Respiratory Pharm

9) The nurse is teaching a client diagnosed with asthma about the medication albuterol. Which statement by the nurse demonstrates appropriate teaching? A. "Call your doctor's office if you need to use the drug more often." B. "Use this medication at bedtime to promote rest." C. "Use this medication after other asthma inhalers." D. "Discontinue the inhaler if you feel dizzy."

A. "Call your doctor's office if you need to use the drug more often."

61) A client is started on long-term corticosteroid therapy for an autoimmune disorder. Which statement by the client indicates the need for more teaching by the nurse? A. "For 1 week each month I will stop taking the medication." B. "I will keep a record of my weight each week." C. "The medication needs to be taken with food." D. "I will be sure to eat foods that are high in potassium."

A. "For 1 week each month I will stop taking the medication." Rationale: Corticosteroids should never be stopped abruptly, they should always be weaned. To suddenly stop this medication may result in a sudden drop in the blood pressure from a loss in fluid volume associated with adrenal crisis. Clients should be warned not to abruptly stop taking the medication. Corticosteroids can lower the amount of potassium in the body so the client should eat more potassium rich foods. Weight gain is an expected effect of corticosteroid therapy. Clients should regularly keep track of their weight. Generally, corticosteroid medications are taken with breakfast.

7) The nurse is educating a client with end stage chronic obstructive pulmonary disease (COPD) about medication management. Which statement by the client indicates an understanding of the teaching? A. "I will use the albuterol in the nebulizer before my other inhalers each morning." B. "I can use my tiotropium inhaler if I get short of breath." C. "I will only use the fluticasone inhaler on the days I am really out of breath." D "The side effects of these medications will be less severe because I'm not taking them by mouth."

A. "I will use the albuterol in the nebulizer before my other inhalers each morning."

34) Which statement regarding mealtime administration by a client who has arthritis and is prescribed corticosteroid medication indicates that the teaching was effective? A. "This will decrease gastric irritation." B. "This will serve as a reminder to take the medication." C. "The presence of food will enhance absorption." D. "The medication is ineffective in an acid medium."

A. "This will decrease gastric irritation." Rationale: The presence of food limits the irritating effect of steroids on the gastric mucosa. Taking the medication at mealtime may help the client remember to take the medication, but it is not the reason for taking it with meals. Food does not increase or decrease absorption of steroids. The medication is not affected by an acid environment.

6) The nurse teaches a client about cortisone therapy. Which statements made by the client indicate the need for further teaching? Select all that apply. One, some, or all responses may be correct. A. 'I should take 3 tablets at a time.' B. 'I should take the tablet twice a week.' C. 'I should take the tablet on an empty stomach.' D. 'I should take the tablet with a meal.'

A. 'I should take 3 tablets at a time.' B. 'I should take the tablet twice a week.' C. 'I should take the tablet on an empty stomach.' Rationale: The client should take the medication as prescribed. The client should not take 3 tablets at a time because this action may lead to drug toxicity. Cortisone therapy involves the administration of 25 to 50 mg of cortisone on a daily basis. Cortisone should be taken with a meal or a snack; taking the medication on an empty stomach would cause gastric irritation. Tablets can be taken with any fluid such as water or fruit juice.

65) The nurse is caring for a child undergoing chemotherapy for acute lymphoid leukemia. The parents ask why the child needs prednisone. Which response by the nurse would be correct? A. 'It decreases inflammation.' B. 'It suppresses the production of lymphocytes.' C. 'It increases appetite and a sense of well-being.' D. 'It may decrease skin irritation and edema.'

A. 'It decreases inflammation.' Prednisone is a synthetic glucocorticoid that exerts an active anti-inflammatory effect by stabilizing lysosomal membranes, thereby inhibiting proteolytic enzyme release. Prednisone does not affect the lymphocytes. Although prednisone increases the appetite and creates a sense of well-being, these are not the reasons it is administered. There is no indication the child is receiving radiation.

1) The spouse of a client with an intracranial hemorrhage asks the nurse, 'Why aren't they administering an anticoagulant?' How will the nurse respond? A. 'It is not advisable because bleeding will increase.' B. 'If necessary, it will be started to enhance circulation.' C. 'If necessary, it will be started to prevent pulmonary thrombosis.' D. 'It is inadvisable because it masks the effects of the hemorrhage.'

A. 'It is not advisable because bleeding will increase.' Rationale An anticoagulant should not be administered to a client who is bleeding because it will interfere with clotting and will increase hemorrhage. Anticoagulants are unsafe and will not be used to enhance the circulation or prevent pulmonary thrombosis. The response 'It is inadvisable because it masks the effects of the hemorrhage' is not the reason why it is contraindicated; if given, it will increase, not mask, the effects of the hemorrhage.

1) The nurse administers albuterol to a 4-year-old child. Which intervention would assist the nurse in evaluating the effectiveness of this medication? A. Auscultate breath sounds. B. Collect a sputum sample. C. Conduct a neurological examination. D. Palpate chest excursion.

A. Auscultate breath sounds.

8) A client with systemic lupus erythematosus is taking prednisone. Which foods would the nurse encourage the client to eat while receiving treatment to prevent hypokalemia? A. Broccoli B. Oatmeal C. Fried rice D. Cooked carrots

A. Broccoli Rationale: Potassium is plentiful in green leafy vegetables; broccoli provides 207 mg of potassium per half cup. Oatmeal provides 73 mg of potassium per half cup. Rice provides 29 mg of potassium per half cup. Cooked fresh carrots provide 172 mg of potassium per half cup; canned carrots provide only 93 mg of potassium per half cup.

12) The nurse is providing discharge education to a client with moderate persistent asthma. The nurse should instruct the client to administer which medication first? A. Bronchodilator B. Glucocorticoid C. Anticholinergic D. Mast cell stabilizer

A. Bronchodilator

15) A client has refused prescribed cortisone. The nurse continues to administer the cortisone while evading the client's questions. When the client later discovers that cortisone continued to be administered, the client decides to sue the nurse. Which elements must be considered in a legal action? Select all that apply. One, some, or all responses may be correct. A. Clients have a right to refuse treatment. B. Nurses are required to answer clients truthfully. C. The health care provider should have been notified. D. The client had insufficient knowledge to make such a decision. E. Legally prescribed medications are administered despite a client's objections.

