In the preoperative holding area for an adrenalectomy, the client is prescribed intravenous cortisol. What is the nurse's best action?

• A. Request a time out to determine whether this is a valid prescription.
• B. Ask the client whether he or she usually takes prednisone.
• C. Hold the dose because the client has a high cortisol level.
• D. Administer the drug as prescribed.

Answer: (D)

The essential idea here is that after an adrenalectomy the body can no longer produce cortisol, so perioperative glucocorticoid replacement is needed to handle the stress of surgery. Administering intravenous cortisol as prescribed maintains adequate cortisol levels to support vascular tone, glucose regulation, and overall hemodynamic stability during the operation and immediate recovery. Holding the dose or questioning it because cortisol might be high beforehand isn’t appropriate, and past prednisone use doesn’t change the need for this stress-dose replacement in the perioperative period. Administering the drug as prescribed helps prevent adrenal crisis and potential shock. After administration, monitor for expected effects and safety concerns such as glucose elevation, fluid retention, or electrolyte changes.