Chapter 45: Assessment and Management of Patients with Endocrine Disorders

16. A client with suspected adrenal insufficiency has been ordered an adrenocorticotropic hormone (ACTH) stimulation test. Administration of ACTH caused a marked increase in the client's cortisol levels. How should the nurse interpret this finding? A. The client's pituitary function is compromised. B. The client's adrenal insufficiency is not treatable. C. The client has insufficient hypothalamic function. D. The client would benefit from surgery.

ANS: A Rationale: An adrenal response to the administration of a stimulating hormone suggests inadequate production of the stimulating hormone. In this case, ACTH is produced by the pituitary and, consequently, pituitary hypofunction is suggested. Hypothalamic function is not relevant to the physiology of this problem. Treatment exists, although surgery is not likely indicated.

2. A client with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been removed. The nurse caring for the client should prioritize what question when addressing potential complications? A. "Do you feel any muscle twitches or spasms?" B. "Do you feel flushed or sweaty?" C. "Are you experiencing any dizziness or lightheadedness?" D. "Are you having any pain that seems to be radiating from your bones?"

ANS: A Rationale: As the blood calcium level falls, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This is characteristic of hypoparathyroidism. Flushing, diaphoresis, dizziness, and pain are atypical signs of the resulting hypocalcemia.

27. A client with Cushing syndrome as a result of a pituitary tumor has been admitted for a transsphenoidal hypophysectomy. What would be most important for the nurse to monitor before, during, and after surgery? A. Blood glucose B. Assessment of urine for blood C. Weight D. Oral temperature

ANS: A Rationale: Before, during, and after this surgery, blood glucose monitoring and assessment of stools for blood are carried out. The client's blood sugar is more likely to be volatile than body weight or temperature. Hematuria is not a common complication.

22. Following an addisonian crisis, a client's adrenal function has been gradually regained. The nurse should ensure that the client knows about the need for supplementary corticosteroid therapy in which circumstance? A. A significant illness B. Periods of dehydration C. Episodes of physical exertion D. Administration of a vaccine

ANS: A Rationale: During stressful procedures, significant illnesses, or for clients in the third trimester of pregnancy, additional supplementary therapy with corticosteroids is required to prevent addisonian crisis. Physical activity, dehydration, and vaccine administration would not normally add significant stress and would not require supplemental therapy.

18. The nurse is assessing a diverse group of clients. What client is at a greater risk for the development of hypothyroidism? A. A 75-year-old female client with osteoporosis B. A 50-year-old male client who is obese C. A 45-year-old female client who uses oral contraceptives D. A 25-year-old male client who uses recreational drugs

ANS: A Rationale: Even though osteoporosis is not a risk factor for hypothyroidism, the condition occurs most frequently in older women. Younger men and women generally face a lower risk.

36. While reviewing a client's medical record, the nurse notes that the client has hypothyroidism resulting from dysfunction of the thyroid gland itself. The nurse identifies this as which type of hypothyroidism? A. primary B. central C. secondary D. tertiary

ANS: A Rationale: Often clients with hypothyroidism may have primary (thyroidal) hypothyroidism, which refers to dysfunction of the thyroid gland itself. If the cause of the thyroid dysfunction is failure of the pituitary gland, the hypothalamus, or both, then the hypothyroidism is known as central hypothyroidism. If the cause is entirely a pituitary disorder, then it may be referred to as pituitary, or secondary, hypothyroidism. If the cause is a disorder of the hypothalamus resulting in inadequate secretion of TSH due to decreased stimulation by TRH, then it is referred to as hypothalamic, or tertiary, hypothyroidism.

11. A client presents at the walk-in clinic reporting diarrhea and vomiting. The client has a documented history of adrenal insufficiency. Considering the client's history and current symptoms, the nurse should anticipate that the client will be instructed to increase intake of: A. sodium. B. potassium. C. simple carbohydrates. D. calcium.

ANS: A Rationale: The client will need to supplement dietary intake with added salt during episodes of GI losses of fluid through vomiting and diarrhea to prevent the onset of addisonian crisis. While the client may experience the loss of other electrolytes, the major concern is the replacement of lost sodium.

