A client who abruptly stopped long-term prednisone has blood pressure 78/44 mm Hg, sodium 126 mEq/L, potassium 5.9 mEq/L, and severe weakness. Complete the emergency plan.
Drop-down Cloze
Choose your responses, then check the answer.
Explanation
Abrupt withdrawal after prolonged glucocorticoid exposure can cause adrenal insufficiency. Severe hypotension with weakness, hyponatremia, and hyperkalemia is a life-threatening adrenal-crisis pattern. Current endocrine guidance recommends immediate parenteral hydrocortisone at a stress dose and rapid isotonic-saline resuscitation; treatment should not wait for confirmatory testing. The nurse also monitors hemodynamics, glucose, electrolytes, urine output, mental status, and the response to fluids and corticosteroid therapy.
Correct Answer Suspect adrenal crisis, administer the prescribed emergency parenteral hydrocortisone without delay, and begin rapid isotonic-saline resuscitation with continuous reassessment.
Why It Fits Shock after abrupt long-term steroid withdrawal, together with hyponatremia, hyperkalemia, and profound weakness, indicates loss of adequate cortisol effect and possible mineralocorticoid deficiency.
Clinical Picture This client can deteriorate from refractory hypotension, hypoglycemia, dysrhythmia, and worsening electrolyte disturbance. Emergency glucocorticoid and volume replacement address the immediate physiology while the cause is confirmed later.
Memory Link Steroid stopped + shock + low sodium/high potassium: hydrocortisone and saline now.
NCLEX Rule When adrenal crisis is suspected in an unstable client, collect ordered diagnostic samples only if doing so does not delay lifesaving treatment.
Why the Alternatives Fail Fluid restriction worsens volume depletion. Potassium intake is unsafe with hyperkalemia. Oral outpatient follow-up is inappropriate in shock, and waiting for a stimulation test delays treatment.
Source
1Endocrine Society Primary Adrenal Insufficiency Guideline
2Society for Endocrinology Adrenal Crisis Emergency Guidance
32026 NCLEX-RN Test Plan
The client is acutely ill with shock and has IV access. Blood may be collected for ordered testing if this does not delay treatment, but the emergency response is not postponed while waiting for confirmatory results.
Adrenal crisis — Acute, life-threatening adrenal insufficiency that can cause shock, electrolyte abnormalities, hypoglycemia, and altered mental status.
Stress-dose hydrocortisone — Immediate parenteral glucocorticoid replacement used during suspected adrenal crisis or major physiologic stress.
Isotonic-saline resuscitation — Rapid intravenous volume replacement with 0.9% sodium chloride, individualized through hemodynamic and fluid-tolerance reassessment.