Prolonged steroid therapy has caused a child to have Cushing syndrome. To lessen the cushingoid effects, the steroid should be administered at which time?
a. In the PM
b. After lunch
c. QD in the AM
d. QOD in the AM
ANS: D
When cushingoid features are caused by steroid therapy, the effects may be lessened with administration of the drug early in the morning and on an alternate-day basis. Giving the drug early in the day maintains the normal diurnal pattern of cortisol secretion. If given during the evening, it is more likely to produce symptoms because endogenous cortisol levels are normally low and the additional supply exerts more pronounced effects. An alternate-day schedule allows the anterior pituitary an opportunity to maintain more normal hypothalamic–pituitary–adrenal control mechanisms.
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The nurse reviewing the waveform of a patient's central venous pressure line notes two positive waves. Which of the following does this information suggest to the nurse?
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