PrepU Ch 17: Drug Therapy with Corticosteroids

When explaining the rationale for alternate-day administration of corticosteroids, the nurse would say that it is to: a) maximize the client's adherence to medication tapering. b) minimize the client's susceptibility to the flu. c) minimize the suppression of normal adrenal function. d) maximize the suppression of normal adrenal function.

Minimize the suppression of normal adrenal function. Rationale: Alternate-day therapy (ADT), in which a double dose is taken every other morning, is usually preferred for other chronic conditions. This schedule allows rest periods so that adverse effects are decreased while anti-inflammatory effects continue. ADT is used only for maintenance therapy.

Based on the metabolic action of glucocorticoids, a client who is on long-term glucocorticoid therapy is at risk of developing what disease? a) Osteoporosis b) Bronchoconstriction c) Cryptorchism d) Swelling in the brain and spinal cord

Osteoporosis Rationale: The client who is on long-term glucocorticoid therapy is at risk for osteoporosis due to the reduction in new bone synthesis. Glucocorticoids are used to reduce swelling in the brain and spinal column and to promote bronchodilation. Cryptorchism is the failure of the testes to descend into the scrotum and is not the result of glucocorticoid therapy.

The nurse anticipates an order for a glucocorticoid when caring for a client with what condition? a) septicemia b) hypoglycemia c) arthritis d) appendicitis

arthritis Rationale: Glucocorticoids are indicated for the short-term treatment of many inflammatory disorders, to relieve discomfort, and to give the body a chance to heal from the effects of inflammation. They block the actions of arachidonic acid, which leads to a decrease in the formation of prostaglandins and leukotrienes. Without these chemicals, the normal inflammatory reaction is blocked. Hypoglycemia would more safely be treated with glucose. Appendicitis and septicemia are infections that would contraindicate the use of glucocorticoids because of the immunosuppressant effects of the drugs.

Which finding should alert the nurse to a potential Cushing's syndrome manifestation presented by a client prescribed long-term corticosteroid therapy? a) weight loss b) hair loss c) buffalo hump d) insomnia

buffalo hump Rationale: Signs and symptom of potential Cushing's syndrome manifestations include abdomen that sticks out and thin arms and legs (central obesity); acne; collection of fat between the shoulders (buffalo hump); depression; euphoria not related to life situation; excessive facial hair growth in females; frequent and easy bruising; round, red, and full face; weakness; and weight gain. Cushing's syndrome is not associated with insomnia, hair loss, or weight loss.

A nurse is providing discharge instructions to a client who will be taking fludrocortisone at home. The nurse will encourage the client to eat a diet that is: a) low in sodium, high in potassium. b) low in sodium and potassium. c) high in iron. d) low in proteins.

low in sodium, high in potassium. Rationale: The client should avoid foods that are high in sodium and eat foods that are high in potassium. The client should eat foods rich in proteins because long-term fludrocortisone therapy promotes the deposition of liver glycogen and induces a negative nitrogen balance. Iron-rich food is not typically shown to have therapeutic or adverse effects of fludrocortisone; therefore, it is more important to instruct the client to avoid high-sodium foods and to eat potassium-rich ones.

The nurse is teaching a client who will require long-term corticosteroid therapy how to reduce the risk of infection. What suggestions will the nurse include? a) "Avoid working in areas with other people." b) "Avoid large crowds of people in confined spaces." c) "Avoid touching other people who may carry germs." d) "Avoid exercising to reduce risk of injury."

"Avoid large crowds of people in confined spaces." Rationale: With long-term therapy, the importance of avoiding exposure to infection—crowded areas, people with colds or the flu, activities associated with injury—should be stressed. If an injury or infection should occur, the client should be encouraged to seek medical care. These clients do not need to avoid work, exercise, or touching others but they should use good hand hygiene to avoid infection from these sources.

A 2-year-old client is placed on a course of prednisone following a series of hypersensitivity responses. What instruction the nurse provide the client's family about this drug? a) "Don't stop this medication suddenly; you will have to taper dosage gradually." b) "The child may receive immunizations while on this drug, but keep them to a minimum." c) "Monitor your child closely for any difficulty swallowing or signs of gastric reflux." d) "You might find that your child is sleepier than usual, especially near the beginning of treatment."

