# A client with primary adrenal insufficiency has vomiting, hypotension, and confusion. Which action is the priority?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522755&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client with primary adrenal insufficiency has vomiting, hypotension, and confusion. Which action is the priority?

History

Vitals

Labs

Orders

Notes

Primary adrenal insufficiency; unable to keep oral hydrocortisone down during gastroenteritis

(데이터 없음)

(데이터 없음)

Emergency glucocorticoid, isotonic fluid, glucose support, and monitoring protocol available

(데이터 없음)

1

Wait for the corticotropin stimulation result before treating.

✕

2

Administer authorized parenteral hydrocortisone and begin isotonic fluid resuscitation immediately.

✕

3

Give the usual oral hydrocortisone dose after the vomiting stops.

✕

4

Restrict sodium and fluids until the potassium result normalizes.

✕

## Explanation

Suspected adrenal crisis requires immediate parenteral hydrocortisone and fluid resuscitation; treatment should not wait for confirmatory testing. Hypoglycemia is corrected when present.

## In-depth explanation

Quick answer
Treat shock plus inability to retain oral steroid as adrenal crisis.

Why this is correct
Cortisol deficiency impairs vascular tone and stress response. Vomiting prevents reliable oral replacement while volume depletion, hyponatremia, hyperkalemia, or hypoglycemia can progress rapidly.

Easy analogy or mental picture
Build a medication safety chain: identify the cue cluster, connect it to the drug mechanism, stop preventable exposure, stabilize the client, and verify the response with measurable findings.

Memory hook
Cue cluster, medication mechanism, protective action, and measurable reassessment.

NCLEX decision rule
Choose the action that prevents the most immediate medication-related harm while preserving treatment for the underlying condition.

Why the other choices are wrong
Options that rely on one reassuring value, continue a suspect exposure, bypass monitoring, or delay escalation leave the medication hazard active.References
1Endocrine Society Guideline: Primary Adrenal InsufficiencyImmediate parenteral hydrocortisone and fluid resuscitation for suspected adrenal crisis before confirmatory results

## Clinical scenario

Medication-safety review
Verify the indication, current assessment, laboratory trend, timing, route, interactions, authorized action, and measurable follow-up.

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