exam 3 prepU chp 17

A woman with an inflammatory skin disorder has begun taking prednisone in an effort to control the signs and symptoms of her disease. The nurse who is providing care for this client should prioritize which potential nursing diagnoses in the organization of the client's care? Acute confusion Fluid volume excess Constipation Impaired gas exchange

Fluid volume excess

What is a strategy to minimize HPA suppression and risks of acute adrenal insufficiency? -Drug holidays for clients with long-term corticosteroid use -Reducing the dose of systemic corticosteroids when the client on long-term therapy experiences high-stress situations -Administering a systemic corticosteroid during high-stress situations in clients on long-term systemic therapy -Concurrent use of oral contraceptives and corticosteroids in women to reduce the stress on the adrenal gland

Fluid volume excess

When caring for a client receiving long-term therapy with corticosteroids, the nurse would plan care incorporating interventions aimed at preventing what?

Infection 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.

At which time would a nurse expect peak levels of adrenocorticotropic hormone to occur?

6 AM to 9 AM A peak response of increased adrenocorticotropic hormone and adrenocortical hormones occurs sometime early in the morning, about 6 AM to 9 AM. The corticosteroid levels fall to low levels by evening. Then, the hypothalamus and pituitary sense low levels of the hormones and begin the production and release of corticotropin-releasing hormone usually during sleep, around midnight.

The anatomy and physiology instructor is discussing reactions of the body to stress. According to the instructor, what is responsible for the release of cortisol (hydrocortisone) during times of stress?

Activation of the sympathetic nervous system The stress response activates the sympathetic nervous system, causing the adrenal cortex to secrete adrenocortical hormones such as cortisol.

A client has suddenly stopped corticosteroid therapy because the symptoms are now under control. The nurse should assess the client for signs and symptoms similar to what disorder? irritable bowel syndrome Addison's disease Crohn's disease Cushing's disease

Addison's disease

A patient is taking low-dose corticosteroids on a long-term basis for COPD. What does prolonged use of corticosteroids put the patient at risk for? Adrenal storm Adrenal atrophy Hypothalamic insufficiency Stunted growth

Adrenal atrophy

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? Advocate for intravenous, rather than oral, administration. Avoid OTC antacids for the duration of treatment. Teach the client strategies for dealing with headaches. Carefully assess the client for infections.

Carefully assess the client for infections.

A male client taking oral prednisone informs the home care nurse that the medication is upsetting his stomach. What guidance can the nurse provide to help the client?

Confirm that the client takes the medication with a meal. Oral corticosteroids should be taken with food to decrease gastrointestinal irritation and the risk of ulceration.

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? Vasopressors Beta-blockers Corticosteroids ACE inhibitors

Corticosteroids

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?

Corticosteroids impair growth in children. 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.

The anatomy and physiology instructor is discussing what happens to the body during times of stress. What would the instructor tell the students causes the release of cortisone during times of stress? Adrenal cortex atrophy Stimulation of the hypothalamus Release of epinephrine and norepinephrine Negative feedback mechanism

Release of epinephrine and norepinephrine

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?

Monitoring blood glucose levels frequently 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.

Based on the metabolic action of glucocorticoids, a client who is on long-term glucocorticoid therapy is at risk of developing what disease?

Osteoporosis 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.

A male client is diagnosed with Addison's disease. What daily medication would the nurse expect to be administered?

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

A 31-year-old client is being treated with fludrocortisone for Addison disease. In addition to monitoring the client's urinary output, what other assessment should the nurse prioritize? Blood pressure Level of consciousness Hydration status Measures of coagulation

blood pressure

Which finding should alert the nurse to a potential Cushing's syndrome manifestation presented by a client prescribed long-term corticosteroid therapy?

buffalo hump 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 preparing medication information for the spouse of a client diagnosed with cerebral edema. Which medication should the nurse include in this information? dexamethasone cytosine triamcinolone beclomethasone

dexamethasone

A nurse is caring for a client with adrenocortical deficiency. The health care provider has prescribed a fludrocortisone drug to the client. Which adverse reaction should the nurse monitor for in the client? edema malaise nasal congestion sore throat

edema

The nurse is monitoring a child who has been receiving long-term therapy with systemic corticosteroids. Which would be most important for the nurse to assess? Rectal bleeding Cognitive development Epistaxis Growth pattern

growth pattern

While the nurse is preparing the client for discharge, the client asks why the health care provider has prescribed prednisone every other day instead of daily. What would be the nurse's best response?

in the morning. 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.

A 13-year-old girl is brought to the clinic by her mother for a skin rash. The client is diagnosed with severe poison ivy, and a steroid cream is ordered to be administered topically. What would be important to teach this client and her mother about the application of this medication? Apply a thick layer of cream to the lesions. Cover the cream with an air-tight dressing. Apply the medication sparingly. Apply as often as you need to keep the rash covered.

Apply the medication sparingly.

Which client demonstrates the clearest indication for treatment with prednisone?

minimize the suppression of normal adrenal function. 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.

A client being treated with oral prednisone is also prescribed furosemide. The nurse should prioritize assessment of what laboratory value?

potassium The combination of corticosteroids and diuretics constitutes a risk for hypokalemia. The nurse must pay particular attention to the client's potassium levels. This combination of medications is not associated with risks involving any of the other options.

A 72-year-old woman is on long-term glucocorticoid therapy. It will be most important for the nurse to instruct the client to: take measures to minimize the risk of falls. avoid direct sunlight. avoid eating excess red meat. avoid dairy products.

take measures to minimize the risk of falls.

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?