"Don't stop this medication suddenly; you will have to taper dosage gradually." Rationale: Prednisone is usually ordered for short-term use with tapering dosage. It is important to instruct the parent to taper doses and to not just stop the drug suddenly when discontinuing from high doses so as to give the adrenal glands a chance to recover and produce adrenocorticoids. Parents should also be told to wait to have the child immunized until after drug therapy is completed. Insomnia or agitation is more likely than drowsiness, and the drug does not create a risk for dysphagia or reflux.

The nurse just completed client education relative to chronic adrenocortical insufficiency and corticosteroid medication treatment. Which statement indicates the client requires further instruction? a) "I will start this medication as soon as I am feeling ill or tired." b) "I will call my health care provider if I develop a fever." c) "I will report any weight gain above 5 pounds in 1 week to my health care provider." d) "I need to minimize my exposure to anyone who may be ill."

"I will start this medication as soon as I am feeling ill or tired." Rationale: Daily administration is required in cases of chronic adrenocortical insufficiency. Clients should be instructed to call their health care provider if a fever above 101°F (38.3°C) develops, minimize exposure to anyone who may be ill, and report any weight gain above 5 pounds in 1 week.

A 45-year-old woman has been taking a corticosteroid and calls the clinic reporting the development of acne-like lesion on her face as well as facial hair. What is the nurse's best response? a) "Sadly, this is an adverse effect seen in women. It should improve when you finish the medication." b) "If you shave it regularly, no one will notice." c) "Stop taking the drug immediately." d) "This is a permanent problem. You will need to schedule electrolysis treatments."

"Sadly, this is an adverse effect seen in women. It should improve when you finish the medication." Rationale: An adverse effect in women who take corticosteroids is acne and hair on the face. This side effect usually resolves after the medication is discontinued. The drug should never be stopped abruptly but weaned gradually.

The home health nurse provides client teaching to a client who is taking oral prednisolone. The nurse provides what instruction to the client? a) "Take before bedtime." b) "Take 1 hour before meals." c) "Split the dose into two equal doses." d) "Take it first thing in the morning."

"Take it first thing in the morning." Rationale: Timing is dictated by frequency of administration, and if only taken once daily, the medication should be taken in the morning (so bedtime is inappropriate). Splitting the dose would decrease effectiveness and would be inappropriate for the nurse to suggest because it is outside the scope of nursing practice. Taking the medication before meals would mean it was being taken on an empty stomach, which can cause gastric upset.

To minimize adrenal suppression, when should the nurse encourage a client to take his or her daily dose of prescribed prednisone? a) "Take your medications in the morning." b) "Take your medication just before bedtime." c) "Take your medications on an empty stomach." d) "Take your medications with the evening meal."

"Take your medications in the morning." Rationale: A major adverse reaction associated with corticosteroid therapy is suppression of the hypothalamic-pituitary-adrenal, or HPA, axis and subsequent loss of adrenocortical function. Scheduling of medication (morning dosing) is often recommended to prevent or minimize HPA suppression. Daily administration is required in cases of chronic adrenocortical insufficiency. The entire daily dose can be taken each morning, between 06:00 and 09:00. This schedule simulates normal endogenous corticosteroid secretion.

A nurse is overseeing the care of a young man whose ulcerative colitis is being treated with oral prednisone. Which action should the nurse take in order to minimize the potential for risks associated with prednisone treatment? a) Advocate for intravenous, rather than oral, administration. b) Avoid OTC antacids for the duration of treatment. c) Teach the client strategies for dealing with headaches. d) Carefully assess the client for infections.

Carefully assess the client for infections. Rationale: It is important to monitor clients who are taking prednisone carefully for signs of infection, because prednisone's immunologic activity may mask the symptoms of infection. Antacids may normally be used alongside prednisone. Headaches are not associated with the use of prednisone and IV administration is not typical.