26. A client with Cushing syndrome has been hospitalized after a fall. The dietitian works with the client to improve the client's nutritional intake. What foods should a client with Cushing syndrome eat to optimize health? Select all that apply. A. Foods high in vitamin D B. Foods high in calories C. Foods high in protein D. Foods high in calcium E. Foods high in sodium

ANS: A, C, D Rationale: Foods high in vitamin D, protein, and calcium are recommended to minimize muscle wasting and osteoporosis. Referral to a dietitian may assist the client in selecting appropriate foods that are also low in sodium and calories.

37. A 45-year-old client has been admitted to the hospital for a hypertensive crisis. The health care provider (HCP) has ruled out a cerebrovascular accident (CVA) but suspects pheochromocytoma. What additional signs and symptoms would further confirm this diagnosis as correct? Select all that apply. A. hypermetabolism B. hyperkalemia C. hyperglycemia D. hyperhidrosis E. hyperpigmentation

ANS: A, C, D Rationale: Pheochromocytoma is suspected if the client has hypertension along with signs of nervous system overactivity. The five signs of this condition are: hypertension, headache, hyperhidrosis, hypermetabolism and hyperglycemia. Pheochromocytoma is a rare tumor of the adrenal medulla. The tumor is the cause of hypertension and is usually fatal if undetected and untreated. While this condition can happen at any age, it usually occurs between ages 40 and 50. A client with this condition typically has hypokalemia (low potassium). Hyperpigmentation is associated with Addison disease.

34. A nurse is assessing a client with acromegaly. Which finding(s) would the nurse most likely assess? Select all that apply. A. Enlarged feet B. Height greater than 7 feet C. Broad nose D. Enlarged tongue E. Carpal tunnel syndrome

ANS: A, C, D, E Rationale: With acromegaly, the excessive skeletal growth occurs only in the feet, the hands, and the superciliary ridge (bony ridge located above the eye sockets). Facial features (nose, lips, ears, and forehead) become broader and larger, the tongue enlarges, the space between the teeth increases, and the lower jaw grows, resulting in an underbite and extended lower jaw. Enlargement also can involve all tissues and organs of the body. As an example, because of soft tissue enlargement, carpal tunnel syndrome can also occur. Height over 7 feet is associated with gigantism, which occurs in children.

9. The nurse is performing a shift assessment of a client with aldosteronism. What priority assessment(s) should the nurse include that relate to this condition? Select all that apply. A. Urine output B. Signs or symptoms of venous thromboembolism C. Peripheral pulses D. Blood pressure E. Skin integrity

ANS: A, D Rationale: The principal action of aldosterone is to conserve body sodium. Alterations in aldosterone levels consequently affect urine output and blood pressure (BP). Hypertension is the most prominent and almost universal sign of primary aldosteronism. The client's peripheral pulses, risk of venous thromboembolism (VTE), and skin integrity are not typically affected by aldosteronism.

4. The nurse is caring for a client with Addison disease who is scheduled for discharge. When teaching the client about hormone replacement therapy, the nurse should address what topic? A. The possibility of precipitous weight gain B. The need for lifelong steroid replacement C. The need to match the daily steroid dose to immediate symptoms D. The importance of monitoring liver function

ANS: B Rationale: Because of the need for lifelong replacement of adrenal cortex hormones to prevent addisonian crises, the client and family members receive explicit education about the rationale for replacement therapy and proper dosage. Doses are not adjusted on a short-term basis. Weight gain and hepatotoxicity are not common adverse effects.

31. A client who has been taking corticosteroids for several months is experiencing muscle wasting. The client has asked the nurse for suggestions to address this adverse effect. What should the nurse recommend? A. Activity limitation to conserve energy B. Consumption of a high-protein diet C. Use of over-the-counter (OTC) vitamin D and calcium supplements D. Passive range-of-motion exercises

ANS: B Rationale: Muscle wasting can be partly addressed through increased protein intake. Passive ROM exercises maintain flexibility, but do not build muscle mass. Vitamin D and calcium supplements do not decrease muscle wasting. Activity limitation would exacerbate the problem.

39. A client is receiving pharmacologic therapy for treatment of hyperthyroidism and is prescribed propylthiouracil (PTU). When developing this client's plan of care, the nurse integrates understanding that this drug: A. suppresses release of thyroid hormone. B. blocks synthesis of T3 to T4. C. reduces the amount of thyroid tissue. D. destroys overactive thyroid cells.

