Chapter 36 Adrenocortical Agents PrepU

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Which statement is especially important to teach a caregiver of an infant being treated with hydrocortisone?

"Avoid live virus vaccinations."

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

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

A client prescribed corticosteroids following a liver transplant asks if it will be necessary to take this medication indefinitely. How should the nurse respond?

"Daily antirejection drug therapy will continue for as long as your transplanted liver is in place."

What endocrine gland produces corticosteroids?

Adrenal

What would a nurse expect to administer by inhalation?

Beclomethasone Beclomethasone inhalation Prednisone orally Budesonide intranasally Cortisone orally or IM injection

The nurse is caring for a pt receiving fludrocortisone and recognizes what lab finding effect of the drug? A) Increased serum sodium level B) Elevated red blood cell count C) Decreased serum potassium level D) Increased serum calcium level

Which common adverse effects should a nurse assess for when caring for a client prescribed ketoconazole?

Nausea, vomiting, and abdominal pain

Which patient should not receive mitotane as ordered?

The patient experiencing shock

Which administration technique should the nurse question related to hydrocortisone therapy?

The patient takes hydrocortisone every evening at bedtime.

A female client has been taking prednisone for her asthma for 1 month. The nurse will teach her to gradually decrease her dose of prednisone to avoid:

adrenal insufficiency.

What are the most frequently desired pharmacologic effects of exogenous corticosteroids? (Select all that apply.) a) Analgesic b) Anticoagulant c) Antianxiety d) Immunosuppressive e) Anti-inflammatory

• Anti-inflammatory • Immunosuppressive • Antianxiety

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

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

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

"I recently lost my health care coverage and need to look for another job."

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

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

When providing client education relative to an inhaled glucocorticoid, the nurse should include which instruction to prevent a common side effect of the medication?

"Rinse your mouth completely after using the inhaler."

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

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

A child is to receive a topical corticosteroid agent. Which statement by the parents indicates a need for additional teaching?

"We need to cover the area snugly with plastic wrap to prevent scratching." increase the risk for systemic absorption

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

* hyperglycemia * peptic ulcers * mood disorders * cataracts

A 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.

A nurse is completing an assessment on a client diagnosed with adrenocortical excess. What are the expected clinical manifestations? Select all that apply.

-Heavy trunk -Thin extremities -Buffalo hump

Which would a nurse expect to assess in a patient with an adrenocortical hormone deficiency? (Select all that apply.)

-Hyperkalemia -Confusion -Hyponatremia

A pt has been prescribed Prednisone 0.15 mg/kg PO to treat a hypersensitivity reaction to poison ivy. The pt weights 176 lb. How many milligrams of Prednisone should the nurse administer?

12 mg

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

6 AM to 9 AM

At which time would a nurse expect peak levels of adrenocorticotropic hormone to occur? 10 PM to 12 AM 1 AM to 3 AM 6 AM to 9 AM 12 PM to 3 PM

6 AM to 9 AM

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

6 AM to 9 AM Rationale- 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.

A nurse teaches a pt to take a prescribed glucocorticoid first thing in the morning because: A) This time mimics the normal peak diurnal concentration levels B) The risk of adverse effects is reduced C) The drug is absorbed better in the morning D) This time coincides with naturally high blood glucose levels

A pt who is taking corticosteroids is at increased risk for infection and should: A) Be protected from exposure to infections and invasive procedures B) Take anti-inflammatory agents regularly throughout the day C) Receive live virus vaccine to protect him or her from infection D) Be at no risk if elective surgery is needed

A pt with adrenal insufficiency has been prescribed fludrocortisone. What assessment finding by the nurse would most clearly indicate adverse effects of this medication? A) The pt has pitting edema in the feet and lower legs B) The pt's sclerae appears slightly jaundiced C) The pt's BP is 133/81 D) The pt report gas pain and is belching often

Diurnal rhythm if a person with a regular sleep chicle would show: A) High levels of ACTH during the night while sleeping B) Risking levels of corticosteroids throughout the day C) Peak levels of ACTH and corticosteroids early in the morning D) Hypothalamic stimulation to release CRH around noon

