The patient is returning to the unit after undergoing a bilateral adrenalectomy. Which clinical manifestation would indicate that the client is experiencing an Addisonian crisis?

Pain 7/10 at the surgical site

Hyperglycemia

Blood pressure 92/50

Sodium 152 mEq/L

Answer and Explanation

The Correct Answer is C

A. Pain 7/10 at the surgical site: This level of pain is expected following major surgery, such as a bilateral adrenalectomy, and does not specifically indicate an Addisonian crisis.
B. Hyperglycemia: Although hyperglycemia can be associated with stress or corticosteroid treatment, it is not a hallmark of Addisonian crisis. Addisonian crisis is more related to adrenal insufficiency rather than hyperglycemia.
C. Blood pressure 92/50: Low blood pressure is a critical sign of an Addisonian crisis. This condition results from severe adrenal insufficiency where the body cannot maintain adequate blood pressure.
D. Sodium 152 mEq/L: High sodium levels are not characteristic of an Addisonian crisis. Addisonian crisis typically leads to hyponatremia (low sodium levels) due to inadequate aldosterone production.

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Correct Answer is D

Explanation

A. They are more prone to hyperthermia and may require cooling measures: Hypothyroidism typically leads to hypothermia (lower body temperature) rather than hyperthermia. Clients with hypothyroidism are more likely to experience difficulty maintaining normal body temperature.
B. Their levothyroxine should be held for 3 days prior to and after the surgery: Levothyroxine should not be held before or after surgery without specific guidance from the healthcare provider. Maintaining consistent thyroid hormone levels is crucial for clients with hypothyroidism.
C. They are at risk of developing tachycardia and should be given propranolol: Hypothyroidism is more commonly associated with bradycardia (slow heart rate) rather than tachycardia (fast heart rate). Propranolol is used to manage symptoms of hyperthyroidism, not hypothyroidism.
D. They are more sensitive to the effects of opioids and may require lower doses: Clients with hypothyroidism often have a reduced metabolic rate, which can increase their sensitivity to medications, including opioids. Therefore, they may require lower doses of opioids to avoid adverse effects.

A. It is important that you taper off of the corticosteroids you are taking which have caused this disorder. B. You will need to have your adrenal glands removed to reverse your symptoms. C. You will need to begin taking hydrocortisone, and increase your dose during times of stress. D. You will receive glucose checks and sliding-scale insulin until your hormone levels are corrected.

Correct Answer is B

Explanation

A. It is important that you taper off of the corticosteroids you are taking which have caused this disorder: This statement is not applicable because the client has a pituitary adenoma causing Cushing disease, not iatrogenic Cushing syndrome from corticosteroid use.
B. You will need to have your adrenal glands removed to reverse your symptoms: For Cushing disease caused by a pituitary adenoma, treatment typically involves surgical removal of the pituitary tumor, not the adrenal glands.
C. You will need to begin taking hydrocortisone, and increase your dose during times of stress: This is incorrect as hydrocortisone replacement is used for Addison's disease, not for managing Cushing disease.
D. You will receive glucose checks and sliding-scale insulin until your hormone levels are corrected: While glucose monitoring might be necessary due to hyperglycemia, the primary treatment for Cushing disease involves addressing the source of excess cortisol, which is the pituitary adenoma.

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