ANS: B Rationale: PTU blocks the synthesis of hormones, the conversion of T3 to T4. Sodium or potassium iodide (SSKI) and dexamethasone suppress the release of thyroid hormones. Thyroid hormones aid in reducing the amount of thyroid tissue and may be given with antithyroid medications to put the thyroid gland at rest. Radioactive iodine is used to destroy overactive thyroid cells.

38. A client with hyperthyroidism is being treated with radioactive iodine therapy. After receiving the dose of radioiodine, the nurse would assess the client for: A. hypothyroidism. B. thyroid storm. C. hypothermia. D. agranulocytosis.

ANS: B Rationale: Radioactive iodine ablation initially causes an acute release of thyroid hormone from the thyroid gland and may cause an increase of symptoms. The client is observed for signs of thyroid storm, not hypothyroidism. Hyperpyrexia, not hypothermia, is associated with thyroid storm. Agranulocytosis is a complication associated with antithyroid drug therapy.

33. A nurse is providing care to a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse understands that the primary problem involves the: A. anterior pituitary gland. B. posterior pituitary gland. C. thyroid gland. D. adrenal gland.

ANS: B Rationale: The posterior lobe of the pituitary gland secretes antidiuretic hormone (ADH), also known as vasopressin; too little ADH results in diabetes insipidus (DI), while too much ADH leads to syndrome of inappropriate antidiuretic hormone (SIADH). SIADH is not associated with a problem involving the anterior pituitary, thyroid, or adrenal glands.

15. A client with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is being cared for on the critical care unit. What is the priority nursing diagnosis for a client with this condition? A. Risk for peripheral neurovascular dysfunction B. Excess fluid volume C. Hypothermia D. Ineffective airway clearance

ANS: B Rationale: The priority nursing diagnosis for a client with SIADH is excess fluid volume, as the client retains fluids and develops a sodium deficiency. Restricting fluid intake is a typical intervention for managing this syndrome. Temperature imbalances are not associated with SIADH. The client is not at risk for neurovascular dysfunction or a compromised airway.

20. The nurse's assessment of a client with thyroidectomy suggests tetany, and a review of the most recent blood work corroborates this finding. The nurse should prepare to administer what intervention? A. Oral calcium chloride and vitamin D B. IV calcium gluconate C. STAT levothyroxine D. Administration of parathyroid hormone (PTH)

ANS: B Rationale: When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. This has a much faster therapeutic effect than PO calcium or vitamin D supplements. PTH and levothyroxine are not used to treat this complication.

35. A 40-year-old male client with a history of childhood non-Hodgkin lymphoma and radiation treatment is being admitted for thyroid cancer. The client is a commercial airline pilot, does not smoke, exercises regularly, and eats mostly take-out food. What risk factors are primarily associated with his diagnosis? A. Childhood cancer and physical activity B. Employment and smoking history C. Age and radiation history D. Dietary choices and gender

ANS: C Rationale: Cancer of the thyroid is less prevalent than other forms of cancer, but the incidence of the condition is increasing. Thyroid cancer is more likely to develop in clients younger than 50 years old. Exposure to radiation or external radiation of the head, neck or chest in infancy and childhood increases the risk of this condition. Women, not men, are at a greater risk for this condition. Additional risk factors include smoking, low physical activity, unhealthy eating habits, and high stress levels.

6. A nurse caring for a client with diabetes insipidus is reviewing laboratory results. What is an expected urinalysis finding? A. Glucose in the urine B. Albumin in the urine C. Highly dilute urine D. Leukocytes in the urine

ANS: C Rationale: Clients with diabetes insipidus produce an enormous daily output of very dilute, water-like urine with a specific gravity of 1.001 to 1.005. The urine contains no abnormal substances such as glucose or albumin. Leukocytes in the urine are not related to the condition of diabetes insipidus, but if present would indicate a urinary tract infection.

23. A 30-year-old female client has been diagnosed with Cushing syndrome. What psychosocial nursing diagnosis should the nurse prioritize when planning the client's care? A. Decisional conflict related to treatment options B. Spiritual distress related to changes in cognitive function C. Disturbed body image related to changes in physical appearance D. Powerlessness related to disease progression

ANS: C Rationale: Cushing syndrome causes characteristic physical changes that are likely to result in disturbed body image. Decisional conflict and powerlessness may exist, but disturbed body image is more likely to be present. Cognitive changes take place in clients with Cushing syndrome, but these may or may not cause spiritual distress.

