Chapter 60: Drugs for Disorders of the Adrenal Cortex

Chapter 60: Drugs for Disorders of the Adrenal Cortex

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. 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:

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.

 

 

ANS:  C

Patients who take steroids need extra steroid before situations that cause stress, such as surgery. Failure to administer the increased dose can prove fatal. For surgeries that cause moderate stress, such as a cholecystectomy, patients should be given 50 mg of hydrocortisone intravenously the day of the procedure, followed by a taper over 1 to 2 days to the usual replacement dose. Giving the usual dose or giving an increased oral dose is not indicated.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 728

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

 

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.”

 

 

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.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 728

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

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

a.	Cosyntropin
b.	Dexamethasone
c.	Fludrocortisone acetate [Florinef]
d.	Ketoconazole [Nizoral]

 

 

ANS:  D

The role of drugs in the treatment of Cushing’s syndrome is limited; drugs are used only as adjuncts to surgery and radiation therapy. The most effective agent is ketoconazole, which suppresses steroid synthesis. Cosyntropin is used to diagnose adrenal insufficiency. Dexamethasone is a glucocorticoid used for replacement therapy and to diagnose Cushing’s syndrome. Fludrocortisone is used for chronic mineralocorticoid replacement.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 727-728

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

4. 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?

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

 

 

ANS:  D

Patients generally take hydrocortisone once daily in the morning to mimic the body’s natural cortisol release cycle. However, some patients develop fatigue late in the day. These patients may split the daily dose, taking two-thirds in the morning and one-third in the afternoon or early evening. Mineralocorticoids are given to maintain intravascular volume and regulate sodium, potassium, and hydrogen, so adding this drug would not help with fatigue. Fatigue is not a sign of steroid toxicity. Increasing the dose is not indicated.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 728

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies