Author Question: A patient is given 1 mg of dexamethasone at 11:00 PM; a plasma cortisol level recorded at 8:00 PM ... (Read 6 times)

KimWrice · **on:** Jul 23, 2018

A patient is given 1 mg of dexamethasone at 11:00 PM; a plasma cortisol level recorded at 8:00 PM the next day is normal. The nurse knows that this is an indication the patient has what condition?

a. Addison's disease
b. Congenital adrenal hyperplasia
c. Cushing's syndrome
d. Secondary adrenal insufficiency

Question 2

A patient who has been newly diagnosed with adrenal hormone deficiency will begin taking hydrocortisone. The nurse provides teaching for this patient. Which statement by the patient indicates understanding of the teaching?

a. I may take all of my daily dose in the morning or divide it in half and take it twice daily.
b. I will need to take this medication until my symptoms completely clear, and then I may stop.
c. Side effects are common with hydrocortisone, even with therapeutic doses.
d. When I am sick, I should take three times the normal dose for 3 days in a row.

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

Answer to Question 1

ANS: C
The overnight dexamethasone suppression test, which is performed by administering dexamethasone as described, is used to diagnose Cushing's syndrome. In normal individuals, dexamethasone suppresses the release of adrenocorticotropic hormone (ACTH), thereby suppressing the synthesis and release of cortisol, which results in a low cortisol level. In patients with Cushing's syndrome, the cortisol level is normal or only mildly low. This is not an indication of Addison's disease, which is diagnosed by administering cosyntropin. Neither test is useful for diagnosing congenital adrenal hyperplasia or secondary adrenal insufficiency.

Answer to Question 2

ANS: D
Patients who take hydrocortisone as replacement need to be taught to increase their daily dose during times of stress, because the drug causes adrenal suppression, and the adrenals will not be able to release cortisone as usual during stress. A general rule of thumb is the 3 by 3 rule: take 3 times the usual dose for 3 days when sick. The daily dose is usually given once in the morning; if late-day fatigue occurs, patients may split the dose and take two-thirds in the morning and one-third in the late afternoon or evening. Treatment is lifetime. Side effects are uncommon when hydrocortisone is given in therapeutic doses.