Ch 17: Drug Therapy with Corticosteroids

The nurse is teaching a client who will require long-term corticosteroid therapy how to reduce the risk of infection. What suggestions will the nurse include? a) "Avoid working in areas with other people." b) "Avoid large crowds of people in confined spaces." c) "Avoid touching other people who may carry germs." d) "Avoid exercising to reduce risk of injury."

"Avoid large crowds of people in confined spaces." Rationale: With long-term therapy, the importance of avoiding exposure to infection—crowded areas, people with colds or the flu, activities associated with injury—should be stressed. If an injury or infection should occur, the client should be encouraged to seek medical care. These clients do not need to avoid work, exercise, or touching others but they should use good hand hygiene to avoid infection from these sources.

A 2-year-old client is placed on a course of prednisone following a series of hypersensitivity responses. What instruction the nurse provide the client's family about this drug? a) "Don't stop this medication suddenly; you will have to taper dosage gradually." b) "The child may receive immunizations while on this drug, but keep them to a minimum." c) "Monitor your child closely for any difficulty swallowing or signs of gastric reflux." d) "You might find that your child is sleepier than usual, especially near the beginning of treatment."

"Don't stop this medication suddenly; you will have to taper dosage gradually." Rationale: Prednisone is usually ordered for short-term use with tapering dosage. It is important to instruct the parent to taper doses and to not just stop the drug suddenly when discontinuing from high doses so as to give the adrenal glands a chance to recover and produce adrenocorticoids. Parents should also be told to wait to have the child immunized until after drug therapy is completed. Insomnia or agitation is more likely than drowsiness, and the drug does not create a risk for dysphagia or reflux.

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

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

The nurse just completed client education relative to chronic adrenocortical insufficiency and corticosteroid medication treatment. Which statement indicates the client requires further instruction? a) "I will start this medication as soon as I am feeling ill or tired." b) "I will call my health care provider if I develop a fever." c) "I will report any weight gain above 5 pounds in 1 week to my health care provider." d) "I need to minimize my exposure to anyone who may be ill."

"I will start this medication as soon as I am feeling ill or tired." Rationale: Daily administration is required in cases of chronic adrenocortical insufficiency. Clients should be instructed to call their health care provider if a fever above 101°F (38.3°C) develops, minimize exposure to anyone who may be ill, and report any weight gain above 5 pounds in 1 week.

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? a) "Sadly, this is an adverse effect seen in women. It should improve when you finish the medication." b) "If you shave it regularly, no one will notice." c) "Stop taking the drug immediately." d) "This is a permanent problem. You will need to schedule electrolysis treatments."

"Sadly, this is an adverse effect seen in women. It should improve when you finish the medication." Rationale: An adverse effect in women who take corticosteroids is acne and hair on the face. This side effect usually resolves after the medication is discontinued. The drug should never be stopped abruptly but weaned gradually.

The home health nurse provides client teaching to a client who is taking oral prednisolone. The nurse provides what instruction to the client? a) "Take before bedtime." b) "Take 1 hour before meals." c) "Split the dose into two equal doses." d) "Take it first thing in the morning."

"Take it first thing in the morning." Rationale: Timing is dictated by frequency of administration, and if only taken once daily, the medication should be taken in the morning (so bedtime is inappropriate). Splitting the dose would decrease effectiveness and would be inappropriate for the nurse to suggest because it is outside the scope of nursing practice. Taking the medication before meals would mean it was being taken on an empty stomach, which can cause gastric upset.

A client is on daily doses of prednisone. To minimize adrenal suppression, when should the nurse encourage a client to take his or her daily dose of prescribed prednisone? a) "Take your medications in the morning." b) "Take your medication just before bedtime." c) "Take your medications on an empty stomach." d) "Take your medications with the evening meal."

"Take your medications in the morning." Rationale: A major adverse reaction associated with corticosteroid therapy is suppression of the hypothalamic-pituitary-adrenal, or HPA, axis and subsequent loss of adrenocortical function. Scheduling of medication (morning dosing) is often recommended to prevent or minimize HPA suppression. Daily administration is required in cases of chronic adrenocortical insufficiency. The entire daily dose can be taken each morning, between 06:00 and 09:00. This schedule simulates normal endogenous corticosteroid secretion.

A patient with severe arthritis is taking high dose corticosteroids. The patient approaches the clinic nurse and requests a pneumonia vaccine. What would be the nurse's best response? "Pneumonia vaccines are only given if you are at risk for serious pulmonary problems." "Corticosteroids will protect the body from respiratory infections." "Since the body is fighting the arthritis, the vaccine can cause serious adverse effects." "Vaccines cannot be given to people who are significantly immune suppressed."

"Vaccines cannot be given to people who are significantly immune suppressed." Corticosteroids block the inflammatory response and are very helpful in conditions such as arthritis. However, they also block the immune response, making a person immune suppressed. The vaccine would not be given to this patient because the patient's body would not respond by mounting an immune response.

A child is to receive a topical corticosteroid agent. Which statement by the parents indicates a need for additional teaching? "We will apply the medication sparingly" "We will not apply the medication to open lesions or excoriated areas" "We need to cover the area snugly with plastic wrap to prevent scratching."

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

A female client experiences weight gain secondary to her systemic steroid therapy for temporal arteritis. She calls the health care provider's office to ask if she can discontinue the medication for 1 week to fit into her dress for her class reunion. Which response is appropriate?

"Your prescription must be tapered gradually with the provider's order." Explanation: Strategies to minimize HPA suppression and risks of acute adrenal insufficiency include gradually tapering the dose of any systemic corticosteroid.

A patient who has been taking ketoconazole for 1 month reports fatigue. What assessment findings are causes for concern related to this therapy? (Select all that apply.) A reported change in bowel movements to a lighter color A yellow tint to the patient's skin Yellow coloring around the patient's irises Straw-colored urine from the patient Thinning hair in the patient

-A reported change in bowel movements to a lighter color -A yellow tint to the patient's skin - Yellow coloring around the patient's irises Explanation: Light-colored stools, a yellow tint to the skin, and yellow coloring of the eyes could all be symptoms of liver toxicity. The nurse should assess liver enzymes. Straw-colored urine and thinning hair are not causes for concern. BBW for hepatotoxicity (indicated by jaundice)

A male client taking oral prednisone informs the home care nurse that the medication is upsetting his stomach. What guidance can the nurse provide to help the client? -Confirm that the client takes the medication with a meal. -Confirm that the client takes the medication on an empty stomach. -Recommend that the client take the medication shortly before bedtime. -Recommend that the client split the dose into two smaller, equal doses.

-Confirm that the client takes the medication with a meal.

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

-Release of epinephrine and norepinephrine The stress response activates the sympathetic nervous system, causing the adrenal cortex to secrete adrenocortical hormones such as cortisol.

