pharm 33 adrenal

A client with diabetes mellitus is self-administering Humulin N insulin from a vial that is kept at room temperature. The client asks the nurse about the length of time an unrefrigerated vial of insulin will maintain its potency. What is the most appropriate response to the client? 1. 2 weeks 2. 1 month 3. 2 months 4. 6 months

1 month

A client has been taking glucocorticoids to control rheumatoid arthritis. Which laboratory abnormality is the client at risk for as a result of taking this medication? 1. Increased serum glucose 2. Decreased serum sodium 3. Elevated serum potassium 4. Increased white blood cells

1. Increased serum glucose

A client with hypovolemia experiences activation of the renin-angiotensin system to maintain blood pressure. The nurse plans care, understanding that, as part of this response, the endocrine system will increase production and secretion of which mineralocorticoid? 1. Cortisol 2. Glucagon 3. Aldosterone 4. Adrenocorticotropic hormone

Aldosterone

The nurse teaches the client being discharged to home with a prescription for a daily dose of prednisone to take the medication at which best time? 1. Any time of the day 2. In the early morning 3. In the middle of the day 4. An hour before bedtime

2. In the early morning

Discharge teaching for a patient receiving glucocorticoids would include the use of which medication for pain management? 1. Aspirin (Acetylsalicylic acid) 2. Acetaminophen (Tylenol) 3. Ibuprofen 4. Naprosyn (Naproxen)

2. acetaminophen Acetaminophen does not cause GI distress as do aspirin, ibuprofen, naproxen, and glucocorticoid

A nurse is administering a prescribed dose of dexamethasone (Decadron) to a client following cranial surgery. Which would the nurse implement to assess for a common side effect of this medication? 1. Monitor for hair loss. 2. Assess for decreased skin turgor. 3. Perform blood glucose monitoring. 4. Monitor laboratory test results for hyperkalemia.

3. Perform blood glucose monitoring.

Cortisone acetate is prescribed for a client with adrenal insufficiency. The nurse provides instructions to the client regarding the medication. Which statement, if made by the client, indicates a need for further instruction? 1. "I will limit my sodium intake." 2. "I will avoid people with colds." 3. "I will eat a good breakfast every day." 4. "I will stop the medication when I feel better."

4. "I will stop the medication when I feel better."

Fludrocortisone acetate (Florinef) is prescribed for a client with Addison's disease. The nurse prepares to administer the medication. What is the primary action of this medication? 1. It promotes the excretion of water in the distal tubules of the kidney. 2. It promotes the retention of potassium in the distal tubules of the kidney. 3. It promotes the retention of hydrogen ions in the distal tubules of the kidney. 4. It enhances the reabsorption of sodium and chloride ions in the distal tubules of the kidney.

4. It enhances the reabsorption of sodium and chloride ions in the distal tubules of the kidney.

The nurse is providing instructions to a client with a diagnosis of Addison's disease regarding the administration of prescribed glucocorticoids. The nurse should provide which instruction to the client? 1. To stop the medication if side effects occur 2. To avoid taking the medication if nausea occurs 3. That minimal side effects will occur with use of this medication 4. That an increased dose of medication may be needed during times of stress

4. That an increased dose of medication may be needed during times of stress

The nurse has a prescription for a patient to receive prednisone (Deltasone) to treat contact dermatitis. The nurse would question this prescription for this patient with what condition? A.Asthma B.Multiple sclerosis C.Acquired immune deficiency syndrome (AIDS) D.Chronic obstructive pulmonary disease

C.Acquired immune deficiency syndrome (AIDS) Because of their immunosuppressant properties, glucocorticoids are often avoided in the presence of any serious infection, including septicemia, systemic fungal infections, and varicella. These drugs would be contraindicated in patients with active AIDS infection because it could potentially decrease the immune system further. One exception is tuberculous meningitis, for which glucocorticoids may be used to prevent inflammatory central nervous system damage.

Based on the nurse's knowledge of glucocorticoids, what instructions should be given for this drug? A.Take the medication every evening. B.Inform the patient that the drug can be taken with coffee. C.Advise that the drug does not have to be tapered before stopped. D.Advise to take drug with milk, other dairy products, or food.

D.Advise to take drug with milk, other dairy products, or food. Glucocorticoids can cause gastrointestinal (GI) distress and should be given with milk or food. They should not be administered with coffee, which contains caffeine and may increase gastric irritation. The best time to give exogenous glucocorticoids is early in the morning (6 AM to 9 AM) to minimize the amount of adrenal suppression. These medications should be tapered off slowly to prevent adrenal crisis and can be administered intravenously (IV).

A hospitalized client with diabetes mellitus receives Humulin NPH insulin in the morning. The nurse monitors the client for hypoglycemia, knowing that the peak action is expected to occur how soon after the medication administration? 1. 2 to 4 hours after administration 2. 4 to 12 hours after administration 3. 12 to 16 hours after administration 4. 18 to 24 hours after administration

Just know its intermediate... 4-8 or 4-12 hours

A 50 yr old man has been taking prednisone (Deltasone) following a severe reaction to poison ivy. He notices that the dosage of the medication decreases. During a follow-up office visit, he asks the nurse why he must continue the medication and why he cannot just stop taking it now that the skin rash is better. What is the nurse's best response? a. "Sudden discontinuation of this medication may result in adrenal insufficiency." b. "You would experience withdrawal sympotms if the drug were discontinued abruptly." c. "Cushing's syndrome may develop as a reaction to a sudden drop of serum cortisone levels." d. "You can stop taking the medication if his rash is better."

a. "Sudden discontinuation of this medication may result in adrenal insufficiency."

When monitoring a patient who is taking corticosteroids, the nurse observes for which adverse effects? (select all that apply) a. fragile skin b. increased glucose levels c. nervousness d. hypotension e. weight loss f. drowsiness

a. fragile skin b. increased glucose levels c. nervousness

When assessing for potential adverse effects of fludrocortisone (Florinef), the nurse monitors for signs and symptoms of which condition? A. Hypokalemia b. Hypovolemia c. Hyponatremia d. Hypercalcemia

a. hypokalemia Fludrocortisone has mineralocorticoid properties, resulting in sodium and fluid retention along with potassium excretion. Thus, a potential adverse effect is hypokalemia. Assessing for signs and symptoms of hypokalemia and close monitoring of electrolytes is needed.

During long-term corticosteroid therapy, the nurse will monitor the patient's laboratory results for adverse effects, such as: (Select all that apply.) a Increased serum potassium levels b Decreased serum potassium levels c Increased sodium levels d Decreased sodium levels e Hyperglycemia f Hypoglycemia

b. decreased serum potassium levels c. increased sodium levels e. hyperglycemia

Which teaching is appropriate for a patient who is taking an inhaled glucocorticoid for asthma? a "Exhale while pushing in on the canister of the inhaler." b "Blow your nose after taking the medication." c "Rinse your mouth thoroughly after taking the medication." d "Do not eat immediately after taking the medication."

c "Rinse your mouth thoroughly after taking the medication." It is most important to teach patients to rinse their mouth with lukewarm water after each use of a steroid inhaler to prevent the occurrence of oral candidiasis, a fungal infection. Mycostatin is not routinely used to prevent this infection unless the patient is immunocompromised. Reporting irritation after it has occurred does not prevent the infection. Minimizing the use of the inhaler to every other day negates its therapeutic effect.

Because corticosteroids may cause sodium retention, the nurse should closely monitor patient with which condition when administering corticosteroids? a. diabetes mellitus b. seizure disorders c. heart failure d. hyperthyroidism

c. heart failure