Pts who have been receiving corticosteroid therapy for a prolonged period and suddenly stop the drug will experience an adrenal crisis because their adrenal glands will not be producing any adrenal hormones. Your assessment of a pt for the possibility of adrenal crisis may include: A) Physiological exhaustion, shock, and fluid shift B) Acne development and HTN C) Water retention and increased speed of healing D) Hyperglycemia and water retention

SATA. What would the nurse include when describing the possible adverse effects associated with a mineralocorticoid? A) Headache B) Hyperkalemia C) Hypernatremia D) Fluid loss E) Edema

A C E

SATA. The nurse admits a child to the clinic who is taking long-term corticosteroids. The mother brought the child to receive a measles, mumps, and rubella vaccine. What teaching will the nurse provide? A) Long-term corticosteroid administration reduces immune response B) Administer acetaminophen if the child develops a fever after receiving the vaccine C) Children receiving corticosteroids cannot receive injectable medications D) Call the provider if the child develops a fever after receiving the vaccine E) Live virus immunizations cannot be given to people receiving long-term corticosteroids

A E

While learning about corticosteroids in pharmacology class, a student asks the instructor what a clinical indication for the use of corticosteroids would be. What would be the instructor's bestresponse?

A disease with an inflammatory component Rationale- Indications: Replacement therapy in adrenal cortical insufficiency, short-term management of various inflammatory and allergic disorders, hypercalcemia associated with cancer, hematological disorders, ulcerative colitis, acute exacerbations of multiple sclerosis, palliation in some leukemias, trichinosis with systemic involvement.

The nurse is caring for an African American pt who is taking methylprednisolone to suppress immune response to a kidney transplant received previous year. What assessment should the nurse prioritize when monitoring for adverse effects in this specific pt? A) Measure the pt's blood glucose frequently B) Auscultate the pt's apical heart rate frequently C) Assess the pt's strength bilaterally D) Auscultate the pt's lungs for adventitious sounds

A; African American's develop increased toxicity to this corticosteroid

AST, ALT, and GGT

A client diagnosed with Cushing's disease will soon begin treatment with ketoconazole. The nurse should be cognizant of the black box warning for this drug and consequently monitor what laboratory values? white blood cell differential blood urea nitrogen and creatinine AST, ALT, and GGT hemoglobin, hematocrit, and red blood cell count

AST, ALT, and GGT

The anatomy and physiology instructor is discussing reactions of the body to stress. According to the instructor, what is responsible for the release of cortisol (hydrocortisone) during times of stress?

Activation of the sympathetic nervous system

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

Addison disease

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

Administer hormonal replacement.

The nurse is aware that dosing strategies to minimize HPA suppression and risks of acute adrenal insufficiency include which corticosteroid administration schedule?

Administering a systemic corticosteroid during high-stress situations in clients on long-term systemic therapy Rationale-Strategies to minimize HPA suppression and risks of acute adrenal insufficiency include administering a systemic corticosteroid during high-stress situations in clients who are on long-term systemic therapy (i.e., are steroid dependent).

Methylprednisolone is associated with increased toxicity in which of the following patient populations? a) Caucasians b) Asians c) Native Americans d) African Americans

African Americans

A patient is receiving hydrocortisone 40 mg by mouth daily for treatment of severe autoimmune inflammation. Which nursing intervention is most important to implement? Increase dietary sodium Limit dietary protein Limit fluid intake Assess daily blood glucose

Assess daily blood glucose Explanation: Hydrocortisone increases the disposition of liver glycogen. The patient's blood sugar should be assessed daily. When taking hydrocortisone daily, the patient should limit dietary sodium due to fluid retention. The patient should maintain a diet high in protein. The patient should not alter fluid intake unless the patient shows signs of fluid volume overload.

Adrenocortical agents are widely used: A) To cure chronic inflammatory disorders B) For short-term treatment to relieve inflammation C) For long-term treatment of chronic disorders D) To relieve minor aches and pains to make people feel better

The nurse is reviewing the medication administration record of a new client, which includes Budesonide. When identifying the pt's underlying health problem, the nurse should identify what nursing diagnosis? A) Risk for injury related to CNS depression B) Impaired gas exchange related to bronchospasm C) Risk for impaired skin integrity related to adrenal excess D) Impaired physical mobility related to doing inflammation

The nurse is teaching some colleagues about the stress response and reactions what occur. What process, described by the colleagues, would indicate the need for further teaching? A) Slowed protein production B) Decreased blood volume C) Blocked immune response D) Glucose release

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.)

