# A nurse is caring for a client with Addison's disease who is experiencing an adrenal crisis. Which nursing intervention should be the priority? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=177175 > language: ko > subject: Adult Health ## 문제 A nurse is caring for a client with Addison's disease who is experiencing an adrenal crisis. Which nursing intervention should be the priority? A 45-year-old client with Addison's disease presents to the emergency department with severe weakness, nausea, vomiting, and hypotension (BP 80/50 mmHg). The client reports missing several doses of prescribed corticosteroid medication over the past week due to financial constraints. ## 보기 1. Administer IV hydrocortisone as prescribed immediately **✔ 정답** 2. Obtain blood samples for electrolyte levels and cortisol testing 3. Insert a urinary catheter to monitor fluid balance 4. Provide emotional support and reassurance to reduce anxiety **정답: 1** ## 해설 In adrenal crisis (Addisonian crisis), immediate administration of IV corticosteroids is the life-saving priority intervention to replace the critically deficient cortisol and prevent cardiovascular collapse. Adrenal crisis (Addisonian crisis) is a life-threatening emergency that occurs in patients with Addison's disease due to severe cortisol deficiency. This condition represents acute adrenal insufficiency and requires immediate medical intervention to prevent death. Pathophysiologically, the adrenal cortex is unable to produce sufficient amounts of cortisol and aldosterone. Cortisol is essential for maintaining blood pressure, regulating blood sugar levels, and the body's response to stress. When cortisol levels become severely low, patients experience severe hypotension, electrolyte imbalances (particularly hyponatremia and hyperkalemia), hypoglycemia, and cardiovascular collapse. The priority nursing intervention is the immediate administration of intravenous hydrocortisone. This directly addresses the root cause of the crisis, which is cortisol deficiency. Without rapid corticosteroid replacement, the patient's condition will continue to deteriorate, leading to cardiovascular collapse and death. The intravenous route ensures rapid absorption and immediate therapeutic effect. While performing laboratory tests is important for ongoing management, it should not delay life-saving treatment. Urethral catheter insertion and emotional support are secondary interventions that can be performed after addressing the immediate physiological crisis. The NCLEX-RN emphasizes prioritizing interventions that address life-threatening situations first, so immediate corticosteroid replacement is the clear priority in adrenal crisis. ## 심화 해설 Understanding the Priority in Adrenal Crisis The client is presenting with classic signs of an adrenal crisis (also called Addisonian crisis): severe weakness, nausea, vomiting, and profound hypotension with a blood pressure of 80/50 mmHg. The precipitating factor is clear—medication non-adherence due to missing several doses of prescribed corticosteroid. As described in the literature, an adrenal crisis is a life-threatening complication of primary adrenal insufficiency, often triggered by physiological stress, infection, or interruption of glucocorticoid therapy [1]. In this state, the body lacks the critical hormones cortisol and aldosterone, leading to fluid volume deficit, vascular collapse, and potential cardiovascular shock. The immediate priority is to reverse the life-threatening hormone deficiency and hemodynamic instability. The foundational principle of emergency management for adrenal crisis is the prompt administration of parenteral glucocorticoids. Research on emergency department management of adrenal insufficiency confirms that delays in appropriate glucocorticoid administration are a critical failure point that can lead to poor outcomes [3]. Therefore, administering IV hydrocortisone as prescribed immediately is the priority intervention. This directly addresses the underlying pathophysiology by replacing the deficient cortisol, which helps restore vascular tone, stabilize cell membranes, and suppress the inflammatory cascade. While obtaining blood samples for electrolyte levels and cortisol testing (option 2) is an important diagnostic step, it must not delay life-saving treatment. A cortisol level can