Nokea
The nurse caring for a patient with Cushing syndrome is describing the dexamethasone suppression test scheduled for tomorrow. What does the nurse explain that this test will involve?
- A. Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3 hours
- B. Administration of dexamethasone IV, followed by an x-ray of the adrenal glands
- C. Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next morning
- D. Administration of dexamethasone intravenously, followed by a plasma cortisol level 3 hours after the drug is administered
Correct Answer: C
Rationale: Dexamethasone (1 mg) is administered orally at 11 PM, and a plasma cortisol level is obtained at 8 AM the next morning. This test can be performed on an outpatient basis and is the most widely used and sensitive screening test for diagnosis of a pituitary function and adrenal causes of Cushing syndrome.
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A patient presents at the walk-in clinic complaining of diarrhea and vomiting. The patient has a documented history of adrenal insufficiency. Considering the patients history and current symptoms, the nurse should anticipate that the patient will be instructed to do which of the following?
- A. Increase his intake of sodium until the GI symptoms improve
- B. Increase his intake of potassium until the GI symptoms improve
- C. Increase his intake of glucose until the GI symptoms improve
- D. Increase his intake of calcium until the GI symptoms improve
Correct Answer: A
Rationale: The patient will need to supplement dietary intake with added salt during episodes of GI losses of fluid through vomiting and diarrhea to prevent the onset of addisonian crisis. While the patient may experience the loss of other electrolytes, the major concern is the replacement of lost sodium.
A patient has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that the patient knows to do which of the following?
- A. Take the drug concurrent with levothyroxine (Synthroid)
- B. Take each dose of prednisone with a dose of calcium chloride
- C. Gradually replace the prednisone with an OTC alternative
- D. Slowly taper down the dose of prednisone, as ordered
Correct Answer: D
Rationale: Corticosteroid dosages are reduced gradually (tapered) to allow normal adrenal function to return and to prevent steroid-induced adrenal insufficiency. There are no OTC substitutes for prednisone and neither calcium chloride nor levothyroxine addresses the risk of adrenal insufficiency.
A patient with a recent diagnosis of hypothyroidism is being treated for an unrelated injury. When administering medications to the patient, the nurse should know that the patients diminished thyroid function may have what effect?
- A. Anaphylaxis
- B. Nausea and vomiting
- C. Increased risk of drug interactions
- D. Prolonged duration of effect
Correct Answer: D
Rationale: In all patients with hypothyroidism, the effects of analgesic agents, sedatives, and anesthetic agents are prolonged. There is no direct increase in the risk of anaphylaxis, nausea, or drug interactions, although these may potentially result from the prolonged half-life of drugs.
A patient with pheochromocytoma has been admitted for an adrenalectomy to be performed the following day. To prevent complications, the nurse should anticipate preoperative administration of which of the following?
- A. IV antibiotics
- B. Oral antihypertensives
- C. Parenteral nutrition
- D. IV corticosteroids
Correct Answer: D
Rationale: IV administration of corticosteroids (methylprednisolone sodium succinate [Solu-Medrol]) may begin on the evening before surgery and continue during the early postoperative period to prevent adrenal insufficiency. Antibiotics, antihypertensives, and parenteral nutrition do not prevent adrenal insufficiency or other common complications of adrenalectomy.
A patient with Cushing syndrome has been hospitalized after a fall. The dietician consulted works with the patient to improve the patients nutritional intake. What foods should a patient with Cushing syndrome eat to optimize health? Select all that apply.
- A. Foods high in vitamin D
- B. Foods high in calories
- C. Foods high in protein
- D. Foods high in calcium
- E. Foods high in sodium
Correct Answer: A,C,D
Rationale: Foods high in vitamin D, protein, and calcium are recommended to minimize muscle wasting and osteoporosis. Referral to a dietitian may assist the patient in selecting appropriate foods that are also low in sodium and calories.