The nurse is caring for a client who works night shift from 22:00 to 06:00 and normally sleeps from 0800 (8 am) until 1600 (4 pm) each day. The nurse should teach this client to take the prescribed corticosteroid at what time of the day?

16:00

At which time would a nurse expect peak levels of adrenocorticotropic hormone to occur? A patient is being treated with corticosteroids for chronic adrenocortical insufficiency. When should the patient be instructed to take the medication? 21:00 pm 12:00 pm 13:00-14:00 pm 06:00 and 09:00 am

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

Which client demonstrates the clearest indication for treatment with prednisone? A 66-year-old woman whose history of smoking has culminated in a diagnosis of emphysema A 70-year-old man whose rheumatoid arthritis has not responded to OTC pain relievers A 12-year-old boy whose long-standing fatigue and malaise have been attributed to leukemia A 50-year-old woman who is being treated for hypertension with a diuretic and an ACE inhibitor

A 70-year-old man whose rheumatoid arthritis has not responded to OTC pain relievers Explanation: There are numerous clinical indications for treatment with glucocorticoids such as prednisone. Among these are inflammatory diseases such as rheumatoid arthritis. Emphysema, hypertension, and leukemia are not health problems that are typically treated with corticosteroids.

While learning about corticosteroids in pharmacology class, a student asks the instructor to offer an example of indications for use. What could the instructor mention? A disease without an immunological component Any systemic disease state A disease with an inflammatory component Any hormone excessive state

A disease with an inflammatory component Explanation:Because corticosteroids affect virtually every aspect of inflammatory and immune responses, they are used in the treatment of a broad spectrum of diseases with an inflammatory or immunologic component. Corticosteroids are not indicated for the treatment of diabetes mellitus, in fact, these medications can exacerbate the condition if prescribed to a client with this diagnosis. Corticosteroids can increase blood sugar levels.

A male client experiences an acute exacerbation of his asthma secondary to an allergic reaction. The health care provider orders what type of therapy to minimize HPA suppression and risks of acute adrenal insufficiency?

A short course of systemic therapy Explanation: Strategies to minimize HPA suppression and risks of acute adrenal insufficiency include giving short courses of systemic therapy for acute disorders.

When administering long-term systemic corticosteroid medications, which of the following dosing schedules is recommended? A. alternate-day therapy B. once daily at noon C. weekly therapy D. nightly therapy

A. It is recommended that systemic corticosteroid medications be administered on alternate days. The dose administered is two times the normal daily dose.

A boy has contracted a rash caused by poison ivy over a large portion of his arms and legs following a camping trip. His health care provider has prescribed oral prednisone, which is to be administered in a tapering dose over the next 10 days. What effect does the medication have on the rash? A. It decreases the accumulation of neutrophils and macrophages at the site, thus reducing inflammation. B. It eliminates the itching associated with the allergy. C. It increases the white blood cell count to assist in healing D. It increases the protein metabolism to allow for the rejuvenation of tissue.

A. Prednisone decreases the inflammatory response by reducing the accumulation of neutrophils and macrophages at sites of inflammation.

A patient diagnosed with Addison's disease is taking exogenous corticosteroids. The nurse should assess the patient for which of the following adverse effects? A. hyperglycemia B. hyperkalemia C. hypercalcemia D. hypermagnesemia

A. The administration of systemic corticosteroids leads to an increase in blood glucose. The nurse should assess the client for hyperglycemia.

A patient is receiving prednisone 10 mg orally every day to reduce symptoms of Crohn's disease. Which of the following effects is associated with daily administration of prednisone? A. atrophy of the adrenal cortex B. decreased serum glucose C. weight loss D. fluid volume deficit

A. The administration of systemic corticosteroids such as prednisone results in atrophy of the adrenal cortex.

A patient is taking systemic corticosteroids. Which of the following nursing interventions is most important to implement? A. Assess for signs and symptoms of adrenocortical excess B. Hold the corticosteroid before surgery or diagnostic testing C. Assess for fluid volume deficit D. Decrease the intake of vitamin C

A. The nurse should assess the client receiving systemic corticosteroid therapy for adrenocortical excess.

A woman is being treated with long term corticosteroid therapy. Her husband has just received a diagnosis of terminal cancer. How is his diagnosis likely to affect her treatment. A. She may need to have her dose of corticosteroid increased because of stress. B. She may need a decrease in corticosteroids because of the increase in cortisol C. She may need to be changed to a different corticosteroid because of the stress D. She may be switched to a parenteral form of corticosteroid

A. The woman will most likely require a larger dose of corticosteroid as a result of her husband's diagnosis. Periods of increased stress require larger doses of corticosteroids.

A group of students are reviewing the contraindications for glucocorticoid therapy. The students demonstrate understanding when they identify which condition? Acute infection Peptic ulcer disease Endocrine disorder

Acute infection Explanation: Acute infection is a contraindication for glucocorticoid use; the infection could become severe and possibly fatal with the blockage of the immune and inflammatory responses. Glucocorticoids are used cautiously in patients with peptic ulcer disease. Glucocorticoids are used cautiously in patients with endocrine disorders because additional imbalance can occur.

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

Addison disease Characteristics of Addison disease include those related to glucocorticoid deficiency, such as hypoglycemia, anorexia, nausea, vomiting, flatulence, diarrhea, hyperpigmentation of skin, anxiety, depression, and loss of mental acuity, and those related to mineralocorticoid deficiency, such as fluid and electrolyte imbalance, orthostatic hypotension, hyponatremia, hyperkalemia, general malaise, muscle weakness, muscle pain, and cardiac arrhythmias. Hypertension, stroke, and Cushing disease are not associated with this array of signs and symptoms.

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

Addison's disease Explanation: Abrupt cessation of corticosteroid therapy can precipitate an addisonian crisis due to suppression of the hypothalamic-pituitary-adrenal (HPA) axis. The only option associated with adrenocortical insufficiency is Addison's disease.

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

Adrenal atrophy Explanation: Prolonged use of corticosteroids suppresses the normal hypothalamic-pituitary axis and leads to adrenal atrophy from lack of stimulation.

Long-term treatment of chronic illnesses is sometimes accomplished by corticosteroids. What effect of corticosteroid drugs would be considered an adverse effect? Anti-replacement Anti-inflammatory Anti-allergic Immunosuppressive

Anti-replacement Adrenocortical agents are now reserved for use to relieve inflammation during acute stages of illness or for replacement therapy to maintain hormone levels when the adrenal glands are not functioning adequately. Adverse effects of adrenocortical agents do not include anti-allergic, anti-inflammatory, or immunosuppressive response.

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

Apply the medication sparingly. Corticosteroids are used topically and locally to achieve the desired anti-inflammatory effects at a particular site without the systemic adverse effects that limit the usefulness of the drugs. Patient teaching would include leaving the lesions open to air and applying the topical cream as directed by the physician.

Clients taking a corticosteroid medication should be asked about any history of: The nurse is caring for a client who has been prescribed corticosteroid therapy. The nurse should notify the prescribing health care provider when observing chat inc the client's history? A. Asthma B. Peptic ulcer C. Mild hypotension D. Osteoarthritis

B. Peptic ulcer Explanation: Corticosteroids are contraindicated in systemic fungal infections; clients who are hypersensitive to drug formulations; clients at risk for infections; and clients with infections, diabetes mellitus, peptic ulcer disease, inflammatory bowel disorders, hypertension, congestive heart failure, or renal insufficiency.

A patient with chronic obstructive pulmonary disease is being administered a corticosteroid by nebulizer. What effect does the corticosteroid have? A. decrease in blood pressure B. decrease in mucus secretion C. decrease in edema D. increase in immunity

B. The administration of corticosteroids by nebulizer decreases mucous secretion and inflammation in a client with chronic obstructive pulmonary disease.

What would a nurse expect to administer by inhalation?

Beclomethasone

Which adrenocortical hormone drugs influence or regulate functions such as the immune response, glucose, fat, and protein metabolism, and the anti-inflammatory response? (Select all that apply.) Budesonide (Entocort EC) Dexamethasone (Decadron) Hydrocortisone (Cortef) Fludrocortisone (Florinef) Betamethasone (Celestone)

Betamethasone (Celestone) Budesonide (Entocort EC) Hydrocortisone (Cortef) Dexamethasone (Decadron) Glucocorticoids, like betamethasone (Celestone), budesonide (Entocort EC), hydrocortisone (Cortef), and dexamethasone (Decadron), influence or regulate functions such as the immune response, glucose, fat, and protein metabolism, and the anti-inflammatory response.

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

Blood pressure Explanation: Fludrocortisone acts on the distal renal tubule to enhance the reabsorption of sodium and to increase the urinary excretion of both potassium and hydrogen ions. In small oral doses, the mineralocorticoid effects of fludrocortisone predominate: urinary excretion of potassium, marked sodium retention, and a rise in blood pressure as a result of the physiologic effects of these electrolyte levels. The level of consciousness is not affected by fludrocortisone unless there are significant changes in the fluid balance.

A patient is admitted to the emergency department in anaphylactic shock following numerous bee stings. The prescriber orders parenteral administration of corticosteroids. What effect is expected from the administration of these agents? A. decreased heart rate and blood pressure B. increased circulation to the lower extremities C. increased or restored cardiovascular responsiveness D. decreased production of aldosterone

C. After anaphylactic shock resulting from an allergic reaction, corticosteroids may increase or restore cardiovascular responsiveness to adrenergic drugs.

A child is taking long term systemic corticosteroids. What factor influences the child's diminished growth? A, hypokalemia B. fluid retention C. altered DNA synthesis D. increase in parathyroid hormone

C. Corticosteroids alter the synthesis of DNA, resulting in diminished growth.

A cancer patient asks the nurse why he is being given a corticosteroid before his chemotherapy. Which of the following is the nurse's best response? A. It will prevent the development of anemia related to the chemotherapy. B. It will prevent the development of hiccups, which is associated with chemotherapy. C. It will prevent nausea and vomiting that occur with chemotherapy D. It will boost your immune system and prevent infection

C. The administration of corticosteroids before the administration of chemotherapy helps prevent nausea and vomiting, which is an adverse effect of chemotherapy.

A liver transplant patient is receiving corticosteroids. These drugs are important to the care of this patient because they A. prevent thromboctypenia B. increase immunity C. prevent tissue rejection D. decrease inflammation

C. The administration of corticosteroids to clients after liver transplant suppresses cellular and humoral immune responses and helps prevent rejection of transplanted tissue.

A nurse is overseeing the care of a young man whose ulcerative colitis is being treated with oral prednisone. Which action should the nurse take in order to minimize the potential for risks associated with prednisone treatment? a) Advocate for intravenous, rather than oral, administration. b) Avoid OTC antacids for the duration of treatment. c) Teach the client strategies for dealing with headaches. d) Carefully assess the client for infections.

Carefully assess the client for infections. Rationale: It is important to monitor clients who are taking prednisone carefully for signs of infection, because prednisone's immunologic activity may mask the symptoms of infection. Antacids may normally be used alongside prednisone. Headaches are not associated with the use of prednisone and IV administration is not typical.

Which would a nurse expect to assess in a patient with an adrenocortical hormone deficiency? (Select all that apply.) Confusion Hyperkalemia Hyponatremia Hypernatremia Hypokalemia Confusion Purpura Renal calculi

Confusion Hyperkalemia Hyponatremia Explanation: Manifestations of hypoadrenal function include confusion, hyponatremia, and hyperkalemia. Purpura and renal calculi are associated with hyperadrenal function.

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? a) Vasopressors b) Corticosteroids c) ACE inhibitors d) Beta-blockers

Corticosteroids Rationale: In adrenal insufficiency, hypotension is a common symptom in critically ill clients, and hypotension caused by adrenal insufficiency may mimic either hypovolemic or septic shock. If adrenal insufficiency is the cause of the hypotension, administration of corticosteroids can eliminate the need for vasopressor drugs to maintain adequate tissue perfusion.

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? a) Corticosteroids increase the risk for childhood illness. b) Corticosteroids impair the child's mental status. c) Corticosteroids increase the risk for rejection in children younger than 6 years of age. d) Corticosteroids impair growth in children.

Corticosteroids impair growth in children. Rationale: Most immunosuppressants are used in children for the same disorders and with similar effects as in adults. Corticosteroids impair growth in children. As a result, some transplantation centers avoid prednisone therapy until a rejection episode occurs.

Which of the following psychosocial changes are most likely to occur with the administration of corticosteroids? A. lethargy B. malaise C. ataxia D. euphoria

D. Clients receiving systemic corticosteroids may experience euphoria, insomnia, and psychosis.

A patient is taking fluticasone 440 mcg inhaled two times per day. The patient is being seen in the pulmonary clinic and says "I have been very congested and it has been hard to reach for the past 10 days. I have been using my inhaler 4 times per day." The nurse should asses the patient for which of the following systemic adverse effects? A. hypoglycemia B. hypercalcemia C. anxiety D. hypothermic-pituitary-adrenal (HPA) suppression

D. Taking this dose of fluticasone places the client at risk for adrenocortical insufficiency from hypothalamic-pituitary-adrenal (HPA) suppression.