A. Clients have a right to refuse treatment. B. Nurses are required to answer clients truthfully. C. The health care provider should have been notified. Rationale: Clients who are mentally competent have the right to refuse treatment; this right takes precedence over the health care provider's prescription and the nurse must respect this right. A client's questions must always be answered truthfully. The nurse would explore the client's reasons for refusal and then notify the health care provider to plan an alternative treatment. A client's insufficient knowledge is not an acceptable reason for using deliberate deception to administer a treatment that the client has refused.

51) A client with rheumatoid arthritis has been taking a corticosteroid medication for the past year. Prolonged use of corticosteroids puts this client at increased risk for which complication? A. Decreased white blood cells B. Increased C-reactive protein C. Increased sedimentation rate D. Decreased serum glucose levels

A. Decreased white blood cells Rationale Prolonged use of steroids may cause leukopenia as a result of bone marrow depression. C-reactive protein and sedimentation rate are elevated in acute inflammatory diseases; steroids help decrease them. Serum glucose levels increase with steroid use.

1) Which response to fludrocortisone will the nurse teach a client with adrenal insufficiency to report? Select all that apply. One, some, or all responses may be correct. A. Edema B. Rapid weight gain C. Fatigue in the afternoon D. Unpredictable changes in mood

A. Edema B. Rapid weight gain Rationale: Fludrocortisone has a strong effect on sodium retention by the kidneys, which leads to fluid retention, causing edema and weight gain. Fatigue may occur with adrenal insufficiency and is not related to cortisone therapy. Unpredictable changes in mood commonly occur but are not as serious a threat as fluid retention. Fluid retention, and thus decreased urination, may occur.

43) A client is scheduled for a craniotomy to remove a brain tumor. To prevent the development of cerebral edema after surgery, the nurse anticipates the use of medications from which class? A. Glucocorticoids B. Anticholinergics C. Anticonvulsants D. Antihypertensives

A. Glucocorticoids Rationale Glucocorticoids are used for their anti-inflammatory action, which decreases the development of cerebral edema. Anticholinergics are not used to prevent cerebral edema. Anticonvulsants prevent seizure activity, not cerebral edema. Antihypertensives control hypertension, not cerebral edema.

47) A client is admitted to the hospital for an adrenalectomy. Before the client's replacement steroid therapy is regulated fully, the nurse will monitor the client for which complication? A. Hypotension B. Hypokalemia C. Hypernatremia D. Hyperglycemia

A. Hypotension Because of instability of the vascular system and the lability of circulating adrenal hormones after an adrenalectomy, hypotension frequently occurs until the hormonal level is controlled by replacement therapy. Hyperglycemia is a sign of excessive adrenal hormones; after an adrenalectomy, adrenal hormones are not secreted. Sodium retention is a sign of hyperadrenalism; it does not occur after the adrenals are removed. Potassium excretion is a response to excessive adrenal hormones; after an adrenalectomy, adrenal hormones are decreased until replacement therapy is regulated.

30) The nurse is educating a client on self-administration of a fluticasone inhaler. What statement indicates an understanding of the teaching? A. I will rinse my mouth with water after using the inhaler B. Disinfectant wipes can be used to clean the spacer C. I need to wait 15 minutes between puffs D. This inhaler should be used before the others

A. I will rinse my mouth with water after using the inhaler Rationale: To prevent thrush, the client should rinse his or her mouth with water and spit it out. The spacer should be washed with warm water and dish detergent. The client may need two puffs but does not have to wait 15 minutes between. Bronchodilators should be used before corticosteroids.

1) The nurse is providing education to the client prescribed montelukast for the treatment of asthma. What medication should the nurse instruct the client to avoid? A. Ibuprofen B. Prednisone C. Amoxicillin D. Formoterol

A. Ibuprofen

66) The nurse is caring for a child receiving prednisone. Which consideration is most important for the nurse to remember when administering adrenocorticosteroid therapy? A. It suppresses inflammation. B. It may produce hyperkalemia. C. Wound healing is accelerated. D. Antibody production increases.

A. It suppresses inflammation. Rationale Because of suppression of the inflammatory manifestations of infection, such as increase in body temperature, the nurse must be alert to the subtle signs and symptoms of infection (e.g., changes in appetite, sleep patterns, and behavior). Adrenocorticosteroid therapy may cause hypokalemia, not hyperkalemia, because of the retention of sodium and fluid. Adrenocorticosteroid therapy delays, not accelerates, wound healing.

58) A pediatric client is prescribed an intravenous infusion of methylprednisolone. Which clinical manifestation requires immediate intervention during administration of the initial dose? A. Polyuria B. Tinnitus C. Drowsiness D. Hypotension

A. Polyuria Intravenous administration of a steroid can cause a rapid increase in the blood glucose level. One early sign of hyperglycemia is increased urine output. Blood glucose should be checked frequently, and insulin administered as needed. Tinnitus is associated with some antibiotics and with aspirin, not steroids. Drowsiness is associated with sedatives, not steroids. Hypertension, not hypotension, is associated with steroid administration.

59) A client is receiving methylprednisolone 40 mg IV daily. The nurse should monitor which laboratory value closely? A. Serum glucose. B. Serum calcium. C. Red blood cells. D. Serum potassium.

A. Serum glucose. Methylprednisolone is a corticosteroid with glucocorticoid and mineralocorticoid actions. These effects can lead to hyperglycemia (must monitor closely), which is reflected as an increase in the serum glucose value. The client taking methylprednisolone is also at risk for hypocalcemia and hypokalemia (but not severely). These medications also alter the some of the body's immune responses by suppressing the migration of white blood cells decreasing inflammation response.

12) Hydrocortisone is prescribed for a client with Addison's disease. Which response is a therapeutic effect of this medication? A. Supports a better response to stress B. Promotes a decrease in blood pressure C. Decreases episodes of shortness of breath D. Controls an excessive loss of potassium

A. Supports a better response to stress Rationale: Hydrocortisone is a glucocorticoid that has anti-inflammatory action and aids in metabolism of carbohydrates, fats, and proteins, causing elevation of the blood glucose level. Thus it enables the body to adapt to stress. It may promote fluid retention that results in hypertension and edema. Shortness of breath (dyspnea) is caused by hypovolemia and decreased oxygen supply; neither is affected by hydrocortisone. It may cause potassium depletion.