A female client is diagnosed with adrenal insufficiency. She presents to the emergency department with hypotension. What would the nurse expect her to be prescribed? a) Vasopressors b) Corticosteroids c) ACE inhibitors d) Beta-blockers

Corticosteroids Rationale: In adrenal insufficiency, hypotension is a common symptom in critically ill clients, and hypotension caused by adrenal insufficiency may mimic either hypovolemic or septic shock. If adrenal insufficiency is the cause of the hypotension, administration of corticosteroids can eliminate the need for vasopressor drugs to maintain adequate tissue perfusion.

A female client asks the nurse why her 4-year old son is not receiving corticosteroids. The client read in an article that they are more effective to prevent transplant rejection than the medication that is currently prescribed. What is the appropriate response by the nurse? a) Corticosteroids increase the risk for childhood illness. b) Corticosteroids impair the child's mental status. c) Corticosteroids increase the risk for rejection in children younger than 6 years of age. d) Corticosteroids impair growth in children.

Corticosteroids impair growth in children. Rationale: Most immunosuppressants are used in children for the same disorders and with similar effects as in adults. Corticosteroids impair growth in children. As a result, some transplantation centers avoid prednisone therapy until a rejection episode occurs.

You are caring for a client with cerebral edema caused by trauma. Which of the following medications would you anticipate being administered? a) Cytosine b) Beconase c) Triamcinolone d) Dexamethasone

Dexamethasone Rationale: Dexamethasone is considered the corticosteroid of choice for cerebral edema associated with brain tumors, craniotomy, or head injury because dexamethasone is thought to penetrate the blood-brain barrier more readily and achieve higher concentrations in cerebrospinal fluids and tissues.

The nurse is caring for an 84-year-old client with diabetes who is receiving hydrocortisone 40 mg daily PO for treatment of an arthritic flare-up. When writing a plan of care for this client, which nursing intervention would be most appropriate? a) Restricting dietary protein b) Increasing fluids to 2000 mL per day c) Increasing dietary sodium d) Monitoring blood glucose levels frequently

Monitoring blood glucose levels frequently Rationale: Corticosteroids can cause an increase in the production of glucose and a decrease in its use. This promotes hyperglycemia and can lead to development of diabetes mellitus or aggravation of preexisting diabetes mellitus.

A male client is diagnosed with Addison disease. What daily medication would the nurse expect to be administered? a) Warfarin b) Prednisone c) Hydrochlorothiazide d) Apresoline

Prednisone Rationale: Daily administration of corticosteroids and mineralocorticoids is required in cases of chronic adrenocortical insufficiency (Addison disease).

You are providing client education relative to an inhaled glucocorticoid. You would include which of the following instructions? a) While using the inhaler, hold your breath for 10 seconds to assist in the absorption of the medication. b) Rinse your mouth completely after using the inhaler. c) Do not eat or drink anything for 20 minutes after using the inhaler. d) Forcefully exhale after using the inhaler.

Rinse your mouth completely after using the inhaler. Rationale: To prevent thrush, after using the medicine, you should rinse your mouth with water and spit it out.

When monitoring a client who is receiving mineralocorticoid therapy, which assessment finding would be most important for the nurse to report? a) Slight pedal edema b) Weakness c) Shortness of breath d) Headache

Shortness of breath Rationale: Shortness of breath may be a sign of heart failure and needs to be reported immediately. Headache and weakness are general signs and common adverse effects. The nurse would report these if the client reported they were getting worse or interfering with the client's activities of daily living. Slight pedal edema may or may not be significant.

The nurse is working in a home care setting. A female client is prescribed oral corticosteroids by her health care provider secondary to a diagnosis of Addison disease. What is the nurse's responsibility in this situation? a) Supervising and monitoring the administration of the drug b) Administering all doses of the oral medication for the first month of use c) Administering all doses of the oral medication d) Teaching all family members to administer the medication

Supervising and monitoring the administration of the drug Rationale: Because of potentially serious adverse effects, especially with oral drugs, it is extremely important that corticosteroids be used as prescribed. A major responsibility of home care nurses is to teach, demonstrate, supervise, monitor, or do whatever is needed to facilitate correct use.