A woman is experiencing periods of increased anxiety and panic attacks over her illness and that of her family members. Epinephrine and norepinephrine are released. What glucocorticoid is released by the adrenal cortex in response to stress? A. insulin B. glucose C. thyroid hormone D. cortisol

D. The increased activity of the sympathetic nervous system, which assists in the body's response to stress, stimulates the release of cortisol.

A 54-year-old woman with a history of asthma is prescribed prednisone to treat an exacerbation of her condition. The nurse is explaining to the patient how this medication works to decrease the immune response and places the patient at risk for infection. What mechanism of action of the drug causes a decrease in the immune response? Increase in phagocytosis Increase in immunoglobulins Increased antigen-antibody reaction Decrease in the number of eosinophils

Decrease in the number of eosinophils Its immunosuppressant effects are attributable to suppression of phagocytosis, a decrease in the number of circulating eosinophils and lymphocytes, suppression of delayed hypersensitivity reactions, a decrease in antigen-antibody tissue reactions, and a decrease in plasma immunoglobulins.

After teaching a group of students about the stress response and reactions that occur, the instructor determines that additional teaching is needed when the students identify what as a result of the release of adrenocortical hormones? Decreased blood volume Glucose release Slowed protein production Blocked immune response

Decreased blood volume Explanation: Adrenocortical hormones increase blood volume due to the aldosterone effect. Adrenocortical hormones cause the release of glucose for energy. Protein production is slowed as a result of adrenocortical hormones. The activities of the inflammatory and immune responses are blocked.

The nurse is assessing a patient with adrenocortical insufficiency. What presenting symptom supports the patient's diagnosis? Fluid volume excess Hypokalemia Decreased cardiac output Hypothermia

Decreased cardiac output Explanation: Clinical manifestations of adrenocortical insufficiency include dehydration, weakness, fatigue, decreased cardiac output, fever, hyperglycemia, and hyperkalemia.

Glucocorticoids increase the concentration of glucose in the body by what mechanism?

Decreasing the use of glucose in the peripheral tissues

You are caring for a client with cerebral edema caused by trauma. Which of the following medications would you anticipate being administered? a) Cytosine b) Beconase c) Triamcinolone d) Dexamethasone

Dexamethasone Rationale: Dexamethasone is considered the corticosteroid of choice for cerebral edema associated with brain tumors, craniotomy, or head injury because dexamethasone is thought to penetrate the blood-brain barrier more readily and achieve higher concentrations in cerebrospinal fluids and tissues.

A 50-year-old male is admitted to the emergency room after a motorcycle crash. He was not wearing a helmet and has a head injury. He is unconscious with one eye dilated and one constricted. He has a widened pulse pressure. What corticosteroid will be administered parenterally? Dexamethasone (Decadron) Cortisone Prednisone Fluticasone (Flonase)

Dexamethasone (Decadron) Dexamethasone is considered the corticosteroid of cerebral edema. It is thought to penetrate the blood-brain barrier more readily and achieve higher concentrations in cerebrospinal fluid. Cortisone is the drug of choice for adrenal insufficiency. Prednisone is the glucocorticoid of choice in nonendocrine disorders in which anti-inflammatory, antiallergic, antistress, and immunosuppressive effects are desired. Fluticasone (Flonase) is administered by oral inhalation.

You have begun working with a client on corticosteroids following a liver transplant. The client asks you if she will have to take this medication for the rest of her life. You respond: It depends upon how healthy the transplanted organ is. Clients are able to wean off corticosteroids as soon as they have stabilized. Drug therapy is not required for life. No. Most clients discontinue corticosteroids within 6 weeks. Drug therapy is usually continued as long as the transplanted tissue is in place. In order to prevent rejection, you will have to take this every day.

Drug therapy is usually continued as long as the transplanted tissue is in place. In order to prevent rejection, you will have to take this every day.

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? Malaise Edema Sore throat Nasal congestion

Edema Explanation:The nurse should monitor for edema, hypertension, heart failure, enlargement of the heart, increased sweating, and allergic skin rash in the client as adverse reactions to the drug. Sore throat, malaise, and nasal congestion are not adverse reactions to the fludrocortisone drug. The nurse needs to monitor for sore throat and malaise in the client receiving adrenocorticotropic hormone (ACTH). The nurse needs to monitor for nasal congestion as an adverse reaction in a client receiving vasopressin.

Which drug, if combined with corticosteroids, would lead to possible toxic effects? · Erythromycin · Aspirin · Phenobarbital · Phenytoin

Erythromycin

The nurse is teaching a client who is receiving a glucocorticoid about the drug. What would the nurse instruct the client to report immediately? Fever Weight gain Abdominal distention Increased appetite

Fever Explanation: Glucocorticoids interfere with the immune and inflammatory reactions of the body, increasing a client's risk for infection. Thus, fever would need to be reported immediately. Weight gain, abdominal distention, and increased appetite are adverse effects that can occur and do not need to be reported immediately.

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

Fludrocortisone or aldosterone Explanation: Aldosterone is the main mineralocorticoid and is responsible for approximately 90% of mineralocorticoid activity. Glucocorticoids include cortisol, corticosterone, and cortisone. Androgens are male sex hormones. Explanation:Fludrocortisone is a mineralocorticoid. Beclomethasone is a glucocorticoid. Dexamethasone is a glucocorticoid. Flunisolide is a glucocorticoid.

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? Constipation Impaired gas exchange Acute confusion Fluid volume excess

Fluid volume excess Explanation:Treatment with glucocorticoids such as prednisone is associated with numerous adverse effects, including the risk for excess fluid volume. Constipation and impaired gas exchange are not among the most common adverse effects and CNS effects are normally limited to anxiety, mood swings, and insomnia rather than acute confusion.

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

Growth pattern Explanation: Long-term systemic corticosteroid therapy in children can increase the child's risk for growth retardation; therefore, this would be most important to assess. Rectal bleeding can occur with corticosteroids administered via a retention enema. Epistaxis can occur with the use of intranasal corticosteroids. Cognitive development is not generally impacted by corticosteroid therapy.

A patient with adrenal insufficiency has been admitted to the ICU in adrenal crisis. In assessing this patient, what would the nurse know is not a side effect of adrenal insufficiency? Hypertension Physiological exhaustion Hypotension Fluid shift Shock Death

Hypertension Explanation: Because they are not able to supplement the energy-consuming effects of the sympathetic reaction, patients who have an adrenal insufficiency enter an adrenal crisis, which can include physiological exhaustion, hypotension, fluid shift, shock, and even death.

The nurse is assessing a client with adrenocortical excess resulting from long-term use of corticosteroids. What is not a side effect related to this client's corticosteroid use? hypotension hypertension muscle weakness and atrophy obesity moon face

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

A home health nurse is evaluating the patient teaching that was done with a 49-year-old COPD patient who has been started on two inhalers: budesonide (Pulmicort) 2 puffs and fluticasone (Flovent) 3 puffs t.i.d. What statement by the patient would let the nurse know that the patient teaching will need clarifying? I must replace the inhalers before they run out. I should use one inhaler or the other for each dose. I must use the inhalers even when my symptoms start to subside. I should rinse my mouth after administering the doses.