"Avoid large crowds of people in confined spaces." 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 should the nurse provide the client's family about this drug?

"Don't stop this medication suddenly; you will have to taper dosage gradually." 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 immunizationed 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. .

A nurse is caring for a client who is receiving a corticosteroid for arthritic pain. Which statement made by the client would raise concern about medication dosage revision?

"I recently lost my health care coverage and need to look for another job." For people receiving chronic corticosteroid therapy, dosage must be increased during periods of stress or illness. The nurse should recognize that the client has mentioned losing health care coverage and looking for a job. All the other statements are not related to stress or illness.

The nurse just completed client education relative to chronic adrenocortical insufficiency and corticosteroid medication treatment. Which statement indicates the client requires further instruction?

"I will start this medication as soon as I am feeling ill or tired." 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.

The home health nurse provides client teaching to a client who is taking oral prednisolone. The nurse provides what instruction to the client?

"Take it first thing in the morning." 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.

You are caring for a client with cerebral edema caused by trauma. Which of the following medications would you anticipate being administered?

Dexamethasone 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 assessing a client with adrenocortical excess resulting from long-term use of corticosteroids. What is not a side effect related to this client's corticosteroid use?

Hypotension Hypertension (rather than hypotension) is an adverse effect of corticosteroids. Long-term administration can cause Cushingoid characteristics, including muscle weakness and atrophy, obesity, and "moon face" (the presence of abnormal fat deposits in the cheeks).

The nurse is providing client education to a client taking corticosteroids. When would the nurse advise the client to take their medication?

Immediately on awakening in the morning Corticosteroids should be taken immediately on awaking in the morning in order to mimic the normal diurnal pattern. The peak levels of cortisol usually come between 6:00 AM and 8:00 AM. The levels then fall off slowly and reach a low in the late evening with the lowest levels around midnight. For those clients who work night shifts, the schedule would be changed to accommodate their sleep pattern.

A nurse would instruct a client to take an oral glucocorticoid at which time? In the morning Around lunchtime Before dinner At bedtime

In the morning

After teaching a group of students about the effects of mineralocorticoids, the instructor determines that additional teaching is needed when the students identify what as an effect?

Increased calcium retention Mineralocorticoids increase sodium reabsorption in the renal tubules, leading to sodium and water retention and increased potassium excretion. Calcium is not affected by mineralocorticoids.

All corticosteroids are derived from cholesterol and are released directly into the bloodstream. What is a hematological adverse effect from the use of corticosteroids? Increased thyroid hormone levels Decreased serum glucose Decreased sodium and fluid retention Increased serum cholesterol

Increased serum cholesterol

A nurse is writing a plan of care for a client who is receiving a glucocorticoid. What would be an appropriate nursing diagnosis for this client?

Risk for infection related to immunosuppression Risk for infection related to immunosuppression would be the appropriate nursing diagnosis because steroids suppress the immune system. Decreased cardiac output and excess fluid volume would also be appropriate nursing diagnoses for this client. Imbalanced nutrition: More than body requirements might be appropriate since usually clients taking steroids gain weight.

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?

Sadly, this is an adverse effect seen in women. It should improve when you finish the medication." 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.

When monitoring a client who is receiving mineralocorticoid therapy, which assessment finding would be most important for the nurse to report?

Shortness of breath 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's disease. What is the nurse's responsibility in this situation? Supervising and monitoring the administration of the drug Administering all doses of the oral medication Teaching all family members to administer the medication Administering all doses of the oral medication for the first month of use

Supervising and monitoring the administration of the drug

The home health nurse is making a plan of care for a new client who is taking oral prednisolone. What suggestion may decrease the nausea related to oral administration of prednisolone?

Take with a meal Gastrointestinal: Peptic or esophageal ulcers, pancreatitis, abdominal distention, nausea, vomiting, increased appetite, weight gain. Steroids, taken on an empty stomach, would exacerbate the nausea. Taking them before bedtime will not decrease the nausea and splitting the dose would not decrease the nausea.

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?

The inhaled drug should be started during tapering of the oral drug. 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 child is to receive a topical corticosteroid agent. Which statement by the parents indicates a need for additional teaching?

We need to cover the area snugly with plastic wrap to prevent scratching." Covering the area with a dressing or diaper would increase the risk for systemic absorption of the drug and should be avoided. Topical corticosteroids should be used sparingly and should not be applied to any open lesions or excoriated areas to reduce the risk for systemic absorption.

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?

Thinning of the skin 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:

This time mimics the normal peak diurnal concentration levels. 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:

adrenal insufficiency. 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.

What is the most prevalent mineralocorticoid that regulates fluid balance? Aldosterone Sodium Potassium Chloride

aldosterone

A client has been admitted to the unit with salt-losing adrenogenital syndrome. The client is taking fludrocortisone (Florinef) for replacement therapy in combination with a glucocorticoid. The nurse would know that high-dose fludrocortisone requires the nurse to monitor for: -sodium and water depletion along with potassium retention. an increase in sodium and water -retention along with potassium depletion. -development of hypokalemia. -a toxic effect that may occur with the combination of a glucocorticoid.

an increase in sodium and water retention along with potassium depletion.

While learning about corticosteroids in pharmacology class, a student asks the instructor to offer an example of indications for use. What could the instructor mention? Treatment of a disease with an inflammatory component Treatment of any systemic disease state Treatment of any hormone excessive state Treatment of diabetes mellitus

an increase in sodium and water retention along with potassium depletion.

A nurse taking a medical history on a client prescribed a corticosteroid medication should focus on which condition?

infections 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.