In an Addisonian crisis, which intervention should the nurse implement first?

• A. Draw serum electrolyte levels.
• B. Administer methylprednisolone IV.
• C. Start an 18-gauge catheter with normal saline.
• D. Ask the client what medications he or she is taking.

Answer: (C)

In Addisonian crisis the immediate danger is severe volume depletion leading to hypotension and inadequate organ perfusion, so restoring circulating volume is the top priority. The nurse should quickly establish an IV line with a large-bore catheter and begin an isotonic fluid bolus (normal saline) to rapidly expand intravascular volume and stabilize blood pressure. This action directly addresses the life-threatening circulation issue and buys time to implement other treatments, such as electrolyte management and steroid replacement. Drawing electrolyte levels is important for ongoing management but won’t reverse the shock or stabilize the patient right away. Administering steroids is crucial in adrenal crisis, but it’s performed after establishing IV access and starting fluids. Asking about medications is not an urgent intervention in the emergent phase.