3) A client is prescribed albuterol to relieve severe asthma. Which adverse effects will the nurse instruct the client to anticipate? Select all that apply. One, some, or all responses may be correct. A. Tremors B. Lethargy C. Palpitations D. Bronchoconstriction E. Decreased pulse rate

A. Tremors C. Palpitations

41) A child undergoing prolonged steroid therapy takes on a cushingoid appearance. The nurse would expect to find which of these manifestations during further assessment? Select all that apply. One, some, or all responses may be correct. A. Truncal obesity B. Thin extremities C. Increased linear growth D. Loss of hair on the body E. Decreased blood pressure

A. Truncal obesity B. Thin extremities Rationale: An increase in appetite results in deposition of fat on the abdomen and trunk. Muscle wasting results in thin extremities. Increased excretion of calcium causes retardation of linear growth and a resulting short stature. Because of the excess production of androgens, virilization and hirsutism occur. Increased salt and water retention cause hypertension and hypernatremia.

9) A child with nephrotic syndrome has been receiving prednisone for 1 week. Which information in the child's record indicates to the nurse that the medication has been effective? Select all that apply. One, some, or all responses may be correct. A. Weight loss B. Lower blood pH C. Decreased lethargy D. Increased urine output E. Decreased blood pressure

A. Weight loss C. Decreased lethargy D. Increased urine output Rationale: Children with nephrotic syndrome are grossly edematous. Those who have the steroid-sensitive form of nephrotic syndrome respond to corticosteroids with diuresis within 7 to 21 days after therapy is started, and the edematous weight is lost. Once the child feels better, lethargy decreases, and the activity level increases. Steroid therapy does not affect the blood pH. There is no increase in the blood pressure of a child with nephrotic syndrome and no change in blood pressure when the child improves.

18) While receiving an adrenergic beta 2 agonist medication for asthma, the client complains of palpitations, chest pain, and a throbbing headache. Which nursing action is the most appropriate? A. Withhold the medication and notify the health care provider. B. Tell the client that these are expected side effects from the medicine. C. Give instructions to breathe slowly and deeply for several minutes. D. Explain that the effects are temporary and will subside as medication tolerance develops.

A. Withhold the medication and notify the health care provider.

3) Which instruction will the nurse include when performing discharge teaching to a client now receiving hydrocortisone by mouth after stabilization of an acute adrenal insufficiency? A. "Eat a diet high in sodium." B. "Take the medication with food." C. "Maintain the same dose indefinitely." D. "Eliminate a dose if side effects occur."

B. "Take the medication with food." Rationale: Taking the medication with food minimizes the side effect of gastrointestinal irritation; the health care provider should be notified immediately if abdominal pain or tarry stools occur. The diet should be low in sodium because cortisone can cause fluid retention. The dose may have to be adjusted with health care provider supervision when the client is under physical or emotional stress. Cortisone levels must be maintained; changes in dosage must be supervised by the health care provider.

10) The nurse is teaching a client with asthma about albuterol. How should the nurse best describe the action of this medication? A. "The medication is given to reduce secretions that block airways." B. "The medication will help to relax smooth muscles in the airways." C. "The medication will stimulate the respiratory center in the brain." D. "The medication will help to prevent pneumonia."

B. "The medication will help to relax smooth muscles in the airways."

49) Immediately after a bilateral adrenalectomy, a client is receiving corticosteroids thatare to be continued after discharge from the hospital. Which statement by the client indicates to the nurse that additional education is needed? A. 'I need to have periodic tests of my blood for glucose.' B. 'I am glad that I only have to take the medication once a day.' C. 'I must take the medicine with meals.' D. 'I should tell my health care provider if I am overly restless or have troublesleeping.

B. 'I am glad that I only have to take the medication once a day.'

39) A 6-year-old child with asthma is prescribed an inhaled corticosteroid. The nurse would conclude the mother understands teaching about the medication side effects when the mother makes which statement? A. 'I'll watch for frequent urination.' B. 'I'll check for white patches in the mouth.' C. 'I'll be alert for short episodes of not breathing.' D. 'I'll monitor for an increased blood glucose level.'

B. 'I'll check for white patches in the mouth.' Rationale Oral candidiasis is a potential side effect of inhaled steroids because of steroids' anti-inflammatory effect; the child should be taught to rinse the mouth after each inhalation. Frequent urination is not a side effect of steroid therapy. Apneic episodes are not a side effect of steroid therapy. Hyperglycemia is not a side effect of inhaled steroid therapy; it may occur when steroids are administered for a systemic effect.

52) A client is scheduled for an adrenalectomy. Which action would the nurse expect in the plan of care? A. Provide a low-protein diet. B. Administer parenteral corticosteroids. C. Collect a preoperative 24-hour urine specimen. D. Withhold all medications 48 hours before surgery.

B. Administer parenteral corticosteroids. Steroid therapy usually is given intravenously or intramuscularly preoperatively and continued intraoperatively to prepare for the acute adrenal insufficiency that follows surgery. The diet must supply ample protein and potassium. A 24-hour urine specimen is unnecessary. Corticosteroids must be administered preoperatively to prevent adrenal insufficiency during surgery, so withholding all medications for 48 hours before surgery is contraindicated.

26) A beclomethasone inhaler would be prescribed for which purpose? A. Prevents atelectasis B. Decreases inflammation C. Relaxes smooth muscle in the airways D. Reduces bacteria in the respiratory tract

B. Decreases inflammation Rationale: Beclomethasone reduces the inflammatory response in bronchial walls by suppression of polymorphonuclear leukocytes and fibroblasts and the reversal of capillary permeability. Beclomethasone does not prevent atelectasis. Beclomethasone does not cause smooth muscle relaxation in the airways. Beclomethasone is not an antibiotic.

17) Which intervention would the nurse implement for a client admitted for an exacerbation of asthma? A. Determine the client's emotional state. B. Give prescribed medications to promote bronchiolar dilation. C. Provide education about the effect of a family history. D. Encourage the client to use an incentive spirometer routinely.

B. Give prescribed medications to promote bronchiolar dilation.

11) The nurse is preparing to administer an albuterol nebulizer treatment to a patient with asthma. Which assessment finding should be brought to the health care provider's attention prior to administering the medication? A. Temperature of 101°F (38.3°C) B. Heart rate of 116 bpm C. Respiratory rate of 28 D. Lower extremity edema

B. Heart rate of 116 bpm

8) The nurse is teaching the parents of a child prescribed a high dose of oral prednisone for asthma. Which information is critical for the nurse to include when teaching about this medication? A. It protects against infection. B. It should be stopped gradually. C. An early growth spurt may occur. D. A moon-shaped face will develop.

B. It should be stopped gradually. Rationale: Gradual weaning from prednisone is necessary to prevent adrenal insufficiency or adrenal crisis. Prednisone depresses the immune system, thereby increasing susceptibility to infection. The medication usually suppresses growth. A moon face may occur, but it is not a critical, life-threatening side effect.