Betamethasone (Celestone) Budesonide (Entocort EC) Hydrocortisone (Cortef) Dexamethasone (Decadron) Rationale- 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? Level of consciousness Measures of coagulation Blood pressure Hydration status

Blood pressure

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 Rationale- 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.

If a nurse was asked to explain the adrenal medulla to a pt, it would be appropriate for her to tell that pt that it: A) Is the outer core of the adrenal gland B) Is the site of production of aldosterone and corticosteroids C) Is actually a neural ganglion of the SNS D) Consists of three layers of cells that produce different hormones

Mineralocorticoids are used to maintain electrolyte balance in situations of adrenal insufficiency. Mineralocorticoids: A) Are usually given alone B) Can be given only IV C) Are always given in conjunction with appropriate glucocorticoids D) Are separate in their function from the glucocorticoids

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?

Carefully assess the client for infections.

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

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

A patient taking glucocorticoid therapy for a chronic illness has been gaining weight and having other changes in appearance. What statement is true related to this patient's symptoms? The weight changes are probably unrelated to the glucocorticoid therapy. The patient should not be on glucocorticoid therapy long term. Changes in appearance will reverse once the therapy is tapered off. The patient most likely has a secondary problem causing symptoms.

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

A nurse completing a pre-administration assessment on a 70-year-old client prior to the administration of levothyroxine (Synthroid) may confuse which symptom of hypothyroidism with which symptom associated with the aging process? (Select all that apply.)

Confusion Unsteady gait Cold intolerance Rationale- The symptoms of hypothyroidism may be confused with symptoms associated with aging, such as depression, cold intolerance, weight gain, confusion, or unsteady gait.

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

Contact the care provider promptly.

A female clienterm-50t is diagnosed with adrenal insufficiency. She presents to the emergency department with hypotension. What would the nurse expect her to be prescribed?

Corticosteroids

A female client asks the nurse why her 4-year old son is not receiving corticosteroids. The client read in an article that they are more effective to prevent transplant rejection than the medication that is currently prescribed. What is the appropriate response by the nurse?

Corticosteroids impair growth in children.

A pt started on a regimen of prednisone because of a crisis if her ulcerative colitis. Nursing care of this pt would need to include: A) Immunizations to prevent infections B) Increased calories to deal with metabolic changes C) Fluid restriction to decrease water retention D) Administration of the drug around 8 or 9 AM to mimic normal diurnal rhythm

Glucocorticoids are hormones that: A) Are released in reopen to high glucose levels B) Help to regulate electrolyte levels C) Help to regulate water balance in the body D) Promote the preservation of energy through increased glucose levels, protein breakdown, and fat formation

The nurse should recognize both mineralocorticoid and glucocorticoid effects after long-term administration of what drug? A) Betamethasone B) Dexamethasone C) Triamcinolone D) Prednisone

D; Hydrocortisone, cortisone and prednisone have both effects

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.

Which medications is classified as a long-acting glucocorticoid?

Dexamethasone

A client has been placed on daily glucocorticoid therapy. The nurse should teach the client to take the medication at which time of day? Afternoon Bedtime Early morning Lunch time

Early morning

A client has been placed on daily glucocorticoid therapy. The nurse should teach the client to take the medication at which time of day?

Early morning Rationale- Daily oral doses are usually given before 9 a.m. to minimize adrenal suppression and to coincide with normal adrenal function.

Which herbal supplement taken with ketoconazole can cause hepatotoxicity?

Echinacea

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

Electrolytes

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

Erythromycin

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

Fludrocortisone

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

Fludrocortisone

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

A child with adrenal insufficiency takes PO hydrocortisone daily. The nurse follows the child regularly and assesses the child every three months. What assessment data should the nurse prioritize during these assessments?

Height and weight

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

Histoplasmosis infection

Hold the cholestyramine.

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

Hold the cholestyramine.

