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?
a. Addison's disease
b. Congenital adrenal hyperplasia
c. Cushing's syndrome
d. Secondary adrenal insufficiency
C
The overnight dexamethasone suppression test, which is performed by administering dexame-thasone as described, is used to diagnose Cushing's syndrome. In normal individuals, dexame-thasone 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.
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A 75-year-old client with cardiac disease describes a decline in the amount of sleep he gets and difficulty falling asleep at night. Which of the following should the nurse consider is occurring with this client?
1. Signs of anxiety and depression 2. Normal signs of aging 3. Normal signs of cardiac disease 4. Normal signs of respiratory disease
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1. White grape juice until 2 hours before the procedure 2. Breast milk until 2 hours before scheduled surgery 3. Infant formula 4 hours before an elective procedure begins 4. Meal containing roast chicken 6 hours before scheduled surgery
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