I should use one inhaler or the other for each dose.

Which of the following is not a pharmacologic effect of corticosteroid drugs? Immunosupportive anti-inflammatory immunosuppressive antiallergic antistress.

Immunosupportive The most frequently desired pharmacologic effects are anti-inflammatory, immunosuppressive, antiallergic, and antistress.

Nursing care for the postoperative client requiring long-term glucocorticoid therapy will be directed at overcoming what adverse effect of the drug? When a nurse is doing a shift assessment on a client, which symptom should be reported as a possible side effect from administration of methylprednisolone? Impaired wound healing Autoimmune response Lack of mobility Photophobia Constipation Urinary retention

Impaired wound healing Explanation: Clients taking long-term glucocorticoid therapy will have impaired wound healing so nursing care is directed toward promoting healing. The drug has an anti-inflammatory effect so that would not need to be overcome. There is no autoimmune response or lack of mobility so these do not have to be overcome. Explanation:Sensitivity to light would not be appropriate to report as a side effect of the drug. Constipation and urinary retention are not side effects of methylprednisolone.

After teaching a group of students about the effects of mineralocorticoids, the instructor determines that additional teaching is needed when the students identify what as an effect? Increased calcium retention Increased sodium reabsorption Increase water retention Increased potassium excretion

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

All corticosteroids are derived from cholesterol and are released directly into the bloodstream. What is a hematological adverse effect from the use of corticosteroids? Increased serum cholesterol Hyperthyroidism Hyperkalemia Hypercalcemia Decreased blood sugar Hyponatremia

Increased serum cholesterol Explanation: Hematological effects include sodium and fluid retention, hypokalemia, hypocalcemia, increased blood sugar, increased serum cholesterol, decreased thyroid hormone levels.

You are talking to your class of nursing students about the adverse effects of corticosteroid therapy. What dietary change would you tell the students may help prevent osteoporosis related to long-term corticosteroid administration? Increasing vitamin D intake Decreasing protein intake Decreasing calcium intake Increasing caloric intake

Increasing vitamin D intake Explanation: Osteoporosis is a potential adverse effect of corticosteroid therapy. Patients may be able to reduce the risk by increasing dietary intake of calcium, vitamin D, and protein.

A patient has a tumor of the spinal cord. The patient is administered a corticosteroid. What effect will the corticosteroid have on the tumor? It will cause muscle weakness and atrophy, but decrease the tumor. It will decrease the chance of infection and meningitis. It will allow the tumor to be more susceptible to treatment. It will assist in decreasing the edema at the site of the tumor.

It will assist in decreasing the edema at the site of the tumor. The administration of corticosteroids to treat spinal cord tumors is used to decrease the edema around the tumor. The corticosteroid will not allow the tumor to be more susceptible to treatment. The corticosteroid will not prevent meningitis. An adverse effect of corticosteroid administration is muscle weakness and atrophy, but will not provide a therapeutic effect.

Your client asks what the long-term adverse effects of corticosteroid therapy are. You explain that adverse effects may include: Mental changes ranging from mild agitation to psychosis. Hypotension Weight loss Bone stiffness Weight loss. Mental changes ranging from mild agitation to psychosis. Decreased hair growth. Muscle growth and atrophy.

Mental changes ranging from mild agitation to psychosis. Explanation: Adverse effects of systemic corticosteroids may include infections, hypertension, glucose intolerance, obesity, cosmetic changes, bone loss, growth retardation in children, cataracts, pancreatitis, peptic ulcerations, and psychiatric disturbances.

Which hormones are secreted by the adrenal gland? (Select all that apply.) Growth hormone Mineralocorticoids Prolactin Oxytocin Glucocorticoids

Mineralocorticoids Glucocorticoids Explanation: Glucocorticoids, mineralocorticoids, and small amounts of sex hormones are secreted by the adrenal gland.

When explaining the rationale for alternate-day administration of corticosteroids, the nurse would say that it is to: a) maximize the client's adherence to medication tapering. b) minimize the client's susceptibility to the flu. c) minimize the suppression of normal adrenal function. d) maximize the suppression of normal adrenal function.

Minimize the suppression of normal adrenal function. Rationale: Alternate-day therapy (ADT), in which a double dose is taken every other morning, is usually preferred for other chronic conditions. This schedule allows rest periods so that adverse effects are decreased while anti-inflammatory effects continue. ADT is used only for maintenance therapy.

A patient suffers from recurrent sinus infections. Which of the following medications will be prescribed to decrease sinus inflammation? Mometasone (Nasonex) Dexamethasone (Decadron) Cortisone Prednisone

Mometasone (Nasonex) Mometasone (Nasonex) is formulated for nasal inhalation and decreases sinus inflammation. Cortisone is the drug of choice for adrenal insufficiency. Prednisone is the glucocorticoid of choice in nonendocrine disorders in which anti-inflammatory, antiallergic, antistress, and immunosuppressive effects are desired. Dexamethasone is considered the corticosteroid of choice for cerebral edema.

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? a) Restricting dietary protein b) Increasing fluids to 2000 mL per day c) Increasing dietary sodium d) Monitoring blood glucose levels frequently

Monitoring blood glucose levels frequently Rationale: Corticosteroids can cause an increase in the production of glucose and a decrease in its use. This promotes hyperglycemia and can lead to development of diabetes mellitus or aggravation of preexisting diabetes mellitus.

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

Oral

The nurse is preparing to administer prednisone. The nurse would expect to administer this agent by which route? Oral Intravenously Inhalation Intramuscularly

Oral

Based on the metabolic action of glucocorticoids, a client who is on long-term glucocorticoid therapy is at risk of developing what disease? a) Osteoporosis b) Bronchoconstriction c) Cryptorchism d) Swelling in the brain and spinal cord

Osteoporosis Rationale: The client who is on long-term glucocorticoid therapy is at risk for osteoporosis due to the reduction in new bone synthesis. Glucocorticoids are used to reduce swelling in the brain and spinal column and to promote bronchodilation. Cryptorchism is the failure of the testes to descend into the scrotum and is not the result of glucocorticoid therapy.

Naturally occurring aldosterone is regulated by which mechanism? Intercellular sodium and potassium Increased renal blood flow, promoting an increase in aldosterone levels Pituitary ACTH levels In the absence of potassium, aldosterone levels increase.