14) The nurse is evaluating the effectiveness of therapy for a client who received albuterol via nebulizer during an acute episode of shortness of breath due to asthma. Which finding is the best indicator that the therapy was effective? A. Accessory muscle use has decreased. B. Oxygen saturation is greater than 90%. C. Respiratory rate is 16 breaths/minute. D. No wheezes are audible.

B. Oxygen saturation is greater than 90%.

50) Which information from the client's history would the nurse identify as a risk factor for developing osteoporosis? A. Takes estrogen therapy B. Receives long-term steroid therapy C. Has a history of hypoparathyroidism D. Engages in strenuous physical activity

B. Receives long-term steroid therapy Rationale: Increased levels of steroids will accelerate bone demineralization. Hyperparathyroidism, not hypoparathyroidism, accelerates bone demineralization. Weight-bearing that occurs with strenuous activity promotes bone integrity by preventing bone demineralization. Estrogen promotes deposition of calcium into bone which may prevent, not cause, osteoporosis.

16) Dexamethasone has been prescribed for a client after a craniotomy for a brain tumor. Which physiological response is responsible for this medication's therapeutic effect? A. Reduced cell growth B. Reduced cerebral edema C. Increased renal reabsorption D. Increased response to sedation

B. Reduced cerebral edema Rationale: Dexamethasone is a corticosteroid with anti-inflammatory effects, which will reduce cerebral edema. Dexamethasone will not keep the tumor from growing; it will reduce fluid content and therefore cell size, not the number of cells. Dexamethasone does not promote fluid reabsorption, which is undesirable because it increases fluid retention and therefore cerebral edema. Dexamethasone does not promote sedation; sedation is not desired because it may mask the client's adaptations to the craniotomy.

11) A client with rheumatoid arthritis asks the nurse why it is necessary to inject hydrocortisone into the knee joint. Which reason would the nurse include in a response to this question? A. Lubricates the joint B. Reduces inflammation C. Provides physiotherapy D. Prevents ankylosis of the joint

B. Reduces inflammation Rationale Steroids have an anti-inflammatory effect that can reduce arthritic pannus formation. Injecting hydrocortisone into the joint does not provide lubrication. Injection of a medication into a joint is not physiotherapy. Ankylosis refers to fusion of joints. It is only indirectly influenced by steroids, which exert their major effect on the inflammatory process.

16) A health care provider prescribes metaproterenol for a client. For which therapeutic effect would the nurse monitor the client? A. Induced sedation B. Relaxed bronchial spasm C. Decreased blood pressure D. Productive cough

B. Relaxed bronchial spasm

2) A client with chronic obstructive pulmonary disease (COPD) is receiving aminophylline 25 mg/hour intravenously (IV). Which finding would be associated with side effects of this medication? A. Flushing and headache B. Restlessness and palpitations C. Decreased urine volume D. Pruritus

B. Restlessness and palpitations

46) A client who recently started receiving oral corticosteroids for a severe allergic reaction is instructed that the dosage will be reduced gradually until all medication is stopped at the end of 2 weeks. Which reason would the nurse provide for this gradual reduction in dosage? A. Discontinuing the medication too fast will cause the allergic reaction to reappear. B. Slow reduction of the medication will prevent a physiological crisis because the adrenal glands are suppressed. C. The health care provider is attempting to determine the minimal dose that will be effective for the allergy. D. Sudden cessation of the medication will cause development of serious side effects, such as moon face and fluid retention.

B. Slow reduction of the medication will prevent a physiological crisis because the adrenal glands are suppressed. Rationale The body's natural corticosteroid production has been suppressed during treatment; avoiding abrupt cessation of the medication will give the body time to adjust to less and less of the exogenous source and to resume secretion of endogenous corticosteroid. Not completing the course of therapy, rather than stopping it quickly, may cause signs and symptoms of the allergy to recur. The health care provider has already determined the correct dosage, and it has been prescribed. Moon face and fluid retention are associated with long-term steroid use, not with the cessation of therapy.

40) A child who has nephrotic syndrome is prescribed steroid therapy. Which explanation would the nurse give the parents regarding the goal of this treatment? A. Prevents infection B. Stimulates diuresis C. Provides hemopoiesis D. Reduces blood pressure

B. Stimulates diuresis Although the exact mechanism is unknown, steroids produce diuresis in most children with nephrotic syndrome. Steroids will not prevent infection and will mask the signs and symptoms of infection. Steroids have no effect on the production of red blood cells. Steroids do not reduce hypertension, and hypertension is not a common finding in children with nephrotic syndrome.

20) Which nursing assessment is important for a school-age child undergoing long-term steroid therapy? A. Monitoring pulse for irregularities B. Testing of stools for occult blood C. Inspection of urine for mucous threads D. Check of oral mucous membranes for ulcers

B. Testing of stools for occult blood Because steroids decrease production of prostaglandins that have a role in protecting the stomach, gastrointestinal bleeding may occur; stools should be checked for frank and occult blood. Steroids do not cause pulse irregularities, mucus in the urine, or ulceration of mucous membranes.

32) The nurse is providing discharge education to a client newly diagnosed with chronic obstructive pulmonary disease. The client is prescribed the diskus inhaler fluticasone propionate and salmeterol. The client asks, "How will I know when the inhaler is empty?" How should the nurse respond? A. Shake the canister to detect any fluid movement B. The number of doses that remain will be on the inhaler C. Drop the canister in water to observe floating D. Estimate how many doses are usually in the canister

B. The number of doses that remain will be on the inhaler Rationale: There are several methods to monitoring the contents of an inhaler. New MDIs such as diskus inhalers often have counters on them. The counters record the number of doses left in the canister. If the MDI does not have this feature, the client should write the date a refill is needed. This can be done directly on the canister in a permanent marker. Manufacturers do not recommend floating inhalers. The shaking or estimation method will not be accurate.

6) The nurse is teaching a pediatric client and family about prescribed albuterol sulfate extended-release tablets. Which statement should be included? A. If you cannot swallow the tablet, it is ok to chew it B. This medication can cause restlessness C. "This medication can cause restlessness." C. Rinse your mouth after taking this medication

B. This medication can cause restlessness

37) Which intervention would the nurse anticipate providing teaching on when a client presents with extensive lesions caused by psoriasis? A. Advising sunscreen and special clothing B. Topical application of steroids C. Potassium permanganate baths D. Débridement of necrotic plaques

B. Topical application of steroids Rationale Steroids are applied locally, and the lesions usually are covered with plastic wrap at night to reverse the inflammatory process. Solar rays may be used for treatment, but other forms of ultraviolet light are preferred. Potassium permanganate is an antiseptic astringent used on infected, draining, or vesicular lesions. The plaques are not necrotic and do not require débriding.