7. The nurse caring for a client with Cushing syndrome is describing the dexamethasone suppression test scheduled for tomorrow. What does the nurse explain that this test will involve? A. Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3 hours B. Administration of dexamethasone IV, followed by an x-ray of the adrenal glands C. Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next morning D. Administration of dexamethasone intravenously, followed by a plasma cortisol level 3 hours after the drug is given

ANS: C Rationale: Dexamethasone (1 mg) is given orally at 11 PM, and a plasma cortisol level is obtained at 8 AM the next morning. This test can be performed on an outpatient basis and is the most widely used and sensitive screening test for diagnosis of pituitary and adrenal causes of Cushing syndrome.

13. A client has returned to the floor after having a thyroidectomy for thyroid cancer. What laboratory finding may be an early indication of parathyroid gland injury or removal? A. Hyponatremia B. Hypophosphatemia C. Hypocalcemia D. Hypokalemia

ANS: C Rationale: Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result in a decline of calcium levels (hypocalcemia). As the blood calcium levels fall, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This group of symptoms is known as tetany and must be reported to the health care provider immediately because laryngospasm may occur and obstruct the airway. Hypophosphatemia, hyponatremia, and hypokalemia are not expected responses to parathyroid injury or removal. In fact, parathyroid removal or injury that results in hypocalcemia may lead to hyperphosphatemia.

5. A client is prescribed corticosteroid therapy. What would be priority information for the nurse to give the client who is prescribed long-term corticosteroid therapy? A. The client's diet should be low protein with ample fat. B. The client may experience short-term changes in cognition. C. The client is at an increased risk for developing infection. D. The client is at a decreased risk for development of thrombophlebitis and thromboembolism.

ANS: C Rationale: The client is at increased risk of infection and masking of signs of infection. The cardiovascular effects of corticosteroid therapy may result in development of thrombophlebitis or thromboembolism. The diet should be high in protein with limited fat. Changes in appearance usually disappear when therapy is no longer necessary. Cognitive changes are not common adverse effects.

1. A client has been admitted to the postsurgical unit following a thyroidectomy. To promote comfort and safety, how should the nurse best position the client? A. Side-lying with one pillow under the head B. Head of the bed elevated 30 degrees and no pillows placed under the head C. Semi-Fowler with the head supported on two pillows D. Supine, with a small roll supporting the neck

ANS: C Rationale: When moving and turning the client, the nurse carefully supports the client's head and avoids tension on the sutures. The most comfortable position is the semi-Fowler position, with the head elevated and supported by pillows.

40. The nurse is providing education to a client that is to undergo a thyroidectomy. When planning care for this client, the nurse should include which example in their education? A. Pharmacological therapy is not necessary prior to the surgery. B. Symptoms of the disease will disappear immediately after surgery. C. Balance periods of activity and exercise with rest. D. There is no risk for hypothyroidism after the surgery.

ANS: C Rationale: Due to the fatigue of the disease process itself and the stress of surgery, there needs to be an even balance of activity and rest for the client. Pharmacological therapy is needed prior to surgery. Symptoms of the disease will gradually taper off after surgery. There is a risk for hypothyroidism after surgery due to the partial or complete removal of thyroid gland.

24. A client with pheochromocytoma has been admitted for an adrenalectomy to be performed the following day. To prevent complications, the nurse should anticipate preoperative administration of which of the following? A. IV antibiotics B. Oral antihypertensives C. Parenteral nutrition D. IV corticosteroids

ANS: D Rationale: IV administration of corticosteroids (methylprednisolone sodium succinate may begin on the evening before surgery and continue during the early postoperative period to prevent adrenal insufficiency. Antibiotics, antihypertensives, and parenteral nutrition do not prevent adrenal insufficiency or other common complications of adrenalectomy.

