Author Question: A client receives cosyntropin (Cortrosyn). The nurse knows that if plasma cortisol levels fail to ... (Read 11 times)

karlynnae · **on:** Jul 23, 2018

A client receives cosyntropin (Cortrosyn). The nurse knows that if plasma cortisol levels fail to rise after an injection of cosyntropin, the pathology is:

1. idiopathic in nature.
2. at the level of the adrenal gland (primary adrenocortical insufficiency).
3. at the level of the hypothalamus.
4. at the level of the pituitary (secondary adrenocortical insufficiency).

Question 2

A client has been taking corticosteroids. The nurse suspects that the client has a history of adrenocortical insufficiency when the use of which other medication is documented in the record?

1. Isosorbide
2. Ciprofloxacin
3. Fludrocortisone
4. Metformin

cadimas · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

Correct Answer: 2
Rationale 1: Failure of the plasma cortisol levels to rise does not mean that the pathology is idiopathic in nature.
Rationale 2: If plasma cortisol levels fail to rise after an injection of cosyntropin, the pathology is at the level of the adrenal gland (primary).
Rationale 3: Failure of the plasma cortisol levels to rise does not mean that the pathology is at the level of the hypothalamus.
Rationale 4: Failure of the plasma cortisol levels to rise does not mean that the pathology is at the level of the pituitary.
Global Rationale: If plasma cortisol levels fail to rise after an injection of cosyntropin, the pathology is at the level of the adrenal gland (primary). If the levels do rise the pathology is at the level of the hypothalamus or pituitary gland. The test does not determine if the disorder is idiopathic.

Answer to Question 2

Correct Answer: 3
Rationale 1: Isosorbide is not used for adrenocortical insufficiency.
Rationale 2: Ciprofloxacin is not used for adrenocortical insufficiency.
Rationale 3: Clients requiring replacement therapy usually take corticosteroids their entire lifetime, and concurrent therapy with a mineralocorticoid such as fludrocortisone is necessary.
Rationale 4: Metformin is not used for adrenocortical insufficiency.
Global Rationale: Clients requiring replacement therapy usually take corticosteroids their entire lifetime, and concurrent therapy with a mineralocorticoid such as fludrocortisone is necessary. Isosorbide, ciprofloxacin, and metformin are not used as therapy for adrenocortical insufficiency.