# A client with a history of primary adrenal insufficiency presents with vomiting, hypotension 84/52, blood glucose 58, sodium 128, potassium 5.8 after stopping prednisone for 3 days because of nausea. Which intervention is the most immediate priority?

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> language: en  
> subject: NCLEX-RN  
> category: PA

## Question

A client with a history of primary adrenal insufficiency presents with vomiting, hypotension 84/52, blood glucose 58, sodium 128, potassium 5.8 after stopping prednisone for 3 days because of nausea. Which intervention is the most immediate priority?

## Option

1. Administer IV hydrocortisone 100 mg as the immediate priority **✔ Correct answer**
2. Initiate IV insulin drip for blood glucose 58 mg/dL
3. Replace potassium aggressively because of dehydration
4. Wait for cortisol level result before steroid administration

**Correct answer: 1**

## Explanation

Adrenal crisis is a life-threatening emergency. IV hydrocortisone 100 mg bolus is given IMMEDIATELY without waiting for confirmatory testing. Volume resuscitation with isotonic saline plus dextrose for hypoglycemia follows. Insulin would WORSEN hypoglycemia (glucose 58). Potassium is HIGH (5.8) so potassium replacement is contraindicated; volume expansion and steroids correct it. Cortisol can be drawn but treatment must NEVER be delayed.

## In-depth explanation

Sick day rule: triple oral steroid dose with febrile illness; switch to IV stress-dose for vomiting or unable to keep oral. Patient must wear medical alert.

## Clinical scenario

Lethargic but arousable. HR 122, RR 24, temp 37.8 C. No history of cardiac disease.

## Key concepts

- **adrenal crisis** — Acute decompensation of adrenal insufficiency with hypotension and hypoglycemia.
- **stress-dose steroid** — Increased glucocorticoid for illness, surgery, or trauma in adrenal insufficiency.
- **primary adrenal insufficiency** — Adrenal cortex failure (Addison disease); both cortisol and aldosterone deficient.

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