A client with pheochromocytoma is receiving preoperative care. Which finding requires the nurse to take immediate action?
1Nasal congestion and mild positional lightheadedness after the prescribed alpha blocker is started
2Sudden pounding headache with sweating, palpitations, and severe hypertension✓ Correct answer
3Mild fatigue after walking to the bathroom that resolves with a brief rest
4Reduced appetite while waiting for the next scheduled meal before surgery
Explanation
Pheochromocytoma can release excess catecholamines and cause a hypertensive crisis. A sudden pounding headache, sweating, palpitations, and severe hypertension signal dangerous cardiovascular stress requiring immediate intervention. The other findings do not show the same acute crisis pattern.
Quick answer Treat the sudden headache, sweating, palpitations, and severe hypertension as a catecholamine crisis requiring immediate action.
Why this is correct A pheochromocytoma can discharge large amounts of catecholamines, producing abrupt vasoconstriction and cardiac stimulation. The combined symptom cluster signals a hypertensive crisis that can progress to dysrhythmia, myocardial infarction, stroke, or death.
Easy analogy or mental picture A catecholamine surge is like an accelerator and pressure valve failing at the same time: heart drive and vascular pressure rise together. The comparison shows urgency, but treatment must follow the monitored medical plan.
Memory hook Pheochromocytoma crisis cluster: pounding head, sweat, racing heart, severe pressure.
NCLEX decision rule For a client with pheochromocytoma, prioritize an abrupt cluster of severe hypertension, headache, sweating, and palpitations as a cardiovascular emergency. Compare the whole acute pattern rather than reacting to one mild expected medication effect.
Why the other choices are wrong Mild nasal congestion or positional lightheadedness can occur with alpha blockade and still requires routine assessment. Brief fatigue or reduced appetite does not match the sudden catecholamine-driven hypertensive crisis pattern.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
Pheochromocytoma and Paraganglioma Treatment, Health Professional VersionNational Cancer Institute
[3]
Preoperative Management of Catecholamine-Producing PheochromocytomasJournal of the Endocrine Society
Clinical Practice GuideFor Stroke dysphagia screening, compare the complete cue pattern with the client's current stability, ordered data, and expected nursing scope.
CautionDo not choose an action from one isolated cue when the full scenario changes priority or safety.
Stroke — An acute neurologic deficit caused by interrupted blood flow or bleeding in the brain.
Dysphagia — Difficulty swallowing that can increase aspiration risk.
Aspiration — Entry of food, fluid, or secretions into the airway.