56) A client presents with extensive lesions caused by psoriasis. Which intervention would the nurse anticipate providing teaching on? A. Advising sunscreen and special clothing B. Topical application of steroids C. Potassium permanganate baths D. Débridement of necrotic plaques

B. Topical application of steroids Rationale Steroids are applied locally, and the lesions usually are covered with plastic wrap at night to reverse the inflammatory process. Solar rays may be used for treatment, but other forms of ultraviolet light are preferred. Potassium permanganate is an antiseptic astringent used on infected, draining, or vesicular lesions. The plaques are not necrotic and do not require débriding.

8) The nurse is reinforcing the correct use of a metered-dose inhaler (MDI) for a client newly-diagnosed with asthma. The client asks, "how will I know the canister is empty?" What is the best response by the nurse? A. "Contact your pharmacy to find out when to obtain a refill." B. "Drop the canister in water to observe if it floats." C. "Count the number of doses as the inhaler is used." D. "Shake the canister and listen for any fluid movement."

C. "Count the number of doses as the inhaler is used."

4) Which information would the nurse provide when administering the first dose of prednisone prescribed to a client with an exacerbation of colitis? A. "Prednisone protects you from getting an infection." B. "The medication may cause weight loss by decreasing your appetite." C. "Prednisone is not curative but does cause a suppression of the inflammatory process." D. "The medication is relatively slow in precipitating a response but is effective in reducing symptoms."

C. "Prednisone is not curative but does cause a suppression of the inflammatory process." Rationale: Prednisone inhibits phagocytosis and suppresses other clinical phenomena of inflammation; this is a symptomatic treatment that is not curative. Prednisone suppresses the immune response, which increases the potential for infection. The appetite is increased with prednisone; weight gain may result from the increased appetite or from fluid retention. Generally, the response to prednisone is rapid.

13) A client with a history of asthma is admitted for a minor surgical procedure. Preoperatively, the peak flow is measured at 480 liters/minute. Postoperatively, the client reports chest tightness and the peak flow is now 200 liters/minute. What should the nurse do first? A. Notify both the surgeon and primary care provider B. Repeat the peak flow reading in 30 minutes C. Administer the PRN dose of albuterol D. Apply oxygen at two liters per nasal cannula

C. Administer the PRN dose of albuterol

4) A client prescribed albuterol tablets reports nausea every evening with the 9:00 p.m. dose. Which action should the nurse perform to alleviate this side effect? A. Change the time of the dose. B. Hold the 9 p.m. dose. C. Administer the dose with a snack. D. Offer an antiemetic with the dose.

C. Administer the dose with a snack.

15) Upon admission to the emergency center, an adult client with acute status asthmaticus is prescribed this series of medications. In which order should the nurse administer the prescribed medications? (Arrange from first to last.) A. Prednisone (Deltasone) orally. B. Gentamicin (Garamycin) IM. C. Albuterol (Proventil) puffs. D. Salmeterol (Serevent Diskus).

C. Albuterol (Proventil) puffs (1) D. Salmeterol (Serevent Diskus).(2) A. Prednisone (Deltasone) orally.(3) B. Gentamicin (Garamycin) IM. (4)

1) The nurse is preparing to discharge a client who presented to the emergency room for an acute asthma attack. The nurse notes that upon discharge the health care provider has prescribed theophylline 300 mg orally to be taken daily at 9:00 AM. The nurse will teach the client to take the medication on which schedule? A. One hour before or 2 hours after eating B. At bedtime C. At the specific time prescribed D. Daily until symptoms are gone

C. At the specific time prescribed

62) The client has been treated with long-term glucocorticoid therapy. While completing the physical assessment, which finding should the nurse expect? A. Jaundice B. Peripheral edema C. Buffalo hump D. Increased muscle mass

C. Buffalo hump Rationale: The most common side effects of glucocorticoid therapy include increased appetite including weight gain, increased blood glucose, acne, thinning of the skin, easy bruising and change in body shape (increase in fatty tissue on the trunk with thinner legs and arms). The client may also develop a hump behind the shoulders due to the accumulation of fat on the back of the neck. This is referred to as a buffalo hump. Jaundice, peripheral edema and increased muscle mass are not side effects of glucocorticoid therapy.

42) A client with myasthenia gravis is to receive immunosuppressive therapy with corticosteroids. Which mechanism of action assures the nurse that this therapy will be effective? A. Inhibits the breakdown of acetylcholine at the neuromuscular junction B. Stimulates the production of acetylcholine at the neuromuscular junction C. Decreases the production of autoantibodies that attack acetylcholine receptors D. Promotes the removal of autoantibodies that impair the transmission of impulses

C. Decreases the production of autoantibodies that attack acetylcholine receptors Rationale Steroids decrease the body's immune response, limiting the production of antibodies that attack acetylcholine receptors at the neuromuscular junction. Inhibiting the breakdown of acetylcholine at the neuromuscular junction is the action of anticholinergic medications. Stimulating the production of acetylcholine at the neuromuscular junction is not the action of immunosuppressives. Promoting the removal of autoantibodies that impair the transmission of impulses is the rationale for plasmapheresis.

35) Which times for the medication schedule would a nurse teach when corticosteroid therapy is prescribed for a client with an exacerbation of ulcerative colitis? A. At bedtime with a snack B. Three times a day with meals C. In the early morning with food D. One hour before or 2 hours after eating

C. In the early morning with food Rationale:Taking the medication in the early morning mimics usual adrenal secretions; food helps reduce gastric irritation. Diurnal rhythms may be altered, and steroids are ulcerogenic; they should be taken with more than just a snack. Steroids cause gastric irritation and should be taken with food. Although food helps decrease gastric irritation, dividing the dose and taking it throughout the day may alter regular diurnal rhythms; it should be taken in the early morning with food.

60) The nurse is teaching a client about newly prescribed inhaled budesonide. The nurse should teach the client to report which finding to the healthcare provider? A. Rounded face B. Bradycardia C. Increased thirst D. Cough

C. Increased thirst Rationale: Respiratory disorders, such as asthma, status asthmatic, chronic obstructive pulmonary disease (COPD), and rhinitis, may all be treated with corticosteroids, including budesonide. Corticosteroids have many common side effects including cushingoid features, such as "moon face" due to redistribution of fat. Fluid retention is also common when using corticosteroids. Increased thirst may be an indication of hyperglycemia and should be reported. Corticosteroids can increase heart rate. A cough is normal with corticosteroids as the airway is dilated.

