Chapter 36
A nurse is providing patient education to a patient who has had corticosteroids prescribed. What drug will the nurse teach the patient to avoid while taking the corticosteroids? A) Aspirin B) Dimenhydrinate (Dramamine) C) Ibuprofen (Advil) D) Famotidine (Pepcid)
A
A patient with adrenal insufficiency has been admitted to the intensive care unit in adrenal crisis. What assessment findings support this diagnosis? (Select all that apply.) A) Physiological exhaustion B) Hypertension C) Fluid shift D) Shock E) Septicemia
A
Nursing care for the postoperative patient requiring long-term glucocorticoid therapy will be directed at overcoming what adverse effect of the drug? A) Poor wound healing B) Inflammation C) Autoimmune response D) Lack of mobility
A
The home health nurse provides patient teaching to his or her patient who is taking oral prednisolone. The nurse provides what instruction to reduce the occurrence of nausea? A) "Take with a meal." B) "Take 1 hour before meals." C) "Take before bedtime." D) "Split the dose into two equal doses."
A
The nurse administers prednisone orally at 8 AM. When would the nurse expect the drug to reach peak effect? A) 9 to 10 AM B) 12 to 1 PM C) 8:30 to 9:00 AM D) 4 to 6 PM
A
The nurse is teaching a class for his or her peers about glucocorticoids. What will the nurse say is initially blocked, resulting in the drug's anti-inflammatory action? A) Arachidonic acid B) Phagocytes C) Lymphocytes D) Antibodies
A
The nurse is teaching the patient who will require long-term corticosteroid therapy how to reduce the risk of infection. What suggestions will the nurse include? A) "Avoid large crowds of people tightly packed together." B) "Avoid working in areas with other people." C) "Avoid exercising to reduce risk of injury." D) "Avoid touching other people who may carry germs."
A
The nurse provides teaching to a patient with chronic obstructive pulmonary disease who has been prescribed budesonide (Pulmicort) two puffs and fluticasone (Flovent) three puffs t.i.d. The nurse evaluates that further teaching is needed when the patient makes what statement? A) "Take all five puffs as quickly as possible." B) "Replace the inhalers before they run out." C) "Rinse the mouth after taking the medication." D) "Continue medication even when symptoms start to subside."
A
What would be important for the nurse to teach the parents of a pediatric patient about the use of topical corticosteroids? A) "Apply the medication sparingly." B) "Apply directly to open lesions." C) "After applying cover with a bandage." D) "Reapply as often as needed to keep the rash coated with the medication."
A
A 66-year-old female patient is on long-term oral glucocorticoid therapy to treat chronic obstructive pulmonary disease. When providing drug teaching, the nurse will inform this patient that she is at particular risk for what? A) Hyponatremia B) Spontaneous fractures C) Respiratory depression D) Ineffective temperature regulation
B
A patient is taking low-dose corticosteroids on a long-term basis for chronic obstructive pulmonary disease. The nurse assesses this patient knowing prolonged use of corticosteroids puts the patient at risk for what? A) Adrenal storm B) Adrenal atrophy C) Stunted growth D) Hypothalamic insufficiency
B
An older adult patient taking high-dose corticosteroids to treat arthritis requests a pneumonia vaccine. What is the nurse's best response? A) "Pneumonia vaccines are only given if you are at risk for serious pulmonary problems." B) "Live virus vaccines cannot be given to people who are significantly immunosuppressed." C) "Patients taking corticosteroids are well protected from viruses and do not need vaccines." D) "Corticosteroids interact with the pneumococcal vaccine to create serious adverse effects."
B
The mother asks the nurse for a steroid cream to put on her infant's diaper rash. What teaching will the nurse provide the mother? (Select all that apply.) A) "Topical corticosteroids are very effective treatment for diaper rash." B) "Topical corticosteroid application should not be occluded with a diaper." C) "Topical corticosteroids should not be applied to open lesions." D) "Use of topical corticosteroids should be limited in children." E) "Topical corticosteroids should be applied in a thick coat to the rash."
B
The nurse administers fludrocortisone (Florinef) to a patient diagnosed with salt-losing adrenogenital syndrome and then assesses for what therapeutic action? A) Development of hypokalemia and elevated serum glucose level B) An increase in sodium and water reabsorption and potassium excretion C) Headache, edema, weakness, arrhythmias, and hypertension D) Sodium and water depletion along with potassium retention
B
What hormones does the adrenal medulla secrete? A) Renin and erythropoietin B) Norepinephrine and epinephrine C) Epinephrine and dopamine D) Dopamine and serotonin
B
A patient who is steroid dependent due to adrenocortical insufficiency calls the clinic and is very upset, telling the nurse of the extreme stress he or she is experiencing right now. What does the nurse expect the health care provider will order concerning his or her medication? A) The dosage may continue as ordered. B) The medication may be discontinued until stress declines. C) The dosage of the medication may be increased. D) The dosage of the medication may be decreased.
