Which nursing intervention is the highest priority for a client with acute adrenal insufficiency presenting with hypotension and dehydration?

• A. Administer furosemide.
• B. Provide isotonic fluids.
• C. Replace potassium losses.
• D. Restricting sodium.

Answer: (B)

The key concept is that adrenal crisis causes severe volume depletion and shock from deficiency of aldosterone and cortisol. The highest nursing priority is to restore circulating blood volume quickly with isotonic fluids. Giving normal saline (isotonic fluid) expands the intravascular compartment, improves preload, raises blood pressure, and enhances perfusion to vital organs, which is essential before addressing other issues.

Diuretic therapy would worsen dehydration and electrolyte losses, so it’s not appropriate in this scenario. Replacing potassium losses isn’t the immediate priority because the fluid deficit and hypotension need attention first, and potassium handling should be addressed after stabilization. Restricting sodium would worsen hyponatremia and dehydration, whereas providing sodium-containing fluids helps correct both volume status and sodium balance. After fluids are started, glucocorticoid replacement (such as IV hydrocortisone) is implemented, with ongoing monitoring of vitals, urine output, and mental status to guide further therapy.