Nokea
The following scenario applies to the next 1 items.
The nurse is caring for a client in the emergency department (ED) with an altered level of consciousness
Item 1 of 1
History and Physical
A 53-year-old male presented to the emergency department (ED) with his wife because the client had become quite tired over the past several days. Today, he was difficult to arouse and spoke incoherently. The client responded to his name during the assessment but did not answer any other questions. Peripheral pulses were thready. Obvious tenting was noted in the skin, which was warm and quite dry. No facial drooping was observed, and when asked to hold out his arms, he could not perform the task. In fact, he did not have many purposeful movements during the exam. The client has a medical history of gout, bipolar disorder, and hypothyroidism, for which he takes levothyroxine, allopurinol, and quetiapine. She reports that he has been taking his medications as prescribed. However, she noted he was recently placed on Prednisone 20 mg PO BID for a gout flare. He self-discontinued the drug after taking it for two weeks and feeling better, and he did not taper as directed.
Vital Signs
Temperature 98.0° F (37° C)
Pulse 121/minute
Respirations 16/minute
Blood Pressure 90/60 mm Hg
Pulse oximetry 95% on room air
Diagnostics
12-lead electrocardiogram: sinus tachycardia with peaked T waves
Complete the sentence below by dragging one (1) condition and one (1) assessment finding. The client is at highest risk for............. related to the client's...........
Correct Answer: C, D
Rationale: Abrupt cessation of prednisone in a client on chronic steroids can precipitate adrenal crisis due to suppressed adrenal function. Altered consciousness, thready pulses, and dehydration support this risk.