5) The nurse is providing teaching to the client prescribed albuterol for the management of asthma. The nurse is including reportable side effects in the teaching plan. Which of the following side effects is the priority? A. Nervousness B. Headache C. Palpitations D. Muscle aches

C. Palpitations

55) A male client receiving prolonged steroid therapy complains of always being thirsty and urinating frequently. Which is the nurse's initial action? A. Have the client assessed for an enlarged prostate. B. Obtain a urine specimen from the client to test for ketonuria. C. Perform a finger stick to test the client's blood glucose level. D. Assess the client's lower extremities for the presence of pitting edema

C. Perform a finger stick to test the client's blood glucose level. Rationale The client has signs of an increased serum glucose level, which may result from steroid therapy; testing the blood glucose level is a method of gathering more data. The symptoms are not those of benign prostatic hyperplasia. The blood glucose level, not the amount of ketones in the urine, should be assessed. The symptoms presented are not those of fluid retention but of hyperglycemia.

38) Which action will a nurse take when a male client receiving prolonged steroid therapy complains of always being thirsty and urinating frequently? A. Have the client assessed for an enlarged prostate. B. Obtain a urine specimen from the client to test for ketonuria. C. Perform a finger stick to test the client's blood glucose level. D. Assess the client's lower extremities for the presence of pitting edema.

C. Perform a finger stick to test the client's blood glucose level. Rationale: The client has signs of an increased serum glucose level, which may result from steroid therapy; testing the blood glucose level is a method of gathering more data. The symptoms are not those of benign prostatic hyperplasia. The blood glucose level, not the amount of ketones in the urine, should be assessed. The symptoms presented are not those of fluid retention but of hyperglycemia.

21) The client who was admitted with exacerbation of ulcerative colitis has developed hyperglycemia. Which medication that the client was prescribed most likely caused this adverse drug effect? A. Dicyclomine B. Acetaminophen C. Prednisone D. Diphenoxylate/atropine

C. Prednisone Rationale: Prednisone is a corticosteroid, specifically a glucocorticoid. Corticosteroid therapy may be prescribed during exacerbations of ulcerative colitis to decrease inflammation. Common adverse effects include hyperglycemia, osteoporosis, peptic ulcer disease and an increased risk for infection. The nurse should monitor clients who are receiving prednisone for hyperglycemia. Dicyclomine hydrochloride and diphenoxylate with atropine are cholinergic blocking drugs prescribed for gas (flatus) and diarrhea, commonly seen with ulcerative colitis. Acetaminophen is a non-narcotic analgesic given for mild-to-moderate pain. None of those drugs are known to cause an elevated blood sugar.

7) A child recovering from a severe asthma attack is given oral prednisone 15 mg twice daily. Which intervention would be a priority for the nurse? A. Having the child rest as much as possible B. Checking the child's eosinophil count daily C. Preventing exposure of the child to infection E. Offering sips of water when administering the medication

C. Preventing exposure of the child to infection Rationale: Prednisone reduces the child's resistance to certain infectious processes and, as an anti-inflammatory medication, masks infection. The child will self-limit activity depending on respiratory status. The eosinophil count is often consistently increased in children with asthma. The child will need adequate hydration to help loosen and expel mucus.

24) A health care provider prescribes dexamethasone for a client with head trauma. The nurse recognizes that it reduces swelling in the brain by which process? A. Acts as a hyperosmotic diuretic B. Increases resistance to infection C. Reduces the inflammatory response of tissues D. Decreases the formation of cerebrospinal fluid

C. Reduces the inflammatory response of tissues Rationale:Corticosteroids act to decrease inflammation, which decreases edema. Dexamethasone is an anti-inflammatory agent, not a diuretic. Resistance to infection is decreased, not increased, with a corticosteroid. The client's problem is not with increased cerebrospinal fluid.

36) Which action is the primary purpose of a topical steroid application to a basal cell carcinoma surgical site? A. Preventing infection of the wound B. Increasing fluid loss from the skin C. Reducing inflammation at the surgical site D. Limiting itching around the area of the lesion

C. Reducing inflammation at the surgical site Rationale Steroids are used for their anti-inflammatory, vasoconstrictive, and antipruritic effects. Steroids increase the incidence of infections because they are anti-inflammatory agents and mask the symptoms of infection. Steroids increase fluid retention because they promote the reabsorption of sodium from the tubular fluid into the plasma. Although steroid ointments have an antipruritic effect, their major purpose after surgery is their systemic anti-inflammatory effect.

57) The nurse provides client teaching on the administration of a topical steroid application to a basal cell carcinoma surgical site. The nurse evaluates the teaching as effective when the client identifies which action as the primary purpose of the medication? A. Preventing infection of the wound B. Increasing fluid loss from the skin C. Reducing inflammation at the surgical site D. Limiting itching around the area of the lesion Rationale

C. Reducing inflammation at the surgical site Rationale Steroids are used for their anti-inflammatory, vasoconstrictive, and antipruritic effects. Steroids increase the incidence of infections because they are anti-inflammatory agents and mask the symptoms of infection. Steroids increase fluid retention because they promote the reabsorption of sodium from the tubular fluid into the plasma. Although steroid ointments have an antipruritic effect, their major purpose after surgery is their systemic anti-inflammatory effect.

28) Which action would the nurse perform when administering fluticasone propionate to a client with asthma? Select all that apply. One, some, or all responses may be correct. A. Assessing heart rate and rhythm B. Monitoring liver function blood tests C. Rinsing the oral cavity with water after use D. Obtaining blood glucose levels before meals E. Giving stool softeners to prevent constipation

C. Rinsing the oral cavity with water after use Rationale Clients using inhaled glucocorticoids are at an increased risk for oral candidiasis. The nurse would instruct the client to rinse the mouth with water after using the inhaler. The nurse would monitor heart rate and pattern in clients taking beta 2 agonists such as albuterol, which can lead to tachydysrhythmias. Liver function is monitored in clients taking leukotrienes such as zileuton. Blood glucose monitoring is necessary for clients taking oral and intravenous glucocorticoids. Stool softeners are given to clients taking tiotropium because of the medication's anticholinergic side effect of constipation.