10. The home care nurse is conducting client teaching with a client on corticosteroid therapy. To achieve consistency with the body's natural secretion of cortisol, when should the home care nurse instruct the client to take the corticosteroids? A. In the evening between 4 PM and 6 PM B. Prior to going to sleep at night C. At noon every day D. In the morning between 7 AM and 8 AM

ANS: D Rationale: In keeping with the natural secretion of cortisol, the best time of day for the total corticosteroid dose is in the morning from 7 to 8 AM. Large-dose therapy at 8 AM, when the adrenal gland is most active, produces maximal suppression of the gland. Also, a large 8 AM dose is more physiologic because it allows the body to escape effects of the steroids from 4 PM to 6 AM, when serum levels are normally low, thus minimizing cushingoid effects.

12. The nurse is caring for a client with hyperparathyroidism. What level of activity would the nurse expect to promote? A. Complete bed rest B. Bed rest with bathroom privileges C. Out of bed (OOB) to the chair twice a day D. Ambulation and activity as tolerated

ANS: D Rationale: Mobility, through walking or use of a rocking chair for those with limited mobility, is encouraged as much as possible because bones subjected to normal stress give up less calcium. Bed rest should be discouraged because it increases calcium excretion and the risk of renal calculi. Limiting the client to getting out of bed only a few times a day also increases calcium excretion and the associated risks.

32. The nurse is providing care for an older adult client whose current medication regimen includes levothyroxine. As a result, the nurse should be aware of the heightened risk of adverse sedation effects when administering an intravenous (IV) dose of what medication? A. A fluoroquinolone antibiotic B. A loop diuretic C. A proton pump inhibitor (PPI) D. A benzodiazepine

ANS: D Rationale: Oral thyroid hormones interact with many other medications. Even in small IV doses, hypnotic and sedative agents may induce profound somnolence, lasting far longer than anticipated and leading to narcosis (stupor-like condition). Furthermore, they are likely to cause respiratory depression, which can easily be fatal because of decreased respiratory reserve and alveolar hypoventilation. Benzodiazepine is a sedative and may be used to treat seizures and alcohol withdrawal. Concurrent usage with levothyroxine can increase benzodiazepine's sedation effects. Concurrent use of fluoroquinolone antibiotics can decrease absorption of the antibiotic. A loop diuretic and proton pump inhibitor IV have no adverse sedation effects. A PPI taken in pill form can inhibit levothyroxine absorption if taken together.

19. A client is admitted to a surgical unit after a thyroidectomy. The nurse takes and maintains the inflated blood pressure cuff on the client and observes a carpopedal spasm. What does this result indicate? A. Chvostek sign and hypocalcemia B. Thyroid storm and elevated triiodothyronine C. Homans sign and deep vein thrombosis D. Trousseau sign and overt tetany

ANS: D Rationale: The Trousseau sign is positive when carpopedal spasm (spasms of the hand or, less commonly, the feet) is induced by occluding the blood flow to the arm for 3 minutes and indicates tetany. Chvostek sign is positive when a sharp tapping over the facial nerve causes spasm, or twitching of the mouth, nose and eye. Chvostek sign also indicates tetany (neuronal excitability), which is usually associated with hypocalcemia. This result is not the product of a thyroid storm, which involves the excessive release of thyroid hormones given the client's surgery. Although blood pressure can be acquired on the leg; this is not the test for the Homans sign. A positive Homans sign is pain in the calf of the leg upon dorsiflexion of the foot and would suggest a deep vein thrombosis (DVT).

25. The nurse providing care for a client with Cushing syndrome has identified the nursing diagnosis of risk for injury related to weakness. How should the nurse best reduce this risk? A. Establish fall-prevention measures. B. Encourage bed rest whenever possible. C. Encourage the use of assistive devices. D. Provide constant supervision.

ANS: A Rationale: The nurse should take action to limit the client's risk for falls. However, bed rest has too many harmful effects, and assistive devices may or may not be necessary. Constant supervision is not normally required or practicable.

8. The nurse is developing a care plan for a client with Cushing syndrome. What nursing diagnosis should the nurse prioritize? A. Risk for injury related to weakness B. Ineffective breathing pattern related to muscle weakness C. Risk for loneliness related to disturbed body image D. Autonomic dysreflexia related to neurologic changes

ANS: A Rationale: The nursing priority is to decrease the risk of injury by establishing a protective environment. The client who is weak may require assistance from the nurse in ambulating to prevent falls or bumping corners of furniture. The client's breathing will not be affected, and autonomic dysreflexia is not a plausible risk. Loneliness may or may not be an issue for the client, but safety is a priority.

