Which finding indicates to the nurse that the current therapies are effective for a patient with acute adrenal insufficiency?

Decreasing serum chloride levels

Increasing serum sodium levels

Increasing serum potassium levels

Decreasing blood sucrose levels

Answer and Explanation

The Correct Answer is B

Acute adrenal insufficiency, also known as adrenal crisis, is characterized by low levels of adrenal hormones, particularly cortisol. One of the primary manifestations of adrenal insufficiency is electrolyte imbalance, specifically hyponatremia (low sodium) and hyperkalemia (high potassium). Inadequate cortisol levels can lead to impaired sodium reabsorption in the kidneys, resulting in sodium loss and low serum sodium levels.

When the patient receives appropriate therapies for acute adrenal insufficiency, such as administration of glucocorticoids (e.g., hydrocortisone), the cortisol levels begin to normalize. As a result, the impaired sodium reabsorption improves, leading to an increase in serum sodium levels.

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Correct Answer is C

Explanation

The assessment findings indicate that the client has diminished lung sounds in the lower lobes, suggesting potential postoperative atelectasis or decreased air movement in the lungs. Using an incentive spirometer can help improve lung expansion and prevent respiratory complications such as pneumonia. It is important to address this issue promptly to prevent further deterioration of lung function.

Administering pain medication may be necessary depending on the client's level of pain, but addressing the respiratory issue takes priority in this situation.

Administering the antibiotic earlier than scheduled or changing the dressing over the wound may not be indicated based on the provided assessment findings.

Therefore, having the client use the incentive spirometer is the most appropriate action at this time to promote optimal lung function and prevent respiratory complications.

A. There are crackles throughout both lung fields. B. The patient's radial pulse is 105 beats/min. C. There is sediment and blood in the patient's urine D. The blood pressure increases from 66/50 to 122/74 mm

Correct Answer is A

Explanation

A 3% saline solution is a hypertonic solution used to increase serum sodium levels in cases of severe hyponatremia. However, it can lead to fluid overload and pulmonary edema. The presence of crackles throughout both lung fields indicates the accumulation of fluid in the lungs, which is a serious adverse outcome.

The patient's radial pulse rate of 105 beats/min is within a normal range and does not directly indicate an adverse effect of the saline infusion.

The presence of sediment and blood in the patient's urine may be unrelated to the 3% saline infusion and could indicate other issues such as urinary tract infection or kidney injury.

An increase in blood pressure from 66/50 to 122/74 mmHg is an expected effect of a hypertonic solution like 3% saline, as it can cause an increase in intravascular volume. While the increase in blood pressure is significant, it does not represent an adverse outcome specific to the infusion itself.

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Which finding indicates to the nurse that the current therapies are effective for a patient with acute adrenal insufficiency?

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Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

A patient is receiving a 3% saline continuous IV infusion for hyponatremia. Which assessment data represents an adverse outcome (side effect) of this infusion?

Correct Answer is A

Explanation

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