confirm the diagnosis, but in a known Addison’s patient with a clear precipitating history and classic presentation, waiting for lab results before giving hydrocortisone is dangerous and can lead to further decompensation. Similarly, inserting a urinary catheter to monitor fluid balance (option 3) is a secondary intervention that supports ongoing monitoring after the initial stabilization. Providing emotional support (option 4) is always a component of holistic nursing care, but it does not address the immediate physiological threat of vascular collapse. In the hierarchy of needs during an adrenal crisis, restoring circulatory volume and corticosteroid levels with IV hydrocortisone takes absolute precedence.References (research sources) - [1]Addisonian Crisis in a 39-Year-Old Woman With Primary Adrenal Insufficiency.Research articleItteera MR, Gutierrez M, Patel KH. (2026) · DOI: 10.7759/cureus.103607 - [3]Impact of Alert Systems on Glucocorticoid Administration for Adrenal Insufficiency in the Emergency Department.Research articleGreeviroj P, Anakepeerasak R, Thavaraputta S, Kerr SJ, Saoraya J, Buranasupkajorn P, Parksook WW, Snabboon T, Sunthornyothin S. (2026) · DOI: 10.1210/clinem/dgag225 ## 임상 시나리오 Clinical Practice Guidance: Adrenal Crisis in Addison's Disease Immediate Priorities - Administer IV hydrocortisone 100 mg bolus immediately, followed by continuous infusion or 50 mg every 6 hours as prescribed. - Initiate rapid IV fluid resuscitation with 0.9% sodium chloride to address volume depletion and hypotension. - Monitor vital signs every 5-15 minutes until hemodynamic stability is achieved. Key Assessment Findings - Profound hypotension unresponsive to fluid challenge alone without glucocorticoid replacement. - Electrolyte imbalances: hyponatremia and hyperkalemia due to aldosterone deficiency. - Precipitating factors: missed corticosteroid doses, infection, surgery, or physiological stress. Nursing Actions and Rationale - Do not delay glucocorticoid administration for diagnostic testing; blood samples can be drawn simultaneously with treatment initiation. - Monitor for fluid overload and electrolyte shifts during aggressive resuscitation. - Identify and address the underlying precipitating cause (e.g., infection, medication non-adherence). - Provide patient education on sick-day rules and the importance of never skipping corticosteroid doses. Patient Education and Discharge Planning - Teach the patient to double or triple the oral corticosteroid dose during illness or stress. - Ensure the patient has an emergency injection kit and knows how to self-administer IM hydrocortisone. - Advise wearing a medical alert bracelet indicating adrenal insufficiency. - Arrange follow-up with endocrinology and social work to address financial barriers to medication adherence. ## 핵심 개념 - **Adrenal crisis** — An acute, life-threatening complication of adrenal insufficiency characterized by severe hypotension, weakness, nausea, and vascular collapse due to cortisol and aldosterone deficiency. - **IV hydrocortisone** — A parenteral glucocorticoid administered immediately during adrenal crisis to replace deficient cortisol, restore vascular tone, and stabilize cell membranes. - **Addison's disease** — Primary adrenal insufficiency where the adrenal glands fail to produce adequate amounts of cortisol and aldosterone, requiring lifelong corticosteroid replacement. - **Hemodynamic instability** — A state of inadequate blood flow and perfusion often presenting with hypotension and shock, which in adrenal crisis results from hormone deficiency. - **Glucocorticoid replacement** — The therapeutic administration of corticosteroids to compensate for deficient endogenous production, critical in managing adrenal insufficiency and crisis. ## 같은 주제 문제 - [A nurse is assessing a client for suspected primary adrenal insufficiency (Addison's disea…](https://mymerci.kr/pages/nclex_q.php?qn_id=177171) - [A nurse is assessing a 58-year-old male client who presents to the emergency department wi…](https://mymerci.kr/pages/nclex_q.php?qn_id=177172) - [A nurse is assessing a 39-year-old client who presents to the emergency department with co…](https://mymerci.kr/pages/nclex_q.php?qn_id=177173) - [A nurse is assessing a patient with suspected Addison's disease. 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