C
The 2-year-old patient with asthma is placed on a short-term dose of prednisone. What important instruction will the nurse provide the patient about this drug? A) "Increase intake of carbohydrates." B) "The child may receive immunizations while on this drug." C) "Do not stop this medication suddenly; you will have to taper dosage gradually." D) "Reduce intake of protein until drug therapy is complete."
C
The adrenal cortex responds to adrenocorticotropic hormone (ACTH), which responds to corticotropin-releasing hormone (CRH) from the hypothalamus in a daily pattern called what? A) Pituitary rhythm B) hypothalamic-pituitary axis C) Diurnal rhythm D) Circadian rhythm
C
The clinic nurse receives a call from the mother of a 4-year-old child on long-term corticosteroid therapy saying the child woke up with a cold and is pulling on his ear. What instructions will the nurse provide? A) "Encourage fluids, monitor his temperature, and he will be better in 3 days." B) "Take him to the emergency room (ER) immediately." C) "Bring him to the clinic to be seen today." D) "Hang up and call 911."
C
The nurse anticipates an order for a glucocorticoid when caring for a patient with what condition? A) Hypoglycemia B) Appendicitis C) Arthritis D) Septicemia
C
The nurse is caring for a patient who is diagnosed with protein-deficient malnutrition. Why would an order to administer androgens to this patient be appropriate? A) Androgens reduce the body's requirement for protein. B) Androgens increase the body's absorption of protein from the bowel. C) Androgens stimulate protein production and decrease protein breakdown. D) Androgens reduce carbohydrate metabolism and promote lipid absorption.
C
The nurse is caring for a patient who works night shift from 2200 (10 PM) to 0600 (6 AM) and normally sleeps from 0800 (8 AM) until 1600 (4 PM) each day. The nurse would teach this patient to take his or her corticosteroid at what time of the day? A) 06:00 (6 AM) B) 08:00 (8 AM) C) 16:00 (4 PM) D) 22:00 (10 PM)
C
The nurse, caring for a patient experiencing stress, knows that activation of the stress reaction will cause the release of what? A) Glucose B) Aldosterone C) Adrenocorticotropic hormone (ACTH) D) Oxytocin
C
What glucocorticoids could the nurse only administer orally? A) Cortisone (Cortone Acetate) B) Hydrocortisone (Cortef) C) Prednisone (Deltasone) D) Triamcinolone (Aristocort)
C
When caring for a patient receiving long-term therapy with corticosteroids, the nurse would plan care incorporating interventions aimed at preventing what? A) Allergies B) Inflammation C) Infection D) Anemia
C
An 8-year-old with asthma has been prescribed triamcinolone (Aristocort). What dosage of medication would the nurse appropriately deliver? A) One inhalation per day B) One inhalation b.i.d. C) Two inhalations every 3 hours D) Two inhalations t.i.d.
D
For what reason might a nurse administer androgen injections to a 9-year-old boy? A) Ovarian atrophy B) Dwarfism C) Acromegaly D) Hypogonadism
D
The nurse is caring for an African American patient who received a kidney transplant and receives methylprednisolone for immunosuppression. What is the nurse's priority assessment specific to this patient? A) Assessing capillary refill time B) Assessing cardiac rhythm C) Assessing white blood cell count D) Assessing blood glucose levels
D
The nurse is developing a plan of care for an 84-year-old diabetic patient who is receiving oral hydrocortisone 40 mg daily for treatment of arthritis. What is this patient's priority nursing intervention? A) Increasing sodium in diet B) Restricting protein in diet C) Increasing fluids to 2,000 mL/d D) Monitoring blood glucose levels frequently
D
The nurse is providing dietary teaching to the patient on long-term mineralocorticoid therapy and includes what teaching point? A) Decreasing sodium B) Increasing calcium C) Increasing vitamin D D) Increasing potassium
D
The nurse is providing discharge teaching for a patient prescribed prednisone to be taken on alternate days. The patient asks why he cannot take half a pill every day. What is the nurse's best response? A) To eliminate adverse side effects B) To prolong therapeutic effects C) To prevent steroid tolerance D) To decrease adrenal suppression
D
The nurse is providing patient education to a patient taking a glucocorticoid and advises the patient to take his or her medication at what time of the day? A) At bedtime B) With the noon meal C) At 3:00 PM D) Immediately on awakening in the morning
D
When developing a plan of care for the patient receiving a glucocorticoid, what nursing diagnosis would be of highest priority? A) Deficient fluid volume related to water retention B) Risk for injury related to muscle weakness C) Imbalanced nutrition: less than body requirements D) Risk for infection related to immunosuppression
D
When doing a shift assessment on the patient, the nurse would report what symptoms as a possible adverse effect of intranasal methylprednisolone? (Select all that apply.) A) Headache B) Impaired wound healing C) Epistaxis D) Hypotension E) Nasal irritation
A,B,C,D,E
The nurse is caring for a patient with a heightened stress response following a fearful experience. When assessing this patient, what findings will the nurse attribute to this response? (Select all that apply.) A) Elevated serum blood glucose B) Reduced inflammatory response C) Heightened immune response D) Increased blood volume E) Extreme hunger
A,B,D