2) The nurse administers albuterol to a child with asthma. Which common side effect would the nurse monitor for in the child? A. Flushing B. Dyspnea C. Tachycardia D. Hypotension

C. Tachycardia

5) Which side effect of prolonged cortisone therapy for adrenal insufficiency would the nurse teach the client and family to expect? Select all that apply. One, some, or all responses may be correct. A. Oliguria B. Anorexia C. Weakness D. Moon face E. Weight gain F. Nervousness

C. Weakness D. Moon face E. Weight gain Rationale: Weakness occurs because of muscle wasting as a result of the catabolic effects of cortisol. Hypokalemia may also cause weakness; potassium is lost in the urine as sodium is retained. Accumulation of adipose tissue occurs in the face (moon face), trunk (truncal obesity), and cervical area (buffalo hump). Weight gain occurs because of increased appetite and fluid retention; 1 liter of fluid is equal to 2.2 pounds (1 kilogram). Cortisone increases sodium and water retention but does not cause oliguria; glucose levels also increase, which, if extreme, will cause polyuria. The appetite usually increases, not decreases. Cortisone increases blood glucose levels, which, if extreme, will cause lethargy, not nervousness.

22) The nurse is preparing a client with rheumatoid arthritis (RA) for discharge to an assisted living facility. Which statement about the prescribed oral glucocorticoid is correct? A. "The medication will reverse the joint deterioration of RA." B. "You will be taking the medication for several years." C. "It is normal to experience some memory loss or hallucinations." D. "The medication will be gradually tapered off over 5 to 7 days."

D. "The medication will be gradually tapered off over 5 to 7 days." RA is an autoimmune, inflammatory disease that affects the joints. It is a progressive disease that causes joint deterioration and destruction, joint deformities and functional limitations for affected clients. The main goal of pharmacotherapy for RA is symptom relief. Glucocorticoids are anti-inflammatory drugs, which can relieve symptoms of RA and may also delay disease progression. For generalized symptoms related to RA, oral glucocorticoids are indicated. The most commonly employed oral glucocorticoids are prednisone and prednisolone.

17) A female client receiving cortisone therapy for adrenal insufficiency expresses concern that she is developing facial hair. How would the nurse respond? A. 'It is just another sign of adrenal insufficiency.' B. 'This side effect will disappear after therapy.' C. 'This is not important as long as you are feeling better.' D. 'The medication contains a hormone that causes male characteristics.'

D. 'The medication contains a hormone that causes male characteristics.' Rationale: Some cortisol derivatives possess 17-keto-steroid (androgenic) properties, which result in hirsutism. Facial hair is not a sign of the illness; it results from androgens that are present in cortisol. Hirsutism will be a long-term problem because therapy is provided on a long-term, usually lifelong, basis. The response 'This is not important as long as you are feeling better' doesn't address the client's concerns.

23) A child is prescribed fluticasone after an acute asthma attack. Which instruction would the nurse give the family about the administration of this medication? A. 'Fluticasone needs to be taken with food or milk.' B. 'Fluticasone is primarily used to treat acute asthma attacks.' C. 'The child should suck on hard candy to help relieve dry mouth.' D. 'Watch for white patches in the mouth and report to the health care provider.'

D. 'Watch for white patches in the mouth and report to the health care provider.' Rationale: Fluticasone is a steroid commonly administered by way of inhalation for long-term control of asthma symptoms. Oral thrush is a side effect that manifests as white patches. Fluticasone is administered via inhalation so food or milk is not needed before administration. Dry mouth is not a side effect of fluticasone.

2) Which explanation would the nurse provide for administering prednisone to a client with an exacerbation of colitis? A. The client will be protected from getting an infection. B. Symptoms associated with the colitis will decrease slowly over time. C. Although the medication causes anorexia, weight loss may not occur. D. Although the medication decreases intestinal inflammation, it will not cure the colitis.

D. Although the medication decreases intestinal inflammation, it will not cure the colitis. Rationale: Prednisone inhibits phagocytosis and suppresses other clinical phenomena of inflammation; this is a symptomatic treatment that is not curative. The medication suppresses the immune response and increases the potential for infection. The response usually is rapid. Appetite is increased; weight gain may result from this or from fluid retention.

10) Which complication is an adverse effect of cortisone therapy? A. Hypoglycemia B. Severe anorexia C. Anaphylactic shock D. Behavioral changes

D. Behavioral changes Rationale:Development of mood swings and psychosis is possible during long-term therapy with glucocorticoids because of fluid and electrolyte alterations. Hypoglycemia, severe anorexia, and anaphylactic shock are not responses to long-term glucocorticoid therapy.

29) The nurse admits a client with tumor-induced spinal cord compression. Which medication should the nurse anticipate to be prescribed to offer the best palliative treatment for this client? A. Morphine sulfate. B. Ibuprofen. C. Amitriptyline. D. Dexamethasone.

D. Dexamethasone. Rationale Dexamethasone is a palliative treatment modality to manage symptoms related to compression due to tumor growth. Morphine sulphate is an opioid analgesic used in oncology to manage severe or intractable pain. Ibuprofen, a nonsteroidal antiinflammatory drug (NSAID), provides relief for mild to moderate pain, suppression of inflammation, and reduction of fever. Amitriptyline, a tricyclic antidepressant, is often prescribed for pain related to neuropathic origin and provides a reduction in opioid dosage.

63) Which increased risk would the nurse consider when assessing a client with diabetes who is receiving long-term corticosteroid therapy and is admitted with leg ulcers? A. Weight loss B. Hypoglycemia C. Decreased blood pressure D. Inadequate wound healing

D. Inadequate wound healing Rationale Because the anti-inflammatory response is depressed as a result of increased cortisol levels, the wounds of clients receiving long-term corticosteroid therapy tend to heal slowly. A common finding associated with long-term corticosteroid use is weight gain, caused not only by fluid retention but also by alterations in fat, carbohydrate, and protein metabolism. Persistent hyperglycemia (steroid diabetes) occurs because of altered glucose metabolism. Hypertension, not hypotension, occurs as a result of sodium and fluid retention.

25) A client is receiving dexamethasone to treat acute exacerbation of asthma. For which side effect would the nurse monitor the client? A. Hyperkalemia B. Liver dysfunction C. Orthostatic hypotension D. Increased blood glucose

D. Increased blood glucose Dexamethasone increases gluconeogenesis, which may cause hyperglycemia. Hypokalemia, not hyperkalemia, is a side effect. Liver dysfunction is not a side effect. Hypertension, not hypotension, is a side effect.