14. The nurse is planning the care of a client with hyperthyroidism. What should the nurse specify in the client's meal plan? A. A reduced calorie diet, high in nutrients B. Small, frequent meals, high in protein and calories C. Three large, bland meals a day D. A diet high in fiber and plant-sourced fat

ANS: B Rationale: A client with hyperthyroidism has an increased appetite. The client should be counseled to consume several small, well-balanced meals. High-calorie, high-protein foods are encouraged. A clear liquid diet would not satisfy the client's caloric or hunger needs. A diet rich in fiber and fat should be avoided because these foods may lead to GI upset or increase peristalsis.

28. What should the nurse teach a client on corticosteroid therapy in order to reduce the client's risk of adrenal insufficiency? A. Take the medication late in the day to mimic the body's natural rhythms. B. Always have enough medication on hand to avoid running out. C. Skip up to 2 doses in cases of illness involving nausea. D. Take up to 1 extra dose per day during times of stress.

ANS: B Rationale: The client and family should be informed that acute adrenal insufficiency and underlying symptoms will recur if corticosteroid therapy is stopped abruptly without medical supervision. The client should be instructed to have an adequate supply of the corticosteroid medication always available to avoid running out. Doses should not be skipped or added without explicit instructions to do so. Corticosteroids should normally be taken in the morning to mimic natural rhythms.

17. The health care provider has ordered a fluid deprivation test for a client suspected of having diabetes insipidus. During the test, the nurse should prioritize what assessments? A. Temperature and oxygen saturation B. Heart rate and blood pressure C. Breath sounds and bowel sounds D. Color, warmth, movement, and sensation of extremities

ANS: B Rationale: The fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until 3% to 5% of the body weight is lost. The client's condition needs to be monitored frequently during the test, and the test is terminated if tachycardia, excessive weight loss, or hypotension develops. Consequently, blood pressure and heart rate monitoring are priorities over the other listed assessments.

29. The nurse is caring for a client at risk for an addisonian crisis. For what associated signs and symptoms should the nurse monitor the client? Select all that apply. A. Epistaxis B. Pallor C. Rapid respiratory rate D. Bounding pulse E. Hypotension

ANS: B, C, E Rationale: The client at risk is monitored for signs and symptoms indicative of addisonian crisis, which can include shock; hypotension; rapid, weak pulse; rapid respiratory rate; pallor; and extreme weakness. Epistaxis and a bounding pulse are not symptoms or signs of an addisonian crisis.

3. The nurse is caring for a client with a diagnosis of Addison disease. What sign or symptom is most closely associated with this health problem? A. Truncal obesity B. Hypertension C. Muscle weakness D. Moon face

ANS: C Rationale: Clients with Addison disease demonstrate muscular weakness, anorexia, gastrointestinal symptoms, fatigue, emaciation, dark pigmentation of the skin, and hypotension. Clients with Cushing syndrome demonstrate truncal obesity, "moon" face, acne, abdominal striae, and hypertension.

30. A client has been assessed for aldosteronism and has recently begun treatment. What are priority areas for assessment that the nurse should frequently address? Select all that apply. A. Pupillary response B. Creatinine and BUN levels C. Potassium level D. Peripheral pulses E. Blood pressure

ANS: C, E Rationale: Clients with primary aldosteronism (Conn syndrome) exhibit a profound decline in the serum levels of potassium, and hypertension is the most prominent and almost universal sign of aldosteronism. Pupillary response, peripheral pulses, and renal function are not directly affected.

21. A client has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that the client knows to take what action? A. Take the drug concurrent with levothyroxine. B. Take each dose of prednisone with a dose of calcium chloride. C. Gradually replace the prednisone with an over-the-counter (OTC) alternative. D. Slowly taper down the dose of prednisone, as prescribed.

ANS: D Rationale: Corticosteroid dosages are reduced gradually (tapered) to allow normal adrenal function to return and to prevent steroid-induced adrenal insufficiency. There are no over-the-counter (OTC) substitutes for prednisone, and neither calcium chloride nor levothyroxine addresses the risk of adrenal insufficiency.