A nurse is caring for a patient who has been undergoing glucocorticoid therapy at a health care facility and is getting discharged. Which of the following instructions should the nurse include in the teaching plan for the patient and family? a) Measure the amount of fluids taken each day. b) Report any symptoms of sore throat or fever immediately. c) Take the oral drug with meals or snacks. d) Notify the PHCP if glucose appears in the urine.

Take the oral drug with meals or snacks. Rationale: The nurse should instruct the patient to take the oral drug with meals or snacks to decrease the gastrointestinal effects and upsets in the teaching plan for the patient and family. Reporting any symptoms of sore throat or fever immediately and notifying the PHCP if glucose appears in the urine should be included in the teaching plan for a patient undergoing adrenocorticotropic hormone (ACTH) therapy. The nurse should instruct the patient to measure the amount of fluids taken each day in the teaching plan for the patient receiving vasopressin.

The nursing instructor is discussing short-term versus long-term corticoid steroid therapy with the nursing students. What would be the most appropriate teaching for a client on long-term corticosteroid therapy? a) Long-term therapy is anything 10 days or longer b) Taper doses when discontinuing drug c) Give with meals d) Short-term therapy is 1 week or less

Taper doses when discontinuing drug Rationale: Taper doses when discontinuing from high doses or from long-term therapy to give the adrenal glands a chance to recover and produce adrenocorticoids. All answers are correct, but most important to teach the client is tapering the drug.

A client with a diagnosis of asthma has responded well to treatment with oral corticosteroids, and a switch to inhaled corticosteroids is planned. What strategy for managing this change in treatment should be implemented? a) The oral drug should be stopped approximately 1 week prior to starting the inhaled drug. b) The inhaled drug should be started during tapering of the oral drug. c) The two drugs should be taken simultaneously for 10 to 12 weeks. d) The inhaled drug should begin 3 to 4 weeks before starting to taper the oral drug.

The inhaled drug should be started during tapering of the oral drug. Rationale: When a client is being switched from an oral to an inhaled corticosteroid, the inhaled drug should be started during tapering of the oral drug, approximately 1 or 2 weeks before discontinuing or reaching the lowest anticipated dose of the oral drug.

A client with a diagnosis of asthma has responded well to treatment with oral corticosteroids, and a switch to inhaled corticosteroids is planned. What strategy for managing this change in treatment should be implemented? a) The oral drug should be stopped approximately 1 week prior to starting the inhaled drug. b) The two drugs should be taken simultaneously for 10 to 12 weeks. c) The inhaled drug should be started during tapering of the oral drug. d) The inhaled drug should begin 3 to 4 weeks before starting to taper the oral drug.

The inhaled drug should be started during tapering of the oral drug. Rationale: When a client is being switched from an oral to an inhaled corticosteroid, the inhaled drug should be started during tapering of the oral drug, approximately 1 or 2 weeks before discontinuing or reaching the lowest anticipated dose of the oral drug.

A male client who is being treated for chronic obstructive pulmonary disease (COPD) is diagnosed with adult respiratory distress syndrome. His family asks whether corticosteroids may help him to breathe easier. Which statement about corticosteroids is accurate? a) They are successfully used for the long-term treatment of ARDS. b) They are not used when the client are diagnosed with a chronic respiratory disorder. c) They are not a beneficial treatment for ARDS. d) They are successful for the short-term treatment of ARDS.

They are not a beneficial treatment for ARDS. Rationale: Although corticosteroids have been widely used, several well-controlled studies demonstrated that the drugs are not beneficial in early treatment or in prevention of adult respiratory distress syndrome (ARDS).

A 65-year-old client who has been on long-term corticosteroid therapy is admitted to the hospital and will need an IV inserted. What adverse effect of corticosteroid may negatively affect this procedure? a) Moon face b) Truncal obesity c) Insomnia d) Thinning of the skin

Thinning of the skin Rationale: The client's thinning skin may make IV insertion more difficult because the skin is so much more fragile and it bruises so easily due to capillary fragility.

A nurse tells a patient to take a prescribed glucocorticoid in the morning based on the understanding that: a) This time ensures that the patient will take the drug. b) This time mimics the normal peak diurnal concentration levels. c) The drug needs to suppress the hypothalamic pituitary axis. d) The drug is absorbed better in the morning.