Pituitary ACTH levels Explanation: Several mechanisms control aldosterone levels: extracellular sodium and potassium levels (when serum sodium levels are low or potassium levels are high, aldosterone levels rise); renal renin release (a reduction in renal blood flow increases aldosterone levels by the renin-angiotensin-aldosterone system); and pituitary ACTH (the glucocorticoid hormones produced in the adrenal cortex have mineralocorticoid effects).

A male client is diagnosed with Addison disease. What daily medication would the nurse expect to be administered? a) Warfarin b) Prednisone c) Hydrochlorothiazide d) Apresoline

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

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

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

Which glucocorticoid used for replacement therapy is available only as an oral agent? Cortisone (Cortone Acetate) Hydrocortisone (Cortef) Prednisone (Deltasone) Triamcinolone (Aristocort)

Prednisone (Deltasone) Explanation:Prednisone is available in oral form only and is used for replacement therapy. Cortisone can be administered orally or intramuscularly and is used for replacement therapy. Hydrocortisone, used for replacement therapy, is administered by the oral, IV, IM, topical, ophthalmic, rectal, and intra-articular routes. Triamcinolone is administered by the oral, IM, inhalant, intra-articular, and topical routes and is used for treatment of allergic and inflammatory disorders and in the management of asthma. Which glucocorticoid used for replacement therapy is available only as an oral agent?

A 47-year-old female client with is admitted to a medical unit for exacerbation of asthma. The client has a BMI of 22 and no other health problems. The client is being treated with steriod therapy. The client asks why she cannot just stay on the prednisone long term. What would be the best answer based on the long-term effects of prednisone therapy? osteoporosis poor wound healing fluid rention glucose intolerance

Prednisone can lead to osteoporosis. Explanation: A clinically important adverse effect of long-term prednisone therapy is osteoporosis, which is often considered to be a major limitation of long-term prednisone therapy. Long-term prednisone therapy (doses over 7.5 mg/day) enhances calcium loss and increases parathyroid hormone levels. Calcium loss from bones decreases bone mineral density, thereby promoting an osteoporotic condition that increases the risk for hip, pelvic, rib, or vertebral fractures. Prednisone does cause poor wound healing, glucose intolerance, and fluid retention, but based on the patient's negative history, this would not be of greatest concern in this patient.

Which would a nurse include when explaining the actions of glucocorticoids? Prostaglandin formation decreases. Prostaglandin formation increases. Prostaglandin formation stays the same.

Prostaglandin formation decreases.

The nurse caring for a patient who is on prednisone understands that the drug's anti-inflammatory effects are due to what mechanism of action? Increased C-reactive protein Reduction in erythrocyte sedimentation rate Increased granulocytosis Increase in fibrinogenesis

Reduction in erythrocyte sedimentation rate Anti-inflammatory effects of prednisone include retardation of the migratory polymorphonuclear leukocytes, suppression of tissue repair and granulation, reduction in the erythrocyte sedimentation rate, decrease in fibrinogenesis, and diminished C-reactive protein.

You are providing client education relative to an inhaled glucocorticoid. You would include which of the following instructions? a) While using the inhaler, hold your breath for 10 seconds to assist in the absorption of the medication. b) Rinse your mouth completely after using the inhaler. c) Do not eat or drink anything for 20 minutes after using the inhaler. d) Forcefully exhale after using the inhaler.

Rinse your mouth completely after using the inhaler. Rationale: To prevent thrush, after using the medicine, you should rinse your mouth with water and spit it out.

A nurse is writing a plan of care for a client who is receiving a glucocorticoid. What would be an appropriate nursing diagnosis for this client? Increased cardiac output related to fluid retention Imbalanced nutrition: Less than body requirements Risk for infection related to immunosuppression Deficient fluid volume related to water retention

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

When monitoring a client who is receiving mineralocorticoid therapy, which assessment finding would be most important for the nurse to report? a) Slight pedal edema b) Weakness c) Shortness of breath d) Headache

Shortness of breath Rationale: Shortness of breath may be a sign of heart failure and needs to be reported immediately. Headache and weakness are general signs and common adverse effects. The nurse would report these if the client reported they were getting worse or interfering with the client's activities of daily living. Slight pedal edema may or may not be significant.

The nurse is working in a home care setting. A female client is prescribed oral corticosteroids by her health care provider secondary to a diagnosis of Addison disease. What is the nurse's responsibility in this situation? a) Supervising and monitoring the administration of the drug b) Administering all doses of the oral medication for the first month of use c) Administering all doses of the oral medication d) Teaching all family members to administer the medication

Supervising and monitoring the administration of the drug Rationale: Because of potentially serious adverse effects, especially with oral drugs, it is extremely important that corticosteroids be used as prescribed. A major responsibility of home care nurses is to teach, demonstrate, supervise, monitor, or do whatever is needed to facilitate correct use.

A nurse is caring for a patient who has been undergoing glucocorticoid therapy at a health care facility and is getting discharged. Which of the following instructions should the nurse include in the teaching plan for the patient and family? a) Measure the amount of fluids taken each day. b) Report any symptoms of sore throat or fever immediately. c) Take the oral drug with meals or snacks. d) Notify the PHCP if glucose appears in the urine.

Take the oral drug with meals or snacks. Rationale: The nurse should instruct the patient to take the oral drug with meals or snacks to decrease the gastrointestinal effects and upsets in the teaching plan for the patient and family. Reporting any symptoms of sore throat or fever immediately and notifying the PHCP if glucose appears in the urine should be included in the teaching plan for a patient undergoing adrenocorticotropic hormone (ACTH) therapy. The nurse should instruct the patient to measure the amount of fluids taken each day in the teaching plan for the patient receiving vasopressin.

The home health nurse is making a plan of care for a new patient who is taking oral prednisolone. What suggestion may decrease the nausea related to oral administration of prednisolone? Take before bedtime Take with a meal Take on an empty stomach Split the dose into two equal doses

Take with a meal

The nursing instructor is discussing short-term versus long-term corticoid steroid therapy with the nursing students. What would be the most appropriate teaching for a client on long-term corticosteroid therapy? a) Long-term therapy is anything 10 days or longer b) Taper doses when discontinuing drug c) Give with meals d) Short-term therapy is 1 week or less

Taper doses when discontinuing drug Rationale: Taper doses when discontinuing from high doses or from long-term therapy to give the adrenal glands a chance to recover and produce adrenocorticoids. All answers are correct, but most important to teach the client is tapering the drug.

A female client who is steroid dependent due to adrenocortical insufficiency calls the clinic and is very upset. Her son has been arrested for manufacture and sale of illegal drugs. What should the nurse tell the client concerning her medication and added stress? The dosage of the medication may be increased. The dosage of the medication may be decreased. The dosage of the medication stay the same. The medication should be discontinued

The dosage of the medication may be increased. Explanation: The client's body may initiate a stress reaction due to the son's arrest. Normally, activation of the stress reaction can cause release of ACTH and secretion of the adrenocortical hormones. Someone with adrenocortical insufficiency may not be able to supplement the increase need for ACTH. The stress reaction may block the immune and inflammatory systems, making the body more susceptible to pathogens. Therefore, an increase in medication may be necessary to prevent further adrenal insufficiency and to meet the increase demands for corticosteroids under stress.

