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A patient has taken high-dose glucocorticoids for 2 months for severe asthma. The symptoms have resolved, and the patient is ready to stop the medication. How should the nurse instruct the patient to stop the medication? 1. The dose should be tapered over the course of 7-10 days. 2. The drug can be stopped immediately if no longer needed. 3. The drug must be continued for life. 4. Another glucocorticoid should be used to reduce cross-tolerance

1

The nurse would question a prescription for high-dose corticosteroids for a patient with: 1. uncontrolled diabetes mellitus. 2. rheumatoid arthritis. 3. septic shock. 4. COPD exacerbation

1

The physician prescribes 20 mg of hydrocortisone orally once each day. The nurse should administer the drug at what time? 1. 0800 2. 1200 3. 1600 4. 2100

1

A patient takes a high-dose glucocorticoid drug. Which nursing diagnosis should be added to the plan of care? 1. Risk for disturbed sensory perception, auditory 2. Risk for infection 3. Risk for fluid volume deficit 4. Risk for ineffective airway clearance

2

A patient who has taken glucocorticoids for 3 years tells a nurse, "I've lost my job. I don't know how I'm going to support my family and pay all the bills." Which glucocorticoid dosage adjustment would the nurse expect? 1. Decreased dosage 2. Increased dosage 3. Alternate-day dosing 4. Discontinuation of the drug

2

A patient who requires long-term glucocorticoid therapy complains of edema. Which instruction would the nurse give? 1. Augment the diet with calcium supplements. 2. Restrict sodium intake. 3. Take the glucocorticoid every 3-4 days instead of daily. 4. Discontinue the glucocorticoid.

2

Medication education for a patient receiving glucocorticoids should include the preferred use of which medication for mild pain management? 1. Aspirin 2. Acetaminophen 3. Ibuprofen 4. Naproxen sodium

2

When patients are taking both glucocorticoids and loop diuretics, the nurse should monitor them for: 1. increased calcium levels. 2. decreased potassium levels. 3. decreased glucose levels. 4. decreased sodium levels.

2

Which effects on the complete blood count would the nurse expect with long-term glucocorticoid use? You may select more than one answer. 1. Decreased hematocrit 2. Increased red blood cells 3. Increased leukocytes 4. Increased monocytes 5. Increased lymphocytes

2,3

A patient on long-term corticosteroids develops a sudden and severe lower back pain after bending to pick up a book. The nurse should assess the patient for: 1. muscle spasm. 2. epidural bleeding. 3. compression fracture. 4. kidney stones.

3

Glucocorticoids are contraindicated in patients with: 1. systemic lupus erythematosus. 2. rheumatoid arthritis. 3. systemic fungal infections. 4. asthma.

3

Which drug can reach toxic levels when high-dose corticosteroids are used concomitantly? 1. Furosemide 2. Calcium carbonate 3. Digoxin 4. Insulin

3

Which statement is accurate regarding the physiologic effect of glucocorticoids? 1. They have little or no impact on carbohydrate metabolism. 2. They block the synthesis of amino acids from glucose. 3. They promote the storage of glucose in the form of glycogen. 4. They increase peripheral glucose in the form of glycogen.

3

The nurse should question a prescription for high-dose corticosteroids for a patient with a. uncontrolled diabetes mellitus. b. rheumatoid arthritis. c. status asthmaticus. d. exacerbation of chronic obstructive pulmonary disease (COPD).

ANS: A High-dose steroids would further complicate a hyperglycemic state. High-dose corticosteroids are used in rheumatoid arthritis. High-dose corticosteroids are used in status asthmaticus. High-dose corticosteroids are used for an exacerbation of COPD.

The prescriber orders 20 mg of hydrocortisone orally once each day. The nurse should administer the drug at what time? a. 0800 b. 1200 c. 1600 d. 2100

ANS: A To allow the adrenals to recover, the doses should be administered prior to 0900 in the morning. These times are incorrect for oral administration of daily hydrocortisone.

A patient with severe asthma has taken high-dose glucocorticoids for 2 months. The symptoms have resolved, and the patient is ready to stop the medication. What patient education would the nurse provide about discontinuing the medication? a. The dose should be tapered off over 7 to 10 days. b. The drug can be stopped immediately if it is no longer needed. c. The drug must be continued for life. d. An inhaled form of glucocorticoid must be added to the medication regimen.

ANS: A To minimize the impact of adrenal insufficiency, glucocorticoid withdrawal should be gradual. Abrupt termination of long-term therapy of high-dose glucocorticoids may result in adrenal crisis. The drug should not be continued for life unless it is taken because of adrenal gland removal. An inhaled form could be used but is not required

A patient who has taken glucocorticoids for 3 years tells a nurse, "I've lost my job. I don't know how I'm going to support my family and pay all the bills." Which glucocorticoid dosage adjustment would the nurse expect? a. Decreased dosage b. Increased dosage c. Alternate-day dosing d. Double the dose

ANS: B At times of physiologic stress, the adrenals secrete large amounts of glucocorticoids and epinephrine (which maintain blood pressure and plasma levels of glucose). If glucocorticoid levels are insufficient, hypotension and hypoglycemia occur. The dose should be increased to compensate for the increased levels of stress. Reducing the dosage would put the patient at risk for glucocorticoid insufficiency. Alternate-day dosing results in decreased dosing, which would put the patient at risk for glucocorticoid insufficiency. The dosage needs to be increased, but doubling the dose is too large of an increase.