45) A client receiving corticosteroid therapy states, 'I have difficulty controlling my temper, which is so unlike me, and I don't know why this is happening.' How will the nurse respond? A. Tell the client it is nothing to worry about. B. Reassure that everyone does this at times. C. Instruct the client to attempt to avoid situations that cause irritation. D. Inquire about mood swings.

D. Inquire about mood swings. Corticosteroids increase the excitability of the central nervous system, which can cause labile emotions manifested as euphoria and excitability or depression. Telling the client it is nothing to worry about or that it is normal denies the value of the client's statement and offers false reassurance. The client has already stated the problem and does not know why this is happening. Instructing the client to attempt to avoid situations that cause irritation is impractical because the mood swings may occur without an overt cause.

27) When a client is receiving dexamethasone for adrenocortical insufficiency, which action would the nurse take to monitor for an adverse effect of the medication? A. Auscultate for bowel sounds. B. Assess deep tendon reflexes. C. Culture respiratory secretions. D. Measure blood glucose levels.

D. Measure blood glucose levels. Rationale: Corticosteroids, such as dexamethasone, have a hyperglycemic effect, and blood glucose levels should be monitored routinely. Assessing bowel sounds is unnecessary; corticosteroids are not known to precipitate cessation of gastrointestinal activity. Although corticosteroids may increase the risk of developing an infection, routine culturing of respiratory secretions is unnecessary. Culturing respiratory secretions becomes necessary when the client exhibits adaptations of a respiratory infection. Monitoring deep tendon reflexes is required when administering magnesium sulfate, not dexamethasone.

44) Long-term corticosteroid therapy has been initiated for a client with myasthenia gravis who experiences inadequate symptomatic control with pyridostigmine bromide. Which action is important for the nurse to take? A. Request a high-sodium diet. B. Establish protective isolation. C. Decrease the client's total daily fluid intake. D. Monitor the client for an exacerbation of symptoms.

D. Monitor the client for an exacerbation of symptoms. Rationale: Rationale Exacerbation of myasthenia gravis may occur temporarily at the beginning of steroid therapy, causing respiratory embarrassment and dysphagia. Increasing sodium intake is contraindicated because corticosteroids increase sodium retention. Although clients should avoid contact with persons who have upper respiratory infections, protective isolation (neutropenic precautions) is not required. Decreasing total daily fluid intake is unnecessary; adequate fluid intake should be maintained.

19) Which side effect would the nurse assess for in a child receiving prednisone? A. Alopecia B. Anorexia C. Weight loss D. Mood changes

D. Mood changes Rationale: Mood swings may result from steroid therapy. Alopecia does not result from steroid therapy. An increased appetite, not anorexia, results from steroid therapy. Weight gain, not weight loss, results from steroid therapy.

14) Which effect explains the purpose for gradual dosage reduction of glucocorticoids such as dexamethasone? A. Builds glycogen stores in the muscles B. Produces antibodies by the immune system C. Allows the increased intracranial pressure to return to normal D. Promotes return of cortisone production by the adrenal glands

D. Promotes return of cortisone production by the adrenal glands Rationale: Hormone therapy must be withdrawn slowly to allow the adrenal glands to adjust and resume production of their hormone. Building glycogen stores in the muscles, producing antibodies by the immune system, and allowing the increased intracranial pressure to return to normal are not reasons for the gradual withdrawal of dexamethasone.

54) A client is admitted to the hospital for an adrenalectomy. When teaching the client about the prescribed medications, which advice will the nurse emphasize? A. Medication therapy will be given in conjunction with insulin. B. Once regulated, the dosage will remain the same for life. C. Medications will need to be held for surgery or other invasive procedures. D. Salt intake may have to be restricted.

D. Salt intake may have to be restricted. Administration of adrenocortical hormones causes sodium retention; dietary intake of salt should be limited. Because pancreatic function is unimpaired, insulin therapy is not indicated. Dosages will likely need to be adjusted over time. The dosage will need to be increased for surgery and severe infections; not doing this can cause a life-threatening crisis.

64) Which outcome would the nurse expect when caring for a child receiving adrenocorticosteroid therapy? A. Accelerated wound healing B. Development of hyperkalemia C. Increased antibody production D. Suppressed inflammatory process

D. Suppressed inflammatory process Rationale Because of the suppression of the inflammatory process, the nurse must be alert to the subtle symptoms of infection, such as changes in appetite, sleep patterns, and behavior. Adrenocorticosteroid therapy delays (not accelerates) wound healing. Adrenocorticosteroid therapy may cause hypokalemia, not hyperkalemia, because of the accompanying retention of sodium and fluid. Adrenocorticosteroid therapy decreases (not increases) the production of antibodies.

53) A client is scheduled for a bilateral adrenalectomy. Which rationale describes why steroids are administered to the client? A. To foster accumulation of glycogen in the liver B. To increase the inflammatory action to promote healing C. To facilitate urinary excretion of salt and water after surgery D. To compensate for sudden lack of these hormones after surgery

D. To compensate for sudden lack of these hormones after surgery Rationale: Adrenal steroids help an individual adjust to stress. Unless received from external sources, there is no hormone available to cope with surgical stresses after an adrenalectomy. Glucose stores (glycogen) will be used by the body to adapt to surgery. Insulin is the hormone that facilitates conversion of glucose to glycogen. Steroids do not increase inflammatory reactions. Steroids will result in fluid retention, not loss.

33) Which symptom would the nurse expect to decrease in response to corticosteroid therapy prescribed for a client with multiple sclerosis? A. Emotional lability B. Muscular contractions C. Pain in the extremities D. Visual impairment

D. Visual impairment Rationale Corticosteroids decrease the inflammatory process around the optic nerve, thus improving vision; visual impairment is the most common physiological manifestation of multiple sclerosis. Steroids are associated with increased emotional lability. Steroids are not effective in easing muscle contractions. Pain in the extremities is not common unless spasms are present; steroids do not relieve spasms.

13) The nurse is caring for a client who is scheduled for a bilateral adrenalectomy. Which medication would the nurse expect to be prescribed for this client? a. Methimazole b. Regular insulin c. Pituitary extract d. Hydrocortisone

d. Hydrocortisone Rationale: Hydrocortisone is a glucocorticoid. A client undergoing bilateral adrenalectomy must be given adrenocortical hormones so that adjustment to the sudden lack of these hormones that occurs with this surgery can take place Methimazole is used to treat a client with hyperthyroidism, not a client with a bilateral adrenalectomy. Because the surgery involves the adrenal glands, not the pituitary gland, secretion of pituitary hormones will not be affected. Regular insulin is not necessary. Insulin is produced by the pancreas, and its function is not altered by this surgery.