# A client with adrenal insufficiency has vomiting, severe weakness, blood pressure 78/42 mm Hg, and confusion. Which prescription should the nurse anticipate first?

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> language: en  
> subject: Illness Management  
> category: PA

## Question

A client with adrenal insufficiency has vomiting, severe weakness, blood pressure 78/42 mm Hg, and confusion. Which prescription should the nurse anticipate first?

## Option

1. Restrict all fluids for 24 hours.
2. Administer a beta blocker for low blood pressure.
3. Give a high-dose oral potassium supplement.
4. Administer IV hydrocortisone and isotonic fluids as prescribed. **✔ Correct answer**

**Correct answer: 4**

## Explanation

Hypotension, vomiting, weakness, and confusion in adrenal insufficiency suggest adrenal crisis. Treatment includes immediate glucocorticoid replacement and isotonic fluids as prescribed. Delaying steroid replacement can be life-threatening.

## In-depth explanation

Clinical Judgment
Adrenal crisis is a shock-risk endocrine emergency.

Memory Tip
Adrenal crisis: steroids and fluids.

## Clinical scenario

Clinical Practice Guide
Adrenal crisis management focuses on rapid steroid replacement, fluid resuscitation, glucose and electrolyte monitoring, and treating triggers.

Caution
Vomiting can prevent oral steroid absorption and worsen crisis risk.

## Key concepts

- **Adrenal Insufficiency** — Inadequate adrenal hormone production, especially cortisol.
- **Hydrocortisone** — A glucocorticoid used to replace cortisol in adrenal crisis.
- **Isotonic Fluid** — IV fluid with tonicity similar to plasma, used for volume resuscitation.

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