# A client on high-dose inhaled fluticasone 1000 mcg/day plus daily prednisone 7.5 mg for severe asthma develops fever, vomiting, and hypotension after a flu-like illness. Which is the priority nursing action?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391774&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client on high-dose inhaled fluticasone 1000 mcg/day plus daily prednisone 7.5 mg for severe asthma develops fever, vomiting, and hypotension after a flu-like illness. Which is the priority nursing action?

## Option

1. Administer IV potassium replacement
2. Anticipate IV hydrocortisone, IV normal saline, and dextrose — adrenal crisis is suspected **✔ Correct answer**
3. Hold all asthma medications and reassess in 4 hours
4. Encourage oral fluids and recheck BP in 30 minutes

**Correct answer: 2**

## Explanation

Correct (2): Long-term high-dose ICS plus chronic systemic steroids cause HPA axis suppression; an acute stressor (illness, vomiting, surgery) without stress-dose steroids precipitates adrenal crisis — hypotension, hypoglycemia, hyponatremia, hyperkalemia, weakness. Treatment: IV hydrocortisone 100 mg STAT, IV saline with dextrose, and supportive care. (1) Delay can be fatal. (3) Adrenal crisis is hypoNa/hyperK — extra K worsens. (4) Inadequate.

## In-depth explanation

Memory Tip Long-term steroid use + acute stress = "Stress dose or Crash." Sick-day rules: triple steroid for fever, surgery, or illness. CPG All chronic steroid users wear a MedicAlert; carry emergency hydrocortisone.

## Clinical scenario

Scenario 48-year-old female on high-dose ICS + prednisone 7.5 mg/day × 2 years for severe asthma. Presents with fever, vomiting, BP 86/52, weak, confused, fingerstick glucose 62.

## Key concepts

- **Adrenal crisis** — Acute glucocorticoid deficiency with shock, hypoglycemia, electrolyte derangement; requires emergent hydrocortisone.
- **HPA axis suppression** — Hypothalamic-pituitary-adrenal axis suppression from prolonged exogenous steroids.
- **Sick-day rules** — Steroid stress dosing during illness, surgery, or trauma to prevent crisis.

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