# A 58-year-old patient with rheumatoid arthritis who has been taking prednisone 10 mg daily for 8 months abruptly stops the medication. Three days later, the patient presents with vomiting, severe weakness, and a blood pressure of 84/50 mm Hg. Laboratory results show sodium 128 mEq/L and potassium 5.8 mEq/L. Which actions should the nurse take? Select the two priority actions.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=505816&lang=en  
> language: en  
> subject: Physiological Adaptation  
> category: PA

## Question

A 58-year-old patient with rheumatoid arthritis who has been taking prednisone 10 mg daily for 8 months abruptly stops the medication. Three days later, the patient presents with vomiting, severe weakness, and a blood pressure of 84/50 mm Hg. Laboratory results show sodium 128 mEq/L and potassium 5.8 mEq/L. Which actions should the nurse take? Select the two priority actions.

The nurse should ::선택::administer intravenous 0.9% sodium chlorideadminister oral prednisone 10 mgobtain a serum cortisol leveladminister oral potassium chloride 40 mEq and ::선택::administer intravenous hydrocortisoneinitiate a continuous dopamine infusionadminister intravenous potassium chlorideadminister oral fludrocortisone.

## Explanation

The patient's history of chronic glucocorticoid use followed by abrupt cessation, along with hypotension, vomiting, weakness, hyponatremia, and hyperkalemia, strongly suggests adrenal crisis. The priority actions are to administer intravenous fluids to correct hypovolemia and hypotension, and to administer intravenous hydrocortisone to replace the deficient glucocorticoid and mineralocorticoid activity. Administering oral prednisone is inappropriate because the patient is vomiting and requires rapid, reliable absorption. Obtaining a serum cortisol level is not a priority and would delay life-saving treatment. Administering a potassium supplement would worsen the existing hyperkalemia. Initiating a dopamine infusion is not the first-line intervention; fluid resuscitation and steroid replacement are primary.

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