Pharmacology II Prep U Chapter 36: Adrenocortical Agents

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

infections

A 26-year-olds gradual development of a "moon face," coupled with protracted weight gain, has caused the nurse practitioner to suspect the possibility of Cushing's disease. When explaining this health problem to the client, how should the nurse describe it?

"Cushing's disease is a result of an overproduction of steroid hormones by your kidneys."

A 38-year-old client has been living with Addison's disease for many years and has achieved adequate symptom control through lifestyle modifications and drug therapy. However, the client has now been admitted to the hospital in addisonian crisis. Which of the nurse's assessment question is most appropriate?

"Have you been under an unusual amount of stress lately?"

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."

A client with a diagnosis of Cushing's is not a surgical candidate and is consequently being treated with ketoconazole. The nurse should be aware that ketoconazole achieves a therapeutic effect by what means?

inhibiting the enzymes that contribute to cortisol synthesis

The nurse administers mitotane (Lysodren) to the patient with Cushing's disease. What is the desired therapeutic effect?

Decreased cortisol levels

Which medications is classified as a long-acting glucocorticoid?

Dexamethasone

Glucocorticoids should be used with caution in patients with what disease process?

Diabetes mellitus

Which herbal supplement taken with ketoconazole can cause hepatotoxicity?

Echinacea

The nurse is caring for a patient who has been prescribed fludrocortisone and furosemide (Lasix). What assessment is essential to monitor for potential complications with this patient?

Electrolytes

Which drug, if combined with corticosteroids, would lead to possible toxic effects?

Erythromycin

After teaching a group of students about mineralocorticoids, the instructor determines that the teaching was successful when they state which agent as an example?

Fludrocortisone

A hospitalized client's serum glucose level is 160mg/dL. Which hormone is most likely being secreted and leading to this elevated lab value?

Glucocorticoid

Which condition in a client's history can be a cause of adrenocortical insufficiency?

Histoplasmosis infection

The patient has been receiving hydrocortisone therapy for asthma and recently was started on cholestyramine. The nurse notes that the patient has increased wheezing on auscultation. What is the nurse's best action?

Hold the cholestyramine.

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

I will start this medication when I am feeling ill or tired.

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

A patient being treated for Cushing's disease is upset about body changes. What information will the nurse tell the patient to provide reassurance?

Once therapy is effective, soft tissue changes will reverse.

A nurse is preparing to administer fludrocortisone. The nurse would administer the drug by which route?

Oral

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

Osteoporosis

Aldosterone causes the kidneys to excrete what electrolyte to restore homeostasis?

Potassium

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

Prednisone

A male client receives IV methylprednisolone to treat status asthmaticus. Corticosteroid use may increase the risk of what condition for the client?

Pulmonary infection

A patient recently had a positive PPD and chest x-ray and was started on Rifampin. The patient is also on ketoconazole for Cushing's disease. What would the nurse be concerned about?

Rifampin may decrease the action of ketoconazole.

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:

low in sodium, high in potassium.

When explaining the rationale for alternate-day administration of corticosteroids, the nurse would say that it is to:

minimize the suppression of normal adrenal function.

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

potassium

Which physiologic action increases a client's stress-related release of cortisol?

release of epinephrine and norepinephrine

A client has been admitted to the emergency department with a diverse constellation of signs and symptoms. What diagnostic finding is most consistent with a diagnosis of Addison's disease?

serum sodium 128 mEq/L (128 mmol/L)

How is the dosage of corticosteroids calculated for a child diagnosed with asthma?

severity of disease

An adult client has been prescribed oral prednisone for the treatment of an acute dermatological condition. When teaching this client about this course of treatment, what teaching point should the nurse emphasize?

the importance of gradually reducing rather than abruptly stopping the drug

What medication creates a safety risk when combined with long-term fludrocortisone therapy?

warfarin

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

Shortness of breath

Which laboratory value monitored in a patient receiving fludrocortisone acetate requires immediate action by the nurse?

Sodium 150 mEq/L

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

The nurse is working in a home care setting. A female client is prescribed oral corticosteroids secondary to a diagnosis of Addison's disease. What task is the nurse's responsibility?

Supervising and monitoring the administration of the drug

A client being treated with desmopressin exhibits confusion and drowsiness, and reports a headache. What is the nurse's best action?

Take the client's vital signs.

A patient reports nausea when taking ketoconazole (Nizoral). What is the best advice for the nurse to give the patient?

Take the medication with food.

A client with suspected adrenal insufficiency has been administered 1 mcg of cosyntropin as an IV bolus. Serum testing 30 minutes later reveals a markedly elevated level of cortisol. What conclusion should the nurse infer from this finding?

The client has normal adrenocortical function.

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.

Which assessment finding indicates a therapeutic response to mitotane therapy?

The patient can lift 10 pounds and was previously unable to lift 5 pounds.

Which patient should not receive mitotane as ordered?

The patient experiencing shock

Which patient action requires immediate intervention by the nurse?

The patient stopped taking hydrocortisone this morning because he does not like taking pills.

