A 47-year-old client presents to the emergency department with severe hypotension, muscle weakness, fatigue, and vomiting. Labs reveal a potassium level of 6.1 mEq/L and a sodium level of 128 mEq/l. Which of the following should the nurse anticipate for this client?

  1. administration of IV spironolactone
  2. boluses of Lactated Ringer’s to increase blood pressure
  3. administration of IV saline, dextrose, or hydrocortisone
  4. boluses of 0.45% normal saline with 40 mEq/L of potassium
Number 3 is correct.
Rationale: This client is experiencing acute adrenal insufficiency, or Addisonian crisis. This is a life-threatening event if left untreated. Treatment consists of IV saline, dextrose, or hydrocortisone. IV spironolactone would not be given, since it is a potassium-sparing diuretic. Boluses of normal saline or dextrose 5% in normal saline are the fluids of choice to deliver medications and restore fluid balance. Since the client is hyperkalemic, fluids containing potassium would not be given. Also, potassium is never given as a bolus due to the risk of cardiac dysrhythmias.