A female client's health care provider discontinues her systemic corticosteroid using a sliding scale and orders an inhaler. The client asks if she can begin flunisolide for treatment of her adrenal deficiency; her friend uses it and suggested it as the client's next option. How should the nurse respond?

The health care provider did not order flunisolide, because it is dangerous to use in cases like yours."

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? a) The oral drug should be stopped approximately 1 week prior to starting the inhaled drug. b) The inhaled drug should be started during tapering of the oral drug. c) The two drugs should be taken simultaneously for 10 to 12 weeks. d) The inhaled drug should begin 3 to 4 weeks before starting to taper the oral drug.

The inhaled drug should be started during tapering of the oral drug. Rationale: When a client is being switched from an oral to an inhaled corticosteroid, the inhaled drug should be started during tapering of the oral drug, approximately 1 or 2 weeks before discontinuing or reaching the lowest anticipated dose of the oral drug.

A 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? a) The oral drug should be stopped approximately 1 week prior to starting the inhaled drug. b) The two drugs should be taken simultaneously for 10 to 12 weeks. c) The inhaled drug should be started during tapering of the oral drug. d) The inhaled drug should begin 3 to 4 weeks before starting to taper the oral drug.

The inhaled drug should be started during tapering of the oral drug. Rationale: When a client is being switched from an oral to an inhaled corticosteroid, the inhaled drug should be started during tapering of the oral drug, approximately 1 or 2 weeks before discontinuing or reaching the lowest anticipated dose of the oral drug.

A male client who is being treated for chronic obstructive pulmonary disease (COPD) is diagnosed with adult respiratory distress syndrome. His family asks whether corticosteroids may help him to breathe easier. Which statement about corticosteroids is accurate? a) They are successfully used for the long-term treatment of ARDS. b) They are not used when the client are diagnosed with a chronic respiratory disorder. c) They are not a beneficial treatment for ARDS. d) They are successful for the short-term treatment of ARDS.

They are not a beneficial treatment for ARDS. Rationale: Although corticosteroids have been widely used, several well-controlled studies demonstrated that the drugs are not beneficial in early treatment or in prevention of adult respiratory distress syndrome (ARDS).

What would a nurse keep in mind about glucocorticoids when teaching a client? They promote fat storage. They decrease glucose levels They decrease the rate of protein breakdown They increase the rate of protein formation from amino acids.

They promote fat storage. Explanation: Glucocorticoids cause lipogenesis, the formation and storage of fat in the body. Glucorticoids stimulate an increase in glucose levels. Glucocorticoids increase the rate of protein breakdown. Glucocorticoids decrease the rate of protein formation from amino acids.

A 65-year-old client who has been on long-term corticosteroid therapy is admitted to the hospital and will need an IV inserted. What adverse effect of corticosteroid may negatively affect this procedure? a) Moon face b) Truncal obesity c) Insomnia d) Thinning of the skin

Thinning of the skin Rationale: The client's thinning skin may make IV insertion more difficult because the skin is so much more fragile and it bruises so easily due to capillary fragility.

A nurse tells a patient to take a prescribed glucocorticoid in the morning based on the understanding that: a) This time ensures that the patient will take the drug. b) This time mimics the normal peak diurnal concentration levels. c) The drug needs to suppress the hypothalamic pituitary axis. d) The drug is absorbed better in the morning.

This time mimics the normal peak diurnal concentration levels. Rationale: Typically a glucocorticoid is taken in the morning to mimic the normal peak diurnal concentration levels and thereby minimize suppression of the hypothalamic-pituitary axis. Drug absorption is not affected by time of administration. The rationale for morning administration is to mimic the normal peak diurnal concentration levels.

The nurse is doing discharge teaching when the client asks the nurse why their prednisone has been ordered on alternate days. What would be the nurse's best response?

To minimize adverse effects

A client is taking long-term corticosteroid therapy. Which finding would alert the nurse to a potential Cushing's syndrome manifestation? Truncal obesity Weight loss Hypotension Loss of facial hair

Truncal obesity Explanation: Signs and symptom of potential Cushing's syndrome manifestations include abdomen that sticks out and thin arms and legs (central obesity); acne; collection of fat between the shoulders; depression; euphoria not related to life situation; excessive facial hair growth in females; frequent and easy bruising; round, red, and full face; weakness; and weight gain.

A patient is undergoing glucocorticoid therapy at a health care facility. The patient develops acne. What should the nurse instruct the patient with acne? Use water-based cosmetics or creams. Avoid exposure to infections. Avoid the use of alcohol while taking the drug. Do not receive live virus vaccines.

Use water-based cosmetics or creams.

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: a) menstrual irregularities. b) adrenal insufficiency. c) hypokalemia. d) gastrointestinal problems.

adrenal insufficiency. Rationale: The client may develop adrenal insufficiency (Addisonian crisis), which is characterized by glucocorticoid insufficiency without mineralocorticoid insufficiency. Hypokalemia occurs as a result of hyperaldosteronism. Gastrointestinal distress and menstrual irregularities are common adverse effects of the drug, but these effects are not as serious as preventing adrenal insufficiency.

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

an increase in sodium and water retention along with potassium depletion. Explanation: Increased doses of fludrocortisone may result in excess retention of sodium and water along with potassium depletion. Hypokalemia does not occur nor are sodium and water depleted or potassium retained. This drug is usually given in combination with a glucocorticoid. Therefore, toxic effects would not be expected.

The nurse anticipates an order for a glucocorticoid when caring for a client with what condition? a) septicemia b) hypoglycemia c) arthritis d) appendicitis

arthritis Rationale: Glucocorticoids are indicated for the short-term treatment of many inflammatory disorders, to relieve discomfort, and to give the body a chance to heal from the effects of inflammation. They block the actions of arachidonic acid, which leads to a decrease in the formation of prostaglandins and leukotrienes. Without these chemicals, the normal inflammatory reaction is blocked. Hypoglycemia would more safely be treated with glucose. Appendicitis and septicemia are infections that would contraindicate the use of glucocorticoids because of the immunosuppressant effects of the drugs.

The nurse is caring for a black client who received a kidney transplant and receives methylprednisolone for immunosuppression. What is the nurse's priority assessment for this client? assessing blood glucose levels assessing of capillary refill time assessing cardiac rhythm assessing RBC count

assessing blood glucose levels Explanation: Black clients develop increased toxicity to the corticosteroid methylprednisolone—particularly when it is used for immunosuppression after renal transplantation. This toxicity can include severe steroid-induced diabetes mellitus. A priority intervention with this client is monitoring blood glucose levels. Assessment of capillary refill time and cardiac rhythm would not be indicated by the data supplied about this client. Red blood cell counts are less likely to be affected client.

