education regarding medications after a bilateral adrenalectomy. The patient should never stop taking hydrocortisone without consulting their doctor, as this can cause severe symptoms of adrenal insufficiency, such as low blood pressure, low blood sugar, weakness, fatigue, and confusion.

Choice D reason: I have nausea or vomiting often is a statement that requires further assessment by the nurse. Nausea or vomiting can be signs of inadequate or excessive hydrocortisone dosage, or other complications after a bilateral adrenalectomy. The nurse should monitor the patient's vital signs, blood glucose, electrolytes, and weight, and report any abnormal findings to the doctor. The patient may need to adjust their hydrocortisone dose or take other medications to manage their symptoms.

Choice A reason: Burning pain and tingling in extremities are not symptoms of autonomic neuropathy, but of peripheral neuropathy. Peripheral neuropathy affects the sensory and motor nerves that innervate the skin, muscles, and joints. It can cause pain, numbness, weakness, and loss of sensation in the extremities. Autonomic neuropathy affects the nerves that control the involuntary functions of the body, such as digestion, blood pressure, heart rate, and sweating.

Choice B reason: Nausea and feeling of abdominal fullness are symptoms of autonomic neuropathy, specifically of gastroparesis. Gastroparesis is a condition where the stomach muscles are weakened or paralyzed, and cannot move food properly. It can cause delayed gastric emptying, nausea, vomiting, bloating, early satiety, and poor blood glucose control. Autonomic neuropathy can damage the vagus nerve, which regulates the stomach motility and secretion.

Choice C reason: Elevated blood pressure and delayed capillary refill are not symptoms of autonomic neuropathy, but of cardiovascular problems. Blood pressure is the force of blood against the walls of the arteries, and capillary refill is the time it takes for the color to return to the nail bed after pressing on it. Elevated blood pressure can indicate hypertension, which is a risk factor for heart disease and stroke. Delayed capillary refill can indicate poor blood circulation, which can be caused by atherosclerosis, peripheral artery disease, or shock. Autonomic neuropathy can affect the blood pressure and heart rate, but usually causes hypotension and tachycardia, not hypertension and delayed capillary refill.

Choice D reason: Increased thirst and excessive urination are not symptoms of autonomic neuropathy, but of diabetes mellitus. Diabetes mellitus is a condition where the body cannot produce or use insulin properly, and the blood glucose level becomes too high. Increased thirst and excessive urination are signs of hyperglycemia, which is a high blood glucose level. Hyperglycemia can cause dehydration, electrolyte imbalance, and ketoacidosis. Autonomic neuropathy can be a complication of diabetes mellitus, but it does not cause increased thirst and excessive urination.