A nurse is screening clients for adrenal insufficiency. The nurse recognizes that which client is at greatest risk for adrenal insufficiency?
A 19-year-old male on low dose steroids for a week
A 35-year-old female who completed 3 weeks of steroids.
An 80-year-old female who takes steroids daily.
A 45-year old male with COPD who uses intermittent steroids.
The Correct Answer is C
A. A short-term, low-dose steroid use (one week) has minimal risk for adrenal suppression.
B. Three weeks of steroids increases risk, but daily use presents a higher risk.
C. Prolonged daily steroid use, especially in an older adult, poses the greatest risk for adrenal insufficiency due to suppression of the hypothalamic-pituitary-adrenal (HPA) axis.
D. Intermittent steroid use is less likely to cause adrenal insufficiency compared to daily long-term use.
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Correct Answer is D
Explanation
A. Increased insulin production would not cause polyuria and low specific gravity urine; rather, hyperglycemia from lack of insulin can cause high specific gravity due to glucose in urine.
B. Increased ACTH affects cortisol production but is not directly related to urine concentration or polyuria.
C. Low T3 and T4 levels are associated with hypothyroidism, which typically does not cause polyuria or decreased specific gravity.
D. Insufficient ADH, as seen in diabetes insipidus, leads to the inability to concentrate urine, resulting in a low specific gravity, polyuria, and nocturia due to excessive water loss.
Correct Answer is B
Explanation
A. While monitoring serum electrolytes is important, it is secondary to assessing for immediate life-threatening conditions.
B. Monitoring for signs of shock is the priority, as Addisonian crisis can lead to severe hypotension and shock, which requires immediate intervention.
C. Monitoring daily weights can help assess fluid status but is not critical in the context of an impending crisis.
D. Monitoring intake and output is important for overall assessment but does not directly address the immediate risks associated with Addisonian crisis.