Which finding should alert the nurse to a potential Cushing's syndrome manifestation presented by a client prescribed long-term corticosteroid therapy? a) weight loss b) hair loss c) buffalo hump d) insomnia

buffalo hump Rationale: Signs and symptom of potential Cushing's syndrome manifestations include abdomen that sticks out and thin arms and legs (central obesity); acne; collection of fat between the shoulders (buffalo hump); depression; euphoria not related to life situation; excessive facial hair growth in females; frequent and easy bruising; round, red, and full face; weakness; and weight gain. Cushing's syndrome is not associated with insomnia, hair loss, or weight loss.

A nurse is caring for a 78-year-old client with rheumatoid arthritis. The health care provider has prescribed cortisone, a corticosteroid, to the client. The nurse would administer the drug cautiously to a client with which condition? Select all that apply. -decreased muscle mass -osteoporosis -migraine headaches -liver disease -heart failure

heart failure decreased muscle mass osteoporosis Rationale: The nurse should be cautious about pre-existing conditions such as heart failure, decreased muscle mass, osteoporosis, and arthritis when administering corticosteroid therapy to elderly clients as their condition may be worsened by their use. The nurse needs to administer vasopressin cautiously to clients with migraine headaches. The nurse needs to administer gonadotropins cautiously to clients with liver disease.

What adverse effects should the nurse discuss with a client prescribed long-term systemic corticosteroid therapy? Select all that apply. -weight loss -mood disorders -peptic ulcers -hyperglycemia -cataracts

hyperglycemia peptic ulcers mood disorders cataracts Rationale: Adverse effects of systemic corticosteroids may include infections, hypertension, glucose intolerance, obesity, cosmetic changes, bone loss, growth retardation in children, cataracts, pancreatitis, peptic ulcerations, and psychiatric disturbances.

A client is on daily doses of prednisone. To minimize adrenal suppression, the nurse's instructions for administration should include to take the medication: a) on an empty stomach. b) with the evening meal. c) in the morning. d) just before bedtime.

in the morning. Rationale: Scheduling of drug administration is more important with corticosteroids than with most other drug classes. A major adverse reaction is suppression of the HPA axis and subsequent loss of adrenocortical function. Scheduling of medication (morning dosing) is often recommended to prevent or minimize HPA suppression. Daily administration is required in cases of chronic adrenocortical insufficiency. The entire daily dose can be taken each morning, between 6 and 9 a.m. This schedule simulates normal endogenous corticosteroid secretion.

A female client has a diagnosis of adrenocortical insufficiency and is steroid dependent. The client is to undergo surgery to remove her uterus. The nurse will explain to the client that in order to promote recovery after the stress of the surgery, her steroid dosage will be: increased decreased the same

increased. Explanation: When a client receiving ongoing corticosteroid therapy requires surgery, the nurse should review the preoperative orders to make sure that the steroid dosage has been increased for several days. If not, the nurse should obtain the order from the prescriber. The increase is needed to promote recovery after the stress of surgery.

When caring for a client receiving long-term therapy with corticosteroids, the nurse would plan care incorporating interventions aimed at preventing what? a) anemia b) infection c) cognitive changes d) allergies

infection Rationale: When planning care for a client taking long-term corticosteroid therapy, the nurse needs to incorporate interventions aimed at reducing risk of infection because the client's immune system will be suppressed, which places the client at increased risk. The drug is not associated with causing allergies, cognitive changes, or anemia.

A nurse taking a medical history on a client prescribed a corticosteroid medication should focus on which condition? a) infections b) depression c) cognitive impairment d) urinary incontinence

infections Rationale: Corticosteroids are contraindicated in systemic fungal infections, clients who are hypersensitive to drug formulations, clients at risk for infections, and clients with infections, diabetes mellitus, peptic ulcer disease, inflammatory bowel disorders, hypertension, congestive heart failure, or renal insufficiency. Corticosteroid therapy is not contraindicated by a history of depression, cognitive impairment, or urinary incontinence.

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: a) low in sodium, high in potassium. b) low in sodium and potassium. c) high in iron. d) low in proteins.

low in sodium, high in potassium. Rationale: The client should avoid foods that are high in sodium and eat foods that are high in potassium. The client should eat foods rich in proteins because long-term fludrocortisone therapy promotes the deposition of liver glycogen and induces a negative nitrogen balance. Iron-rich food is not typically shown to have therapeutic or adverse effects of fludrocortisone; therefore, it is more important to instruct the client to avoid high-sodium foods and to eat potassium-rich ones.

What stimulus would prompt the hypothalamic-pituitary-adrenal (HPA) axis to increase corticosteroid production? A. Active infection B. Decreased renal filtration of corticosteroids C. Low serum levels of corticosteroids D. Cushing-type symptoms

low serum levels of corticosteroids Explanation: The HPA axis normally functions according to a negative feedback mechanism; low levels of corticosteroids prompt synthesis and release. None of the other options have a significant impact on the triggering of corticosteroid production.

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

potassium Explanation:The combination of corticosteroids and diuretics constitutes a risk for hypokalemia. The nurse must pay particular attention to the client's potassium levels. This combination of medications is not associated with risks involving any of the other options. **A serum potassium level less than 3.0 mEq/L would suggest hypokalemia, which should be reported to the prescriber.

The nurse is caring for a child who has been prescribed corticosteroids for the treatment of asthma. The nurse understands that medication dosage for this client is based on what? severity of disease client's age client's weight standard dose for all

severity of disease Corticosteroids are used for the same conditions in children as in adults. Corticosteroid dosages are calculated according to severity of disease rather than weight. (Body surface area and body mass index are both calculated using weight.) For both systemic and inhaled corticosteroids, each child's dose should be titrated to the lowest effective amount

A 72-year-old woman is on long-term glucocorticoid therapy. It will be most important for the nurse to instruct the client to: Take measures to minimize the risk of falls. Avoid direct sunlight Have a low carbohydrate diet Avoid red meats and dairy products

take measures to minimize the risk of falls. Explanation: Long-term glucocorticoid therapy can cause muscle weakness and fatigue, especially in the elderly, and can predispose them to falls. Long-term or high-dose glucocorticoid therapy also places the client at increased risk for osteoporosis, making fractures more likely. Hence, the client should be advised to take measures to minimize the risk of falls. There are no specific precautions related to avoiding direct sunlight during glucocorticoid therapy. A diet that controls carbohydrate and calorie intake is always important, but the client would not need to avoid red meat or dairy products while on glucocorticoid therapy.