Hold the cholestyramine. Rationale- Cholestyramine can decrease the effectiveness of hydrocortisone therapy. The patient may have decreased effects because of this new therapy and the asthma may worsen. The nurse should hold the cholestyramine and contact the health care provider for a change in medication therapy.

After teaching a group of students about glucocorticoids, the instructor determines that the teaching was successful when the students identify which agent as also possessing some mineralocorticoid effects? Hydrocortisone Betamethasone Dexamethasone Triamcinolone

Hydrocortisone

Hydrocortisone Rationale- Hydrocortisone also has some mineralocorticoid activity and effects.

The nurse is caring for a patient who is suspected of having Addison's syndrome. Which sign or symptom would the nurse expect to observe?

Hyperkalemia Rationale- Signs and symptoms of Addison's syndrome include hyperkalemia, hyperpigmentation, hypotension, and hyponatremia. Hypertension and hypernatremia are associated with Cushing's

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 should use one inhaler or the other for each dose.

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

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

Which effects can be caused by glucocorticoids? (Select all that apply.) Increased water retention Increased glucose production Inhibited protein formation Fat deposition Increased sodium reabsorption

Increased glucose production Inhibited protein formation Fat deposition Explanation: Glucocorticoids increase glucose production, inhibit protein formation, and stimulate fat deposition. The mineralocorticoids increase sodium reabsorption in renal tubules, leading to sodium and water retention.

A client prescribed hydrocortisone cypionate should be educated to what fact related to the medication? It is a synthetic mineralocorticoid. It is a naturally derived adrenocorticoid. It is a precursor to mineralocorticoids. It is a combination of a mineralocorticoid and adrenocorticoid.

It is a combination of a mineralocorticoid and adrenocorticoid.

Hydrocortisone has been prescribed to a client for the treatment of Addison's disease. What action should the nurse should encourage the client to take regarding the self-administration of this medication?

It should be taken before 09:00 each morning.

Which hormones are secreted by the adrenal gland? (Select all that apply.)

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

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

Mineralocorticoids Glucocorticoids

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? Increasing dietary sodium Restricting dietary protein Increasing fluids to 2000 mL per day Monitoring blood glucose levels frequently

Monitoring blood glucose levels frequently

The nurse is caring for a client who is seeking care for a chronic condition. The nurse is aware that the FDA has issued a black box warning regarding the use of thyroid hormones for the treatment of what condition?

Obesity Rationale- The FDA has issued a black box warning regarding the use of thyroid hormones for the treatment of obesity or for weight loss, either alone or with other therapeutic agents. Significant and serious complications may develop in euthyroid people taking thyroid hormones.

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

Once therapy is effective, soft tissue changes will reverse.

A patient being treated for Cushing's disease is upset about body changes. What information will the nurse tell the patient to provide reassurance? Once therapy is effective, soft tissue changes will reverse. Once you lose weight, the changes will not be as noticeable. Cosmetic surgery will help ease the changes. Counseling will help you to cope with the changes.

Once therapy is effective, soft tissue changes will reverse.

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

Oral

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

Osteoporosis 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.

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

Potassium

The patient receiving mineralocorticoid therapy usually has which nursing diagnosis as a priority?

Potential for alteration in skin integrity

Which glucocorticoid also exerts some mineralocorticoid effects?

Prednisolone

A 7-year-old child is diagnosed with adrenocortical insufficiency and has been prescribed prolonged steroid therapy. Which is a steroid used for prolonged therapy? Insulin Prednisone Cephalosporin Penicillin

Prednisone

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

Prednisone

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

Pulmonary infection

A nursing student is failing her chemistry class. She is about to take the final examination. She states that she is very nervous. Which of the following actions increases the rate of cortisol release? a) Negative feedback mechanism b) Atrophy of the adrenal cortex c) Release of epinephrine and norepinephrine d) Stimulation of the hypothalamus

Release of epinephrine and norepinephrine

A nurse is caring for a patient with Addison's disease. What therapy is recommended for this patient? (Select all that apply.) Replacement of adrenocorticoids Replacement of mineralocorticoids Replacement of sex hormones Replacement of ACTH

Replacement of adrenocorticoids Replacement of mineralocorticoids Explanation: Patients with Addison's disease need replacement of both adrenocorticoids and mineralocorticoids to treat adrenal insufficiency. Sex hormones and ACTH are not replaced.