This time mimics the normal peak diurnal concentration levels. Rationale: Typically a glucocorticoid is taken in the morning to mimic the normal peak diurnal concentration levels and thereby minimize suppression of the hypothalamic-pituitary axis. A glucocorticoid is taken in the morning to mimic the normal peak diurnal concentration levels and thereby minimize suppression of the hypothalamic-pituitary axis. Drug absorption is not affected by time of administration. The rationale for morning administration is to mimic the normal peak diurnal concentration levels.

A female client has been taking prednisone for her asthma for 1 month. The nurse will teach her to gradually decrease her dose of prednisone to avoid: a) menstrual irregularities. b) adrenal insufficiency. c) hypokalemia. d) gastrointestinal problems.

adrenal insufficiency. Rationale: The client may develop adrenal insufficiency (Addisonian crisis), which is characterized by glucocorticoid insufficiency without mineralocorticoid insufficiency. Hypokalemia occurs as a result of hyperaldosteronism. Gastrointestinal distress and menstrual irregularities are common adverse effects of the drug, but these effects are not as serious as preventing adrenal insufficiency.

A nurse is caring for a 78-year-old client with rheumatoid arthritis. The health care provider has prescribed cortisone, a corticosteroid, to the client. The nurse would administer the drug cautiously to a client with which condition? Select all that apply. -decreased muscle mass -osteoporosis -migraine headaches -liver disease -heart failure

heart failure decreased muscle mass osteoporosis Rationale: The nurse should be cautious about pre-existing conditions such as heart failure, decreased muscle mass, osteoporosis, and arthritis when administering corticosteroid therapy to elderly clients as their condition may be worsened by their use. The nurse needs to administer vasopressin cautiously to clients with migraine headaches. The nurse needs to administer gonadotropins cautiously to clients with liver disease.

What adverse effects should the nurse discuss with a client prescribed long-term systemic corticosteroid therapy? Select all that apply. -weight loss -mood disorders -peptic ulcers -hyperglycemia -cataracts

hyperglycemia peptic ulcers mood disorders cataracts Rationale: Adverse effects of systemic corticosteroids may include infections, hypertension, glucose intolerance, obesity, cosmetic changes, bone loss, growth retardation in children, cataracts, pancreatitis, peptic ulcerations, and psychiatric disturbances.

A client is on daily doses of prednisone. To minimize adrenal suppression, the nurse's instructions for administration should include to take the medication: a) on an empty stomach. b) with the evening meal. c) in the morning. d) just before bedtime.

in the morning. Rationale: Scheduling of drug administration is more important with corticosteroids than with most other drug classes. A major adverse reaction is suppression of the HPA axis and subsequent loss of adrenocortical function. Scheduling of medication (morning dosing) is often recommended to prevent or minimize HPA suppression. Daily administration is required in cases of chronic adrenocortical insufficiency. The entire daily dose can be taken each morning, between 6 and 9 a.m. This schedule simulates normal endogenous corticosteroid secretion.

When caring for a client receiving long-term therapy with corticosteroids, the nurse would plan care incorporating interventions aimed at preventing what? a) anemia b) infection c) cognitive changes d) allergies

infection Rationale: When planning care for a client taking long-term corticosteroid therapy, the nurse needs to incorporate interventions aimed at reducing risk of infection because the client's immune system will be suppressed, which places the client at increased risk. The drug is not associated with causing allergies, cognitive changes, or anemia.

A nurse taking a medical history on a client prescribed a corticosteroid medication should focus on which condition? a) infections b) depression c) cognitive impairment d) urinary incontinence

infections Rationale: Corticosteroids are contraindicated in systemic fungal infections, clients who are hypersensitive to drug formulations, clients at risk for infections, and clients with infections, diabetes mellitus, peptic ulcer disease, inflammatory bowel disorders, hypertension, congestive heart failure, or renal insufficiency. Corticosteroid therapy is not contraindicated by a history of depression, cognitive impairment, or urinary incontinence.