👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-08-23🏷️ Pharmacological Therapies🔖 Free to read, print, and share
Also known as: cortisol replacement · steroid replacement · glucocorticoid
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Use this quick-reference guide to spot, treat, and prevent Hydrocortisone Replacement on the NCLEX. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
📌 Use
Addison disease, adrenal insuff
Replaces cortisol
🎓 Teach
NEVER abruptly stop → crisis
Stress dose: illness, surgery
Take w/ food, AM dosing
🧪 Monitor
Weight, BP, glucose
Wear medical alert bracelet
🚩 Report
Addisonian crisis: ↓BP, shock
Cushingoid: moon face, edema
Infection signs masked
📚 Hydrocortisone Replacement — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Hydrocortisone replacement provides physiologic glucocorticoid (cortisol) for patients with adrenal insufficiency, such as Addison disease or after adrenalectomy. Unlike high-dose anti-inflammatory steroid use, this is lifelong replacement that must never be stopped abruptly to avoid adrenal crisis. Doses must be increased ('stress dosing') during illness, surgery, or major stress because the body cannot mount its own cortisol response.
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Key points
Understand these first
Replaces deficient cortisol in primary (Addison) or secondary adrenal insufficiency; therapy is lifelong.
Must never be stopped abruptly because sudden withdrawal precipitates life-threatening adrenal (Addisonian) crisis.
Stress dosing: the dose must be increased during illness, infection, trauma, or surgery.
Often given to mimic the body's rhythm (larger dose in the morning, smaller in the afternoon).
Long-term or excess dosing causes Cushingoid effects: hyperglycemia, weight gain, infection risk, osteoporosis, and GI ulcers.
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Nursing priorities
What to do, in order
Teach the patient never to stop the drug suddenly and to taper only under provider direction.
Educate on stress dosing (sick-day rules) and ensure access to an emergency injectable hydrocortisone kit.
Monitor for signs of adrenal crisis: hypotension, weakness, nausea, and hyperkalemia.
Monitor blood glucose, weight, blood pressure, and signs of infection.
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Red flags — report now
Escalate immediately
Adrenal crisis — severe hypotension, profound weakness, vomiting, and confusion; emergency, give IV hydrocortisone and fluids.
Abrupt discontinuation — never stop replacement steroids suddenly.
Signs of infection may be masked by steroids; fever or wound changes must be reported promptly.
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Labs & values
Numbers to know
Serum sodium 135-145 mEq/L (often low in adrenal insufficiency)
Serum potassium 3.5-5.0 mEq/L (often high in adrenal insufficiency)
Fasting blood glucose 70-99 mg/dL (may rise with steroids)
Morning serum cortisol used to assess adrenal function
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Patient teaching
What patients must know
Take steroids exactly as prescribed and never stop them abruptly.
Follow sick-day rules: increase the dose during illness, fever, or surgery as instructed.
Carry medical alert identification and an emergency hydrocortisone injection kit.
Take oral doses with food to reduce stomach upset and ulcer risk.
Report signs of infection, severe fatigue, dizziness, vomiting, or rapid weight change.
❓ Hydrocortisone Replacement: NCLEX FAQs
What are the priority nursing interventions for Hydrocortisone Replacement?
Teach the patient never to stop the drug suddenly and to taper only under provider direction. Educate on stress dosing (sick-day rules) and ensure access to an emergency injectable hydrocortisone kit. Monitor for signs of adrenal crisis: hypotension, weakness, nausea, and hyperkalemia. Monitor blood glucose, weight, blood pressure, and signs of infection.
What are the warning signs of Hydrocortisone Replacement a nurse must report?
Adrenal crisis — severe hypotension, profound weakness, vomiting, and confusion; emergency, give IV hydrocortisone and fluids. Abrupt discontinuation — never stop replacement steroids suddenly. Signs of infection may be masked by steroids; fever or wound changes must be reported promptly.
What do I need to know about Hydrocortisone Replacement for the NCLEX?
Replaces deficient cortisol in primary (Addison) or secondary adrenal insufficiency; therapy is lifelong. Must never be stopped abruptly because sudden withdrawal precipitates life-threatening adrenal (Addisonian) crisis. Stress dosing: the dose must be increased during illness, infection, trauma, or surgery. Often given to mimic the body's rhythm (larger dose in the morning, smaller in the afternoon).
What patient teaching is important for Hydrocortisone Replacement?
Take steroids exactly as prescribed and never stop them abruptly. Follow sick-day rules: increase the dose during illness, fever, or surgery as instructed. Carry medical alert identification and an emergency hydrocortisone injection kit. Take oral doses with food to reduce stomach upset and ulcer risk.
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Quick Tip
Replaces deficient cortisol in primary (Addison) or secondary adrenal insufficiency; therapy is lifelong.