Which patient should not receive ketoconazole (Nizoral) as ordered for Cushing's disease?

The patient with elevated liver function tests

Which patient should not start hydrocortisone therapy as ordered at 8 a.m.?

The patient with sepsis

The nurse is assessing the patient on mitotane therapy. Which assessment finding requires action by the nurse?

The patient's blood pressure is 140/90 mm Hg sitting and 90/50 mm Hg standing.

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."

The results of a client's plasma corticotropin (ACTH) stimulation test have confirmed a diagnosis of Addison's disease. The nurse has consequently provided health education around the necessity of hormone replacement therapy. The client has asked the nurse, "How long am I going to have to take these medications?" How should the nurse best respond?

"In order to manage this condition, you'll need to take these for the rest of your life."

A client newly diagnosed with Cushing's disease asks how ketoconazole works. What is the nurse's best response?

"It controls cortisol secretions."

A client, prescribed hydrocortisone, states, "I know quite a few different people who have had unpleasant side effects of steroids." How should the nurse best respond to the client's concern?

"It's true, that hydrocortisone can affect nearly every body system, but your health care team will monitor you thoroughly for indications of adverse reactions."

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."

To minimize adrenal suppression, when should the nurse encourage a client to take his or her daily dose of prescribed prednisone?

"Take your medications in the morning."

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?

"Taking it every other day minimizes adverse effects."

The nurse is educating an adult client diagnosed with adrenocortical carcinoma about the prescribed mitotane 6 g PO in divided doses. Which statement made by the client establishes the need for further clarification?

"The drug will eradicate my tumor and cure my cancer."

The patient receiving ketoconazole (Nizoral) for Cushing's disease reports a headache. What is the best advice for the nurse to give the patient?

"This might be a reaction to the medication. Talk to your health care provider."

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."

A patient reports increasing the intake of herbal therapy because it is "cold and flu season." The patient is currently receiving hydrocortisone therapy for asthma. What is the first question for the nurse to ask the patient related to this statement?

"What herbal therapy are you taking?"

An adult client is preparing to begin corticosteroid treatment for rheumatoid arthritis. When teaching this client about the appropriate use of corticosteroids, the nurse should include what teaching point?

"You will likely gain some weight after you start taking this drug."

What adverse effects should the nurse discuss with a client prescribed long-term systemic corticosteroid therapy? Select all that apply.

* hyperglycemia * peptic ulcers * mood disorders * cataracts

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.

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

6 AM to 9 AM

Which client demonstrates the clearest indication for treatment with prednisone?

A 70-year-old man whose rheumatoid arthritis has not responded to OTC pain relievers

A client diagnosed with Cushing's disease will soon begin treatment with ketoconazole. The nurse should be cognizant of the black box warning for this drug and consequently monitor what laboratory values?

AST, ALT, and GGT

A client learning to self-administer desmopressin subcutaneously should be taught to administer the injection at which site?

Abdomen

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

A female client is admitted to the hospital with hypoglycemia, nausea, muscle weakness, and depression. What is the most likely cause?

Addison disease

A patient with adrenocortical insufficiency is stressed about the inability to go to work and care for the family. The patient begins to vomit. What is the nurse's best action?

Administer hormonal replacement.

What endocrine gland produces corticosteroids?

Adrenal

A client is on daily doses of prednisone. To minimize adrenal suppression, the nurse's instructions for administration should include to take the medication:

in the morning

A client is receiving hydrocortisone 40 mg by mouth daily for treatment of severe autoimmune inflammation. Which nursing intervention is the most important to implement?

Assess daily blood glucose.

A patient taking glucocorticoid therapy for a chronic illness has been gaining weight and having other changes in appearance. What statement is true related to this patient's symptoms?

Changes in appearance will reverse once the therapy is tapered off.

The nurse is caring for a hospital client who has been prescribed fludrocortisone. The nurse has performed a general assessment of the client, including auscultation of the client's apical heart rate. How should the nurse best follow up assessment of an audible S3?

Contact the care provider promptly.

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?

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.

A nurse is providing client education to a female client who is taking fludrocortisone. The nurse will instruct the client to monitor what at home?

Weight gain

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

A client with a visible "buffalo hump" and a history of impaired wound healing has been referred for care to the endocrinology department. This client's signs and symptoms are most likely to be attributed to what factor?

adrenocortical excess

What situation most significantly affects the plan of care of a client prescribed hydrocortisone?

atrial fibrillation and treatment with warfarin

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

buffalo hump

A client will soon begin long-term treatment with hydrocortisone after being diagnosed with Addison's disease. In order to mitigate the potentially adverse effect of this treatment regimen, the nurse should encourage the client to increase the intake of what nutrient?

calcium

A child has received a diagnosis of Addison's disease, and the nurse is providing health education to the child's family around hormone replacement therapy. When planning this child's care, the nurse should know that hormone replacement therapy constitutes a risk for what nursing diagnosis?

delayed growth and development

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

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

Mineralocorticoids directly affect:

electrolyte levels

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?

fluid volume excess