Question 1

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 that the patient has what condition?

Accepted Answer

A)   Addison's disease
B)   Congenital adrenal hyperplasia
C)   Cushing's syndrome
D)   Secondary adrenal insufficiency C

Question 2

A patient with arthritis is admitted to the hospital. The patient's serum glucose level is 350 gm/dL, and the blood pressure is 182/98 mm Hg. The nurse notes that the patient's face appears rounded and puffy. The patient complains of feeling weak. What will the nurse do?

Accepted Answer

A)   Ask which drugs the patient takes for arthritis.
B)   Contact the provider to discuss whether the patient has a pituitary carcinoma.
C)   Request an order for ketoconazole [Nizoral].
D)   Suspect that this patient has Addison's disease. A

Question 3

A patient who has been taking 25 mg of hydrocortisone each morning for several months reports feeling fatigued late in the day each day. What will the nurse tell the patient to discuss with the provider?

Accepted Answer

A)   Adding a mineralocorticoid to the drug regimen
B)   Assessing serum electrolytes to check for toxicity
C)   Increasing the dose to 50 mg daily
D)   Splitting the daily dose into a morning and an afternoon dose D

Question 4

The nurse is providing patient education about glucocorticoid therapy to a patient preparing to be discharged home. Which statement made by the patient best demonstrates understanding of glucocorticoid therapy?

Accepted Answer

A)   "I will take the entire dose early with breakfast."
B)   "I may take two-thirds of the dose in the morning and one-third in the afternoon."
C)   "I will divide the dose in half and take half in the morning and half in the evening."
D)   "I will take a dose with each meal."

Question 5

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?

Accepted Answer

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 3 times the normal dose for 3 days in a row."

Question 6

A patient is admitted with nausea, vomiting, diarrhea, and abdominal pain. The patient appears emaciated and complains of feeling weak. The nurse notes a heart rate of 98 beats/min and a blood pressure of 88/54 mm Hg. The nurse reviews the chart and notes an increased serum potassium level and a decreased serum sodium level. The nurse expects the provider to order which medication initially?

Accepted Answer

A)   Cosyntropin [Cortrosyn]
B)   Dexamethasone
C)   Fludrocortisone [Florinef]
D)   Hydrocortisone

Question 7

A nurse is explaining congenital adrenal hyperplasia (CAH) to a group of nursing students. Which statement by a student indicates understanding of the teaching?

Accepted Answer

A)   "CAH is caused by a deficiency of ACTH production."
B)   "CAH is the result of an inability to synthesize glucocorticoids."
C)   "Newborn screening provides a definitive diagnosis for CAH"
D)   "The enzyme 21-alpha-hydroxylase increases the production of androgens."

Question 8

The nurse is providing patient education to a patient who will begin taking fludrocortisone [Florinef] as adjunctive therapy to hydrocortisone. Which statement by the patient indicates understanding of the teaching?

Accepted Answer

A)   "I should move from sitting to standing slowly."
B)   "I should report any swelling of my hands and feet."
C)   "I should report weight loss to my provider."
D)   "I should report excessive urine output."

Question 9

A patient who has chronic adrenal insufficiency is admitted to the hospital for an open cholecystectomy. The nurse obtaining the admission history learns that the patient takes hydrocortisone 25 mg PO daily in the morning. The patient's surgery is scheduled for the next morning. The nurse will expect an order to:

Accepted Answer

A)   administer the usual morning dose of hydrocortisone 25 mg PO.
B)   administer hydrocortisone 50 mg PO in the morning.
C)   administer hydrocortisone 50 mg IV before surgery.
D)   withhold the morning dose of hydrocortisone and give it after surgery.

Question 10

A patient with Cushing's syndrome has undergone surgery and radiation treatment. The nurse will expect to teach the patient about which medication?

Accepted Answer

A)   Cosyntropin
B)   Dexamethasone
C)   Fludrocortisone acetate [Florinef]
D)   Ketoconazole [Nizoral]

Exam 60: Drugs for Disorders of the Adrenal Cortex