The nurse is caring for a patient on a medical-surgical unit taking methylprednisolone and furosemide (Lasix) concurrently. The nurse would expect which change in laboratory values? a. Increased calcium levels b. Decreased potassium levels c. Decreased glucose levels d. Decreased sodium levels

ANS: B Concomitant use of a glucocorticoid and a loop diuretic may result in low potassium levels. The nurse should monitor the patient's potassium closely. Concomitant use of a glucocorticoid and a loop diuretic can cause decreased calcium levels. Concomitant use of a glucocorticoid and a loop diuretic can cause increased glucose levels. There is no indication that concomitant use of a glucocorticoid and a loop diuretic can cause a decrease in sodium levels.

The nurse is caring for a patient taking high-dose glucocorticoids and is creating a plan of care for the patient. Which nursing diagnosis is the priority for the plan of care? a. Risk for disturbed sensory perception, auditory b. Risk for infection c. Risk for fluid volume deficit d. Risk for ineffective airway clearance

ANS: B Patients taking glucocorticoids are at risk for infection, because glucocorticoids increase the susceptibility to infection by suppressing host defenses. Glucocorticoids do not disturb sensory perception. Glucocorticoids do not put the patient at risk for fluid volume deficit, but rather for fluid volume excess. Glucocorticoids do not promote a risk of ineffective airway clearance

Medication education for a patient receiving glucocorticoids should include the preferred use of which medication for mild pain management? a. Aspirin b. Acetaminophen c. Ibuprofen d. Naproxen sodium

ANS: B The nurse should counsel the patient to use acetaminophen for mild pain, because it does not erode the stomach, as do nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen sodium when taken by a patient who also is taking glucocorticoids.

The nurse is caring for a patient receiving long-term glucocorticoid therapy. Upon assessment, the nurse notes that the patient has 1+ pitting edema of the lower extremities. What instruction provided by the nurse would be most appropriate for this patient? a. "Augment your diet with calcium supplements." b. "Restrict your sodium intake." c. "Take the glucocorticoid every 3 to 4 days instead of daily." d. "Discontinue the glucocorticoid."

ANS: B The patient should be advised to restrict sodium intake to prevent the retention of fluid associated with glucocorticoid therapy. There is no need to augment the diet with calcium supplements, because there is no indication that the patient is calcium deficient. Glucocorticoids must be taken on a daily basis, preferably at the same time each day. The medication should never be abruptly discontinued; it should be tapered to prevent insult to the adrenals.

The nurse would anticipate the complete blood count in a patient on long-term glucocorticoid therapy to demonstrate which of the following? (Select all that apply.) a. Decreased hematocrit b. Increased red blood cells c. Increased leukocytes d. Increased monocytes e. Increased lymphocytes

ANS: B, C Glucocorticoids increase the number of circulating red blood cells and polymorphonuclear leukocytes. Glucocorticoids reduce the numbers of lymphocytes, eosinophils, basophils, and monocytes.

The family of a patient who has been on long-term corticosteroids brings him to the emergency department. The wife states that, "He just started coughing forcefully and began complaining of chest pain. Now he is having a little difficulty breathing." The nurse should assess the patient for a. muscle spasm. b. myocardial infarction. c. broken ribs. d. pleuritis.

ANS: C Because the patient has been on long-term therapy with corticosteroids, he is at risk for osteoporosis. The most common areas affected are the ribs and vertebrae, which are subject to osteoporotic fractures. The nurse should assess the patient for broken ribs, because he was coughing forcefully and now is having difficulty breathing. Nothing indicates that the patient has a muscle spasm. There is no apparent indication that the patient is experiencing a myocardial infarction. Nothing indicates that the patient has pleuritis.

The nurse is preparing to administer medication to a patient taking betamethasone. Which additional drug, when administered concurrently with betamethasone, would put the patient at risk for cardiotoxicity? a. Furosemide (Lasix) b. Calcium carbonate c. Digoxin (Lanoxin) d. Insulin

ANS: C Concurrent use of betamethasone and digoxin would put the patient at risk for cardiotoxicity as a result of hypokalemia, which increases the risk of digoxin-induced dysrhythmias. Furosemide with betamethasone could result in some slight alterations in electrolytes but should not lead to toxicity. Calcium carbonate is an antacid and should not predispose the patient to cardiotoxicity. Glucose levels may be affected but should not lead to cardiotoxicity.

The nurse is teaching a group of nursing students about the use of glucocorticoids and the resultant physiologic effects. Which statement by one of the students best demonstrates understanding of these effects? a. "Glucocorticoids inhibit the metabolism of fatty acids for fuel." b. "Glucocorticoids block the synthesis of glucose from amino acids." c. "Glucocorticoids promote the storage of glucose in the form of glycogen." d. "Glucocorticoids increase cellular sensitivity to insulin."

ANS: C Glucocorticoids promote the storage of glucose in the form of glycogen. The most consistent effect of glucocorticoids on fat metabolism is not inhibition but stimulation of lipolysis (fat breakdown). Glucocorticoids promote rather than block the synthesis of glucose from amino acids. Glucocorticoids do not increase cellular sensitivity to insulin. Other drugs, such as the sulfonylureas, increase cellular sensitivity to insulin.

The nurse would question an order for the administration of a glucocorticoid in a patient with a. systemic lupus erythematosus. b. rheumatoid arthritis. c. systemic fungal infections. d. asthma.

ANS: C The nurse should question administration of a glucocorticoid to a patient with a fungal infection, because the drug could mask the symptoms of a systemic-wide infection. The use of glucocorticoids in a patient with systemic lupus erythematosus is expected, because it is an autoimmune disorder that would respond to glucocorticoid intervention. The use of glucocorticoids in a patient with rheumatoid arthritis is expected, because it is an autoimmune disorder that would respond to glucocorticoid intervention. The use of glucocorticoids in a patient with asthma is expected, because it is an inflammatory disorder that would respond to glucocorticoid intervention.