# The emergency nurse reviews the record. Which findings require immediate follow-up? Highlight the findings that support possible adrenal crisis.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=568935&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

The emergency nurse reviews the record. Which findings require immediate follow-up? Highlight the findings that support possible adrenal crisis.

Nurses' Notes
1025:
The client arrived from home by private vehicle accompanied by the spouse. The client is brought to the emergency department after two days of fever and gastrointestinal illness. The client has taken prednisone daily for autoimmune disease for the past eight months. The spouse reports that the client stopped taking prednisone three days ago because the prescription bottle was empty. The client has had six episodes of vomiting since last night and cannot keep liquids or medication down. Chronic fatigue and gradual weight loss were documented at a clinic visit last month without an acute change. The skin has stable darkening over old scars that has been present for months and has not changed recently. On arrival, the blood pressure is 78/44 mm Hg with a weak peripheral pulse. The pulse is 126 beats per minute, respirations are 24 breaths per minute, and oxygen saturation is 96% on room air. The client answers slowly and reports diffuse weakness. Point-of-care testing shows a blood glucose level of 52 mg/dL. The abdomen is mildly tender without rigidity, guarding, or rebound tenderness. Laboratory results show sodium 124 mEq/L and potassium 5.9 mEq/L. The spouse reports one loose stool this morning. The nurse places the client on continuous monitoring, obtains intravenous access, and alerts the emergency provider.

## Explanation

Abrupt steroid interruption, persistent vomiting, severe hypotension, hypoglycemia, hyponatremia, and hyperkalemia form a life-threatening adrenal-crisis pattern. Rapid corticosteroid and fluid treatment is expected after urgent evaluation.

## In-depth explanation

Quick answer
The dangerous pattern is interrupted long-term prednisone, repeated vomiting, blood pressure of 78/44 mm Hg, glucose of 52 mg/dL, and sodium of 124 mEq/L with potassium of 5.9 mEq/L. These cues support possible adrenal crisis.

Why this is correct
During illness, the body needs more cortisol. A client with adrenal suppression who cannot take replacement steroid can develop low blood pressure, low glucose, low sodium, and high potassium.[1] Immediate treatment includes intravenous corticosteroid and saline, often with dextrose.[2]

Easy analogy or mental picture
Think of cortisol as an emergency backup generator. Infection raises demand just as the fuel supply is cut off, so circulation and glucose support fail. The analogy explains the timing, not the exact cause of every laboratory value.

Memory hook
Steroid stopped plus stress: pressure, sugar, and sodium drop; potassium rises.

NCLEX decision rule
When illness or vomiting interrupts chronic glucocorticoids and shock-like findings appear, think adrenal crisis; check circulation and glucose while preparing emergency steroid and fluid treatment.

Why the other choices are wrong
Chronic fatigue, gradual weight loss, stable skin darkening, mild abdominal tenderness, and a normal oxygen saturation can occur in the background. They do not explain the abrupt circulatory and metabolic collapse as strongly as the selected cues.References

- [1]NIDDK: Adrenal Insufficiency Definition and FactsNational Institute of Diabetes and Digestive and Kidney Diseases

- [2]NIDDK: Treatment for Adrenal InsufficiencyNational Institute of Diabetes and Digestive and Kidney Diseases

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