Adult Health Nursing Flashcards

A patient with Addison's disease is brought to the emergency department in crisis. Which intervention is highest priority?

Answer: Administer IV hydrocortisone and normal saline immediately

Addisonian crisis is life-threatening acute adrenal insufficiency characterized by severe hypotension, hyponatremia, hyperkalemia, and hypoglycemia. IV hydrocortisone replaces deficient cortisol and IV normal saline corrects hypovolemia.

Which assessment indicates a patient with hypothyroidism is experiencing myxedema coma?

Answer: Altered consciousness, hypothermia, bradycardia, and hypoventilation

Myxedema coma is a life-threatening complication of severe hypothyroidism presenting with impaired consciousness, hypothermia (<35°C), bradycardia, hypotension, and respiratory depression. IV thyroxine and supportive care are required.

A patient on heparin infusion develops a platelet count drop from 250,000 to 60,000 over 5 days with a new clot. What condition is most likely?

Answer: Heparin-induced thrombocytopenia type 2 (HIT)

HIT type 2 is an immune-mediated reaction to heparin-platelet factor 4 complexes, causing platelet destruction and paradoxical thrombosis. The 4T score (Thrombocytopenia, Timing, Thrombosis, oTher causes) aids diagnosis. Stop all heparin immediately.

Which intervention is priority for a patient in status epilepticus lasting more than 5 minutes?

Answer: Administer IV lorazepam or diazepam and protect the airway

Status epilepticus (continuous seizure >5 minutes) is a neurological emergency. First-line treatment is IV benzodiazepines (lorazepam, diazepam, or midazolam). Airway protection and preventing hypoxia are simultaneous priorities. Never place objects in the mouth.

A post-operative patient suddenly develops fever of 38.5°C on day 1. What is the most likely cause?

Answer: Atelectasis due to shallow breathing post-anesthesia

Fever in the first 24–48 hours post-operatively is most commonly caused by atelectasis (collapsed alveoli from shallow breathing, pain, and immobility). Incentive spirometry, deep breathing, and ambulation are the treatment. Wound infections typically present after day 5.

Which electrolyte disturbance is most dangerous in a patient receiving digoxin therapy?

Answer: Hypokalemia

Hypokalemia potentiates digoxin toxicity because potassium and digoxin compete for the same binding site on Na+/K+-ATPase. Low potassium means digoxin has less competition, increasing its effect and causing toxicity even at therapeutic levels.