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

Rifampin may decrease the action of ketoconazole.

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

Shortness of breath *indication of heart failure

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

Sodium 150 mEq/L

Which laboratory value monitored in a patient receiving fludrocortisone acetate requires immediate action by the nurse? Hemoglobin 14 g/dL Creatinine 1.1 mg/dL Sodium 150 mEq/L Potassium 4.5 mEq/L

Sodium 150 mEq/L

The patient being treated for Addison's disease that is responding to therapy would have which assessment finding? Decreased sodium Increased urinary output Weight loss Stable blood pressure

Stable blood pressure Explanation: The patient being treated for Addison's disease will have a stable blood pressure. Weight loss, increased urinary output, and decreased sodium are all symptoms of the disease.

The patient being treated for Addison's disease that is responding to therapy would have which assessment finding?

Stable blood pressure Rationale- The patient being treated for Addison's disease will have a stable blood pressure. Weight loss, increased urinary output, and decreased sodium are all symptoms of the disease.

A client is to receive teriparatide. The nurse would instruct the client in:

Subcutaneous injection Rationale- Teriparatide is administered subcutaneously.

A child is prescribed therapy with glucocorticoids. The child is placed on alternate-day therapy. What is the advantage of alternate-day therapy in this child?

The child will have less chance of infection. Rationale- Intermediate-acting glucocorticoids are the drugs of choice for alternate-day therapy and will decrease the susceptibility of infection by minimizing the adverse effects on the immune system. Alternative-day therapy will not protect from hyperglycemia. Alternate-day therapy will not affect blood pressure. Alternate-day therapy is not used as a strategy for improving adherence. None of the remaining options are supported by the decreased effect on the immune system and the subsequent effect on the risk for infection.

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

The client has normal adrenocortical function.

The nurse administers hydrocortisone cypionate (Cortef). What intervention is appropriate for this medication?

The nurse will monitor the patient's blood glucose level.

What is the body's physiological response when blood levels of calcium are excessive?

The parathyroid glands stop making parathyroid hormone. Rationale- When blood calcium levels increase above a certain point, calcium-sensing receptors in the parathyroid gland are activated to decrease hormone production.

Which assessment finding indicates a therapeutic response to mitotane therapy?

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

Which assessment finding indicates a therapeutic response to mitotane therapy?

The patient can lift 10 pounds and was previously unable to lift 5 pounds. Rationale- The only answer indicating therapeutic effects is that the patient can lift more weight than was possible previously. The medication should decrease muscle weakness. Dizziness is a possible adverse effect. Increased weight and urination are not therapeutic effects of the medication.

Which patient should not receive ketoconazole (Nizoral) as ordered for Cushing's disease? The patient with a headache The patient reporting fatigue The patient recently diagnosed with hepatitis C The patient with elevated liver function tests

The patient with elevated liver function tests Explanation: The medication has a Black Box Warning: It can cause hepatotoxicity and should be given with caution to patients with known liver dysfunction. The medication may cause a headache or fatigue; however, this is not a contraindication. The patient recently diagnosed with hepatitis C needs to have liver function tests performed to see if liver function is an issue at this time.

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

The patient with sepsis

A nurse tells a patient to take a prescribed glucocorticoid in the morning based on the understanding that:

This time mimics the normal peak diurnal concentration levels.

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?

Treatment of a disease with an inflammatory component

A client is taking long-term corticosteroid therapy. Which finding would alert the nurse to a potential Cushing's syndrome manifestation?

Truncal obesity

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

When is calcitonin released by the body?

When serum calcium levels rise Rationale- The release of calcitonin is not controlled by the hypothalamic-pituitary axis, but is regulated locally at the cellular level. Calcitonin is released when serum calcium levels rise.

An adult client has been experiencing severe lethargy and fatigue over the past several days, as well as feeling "shaky." Random blood glucose testing reveals a glucose level of 38 mg/dL (2.11 mmol/L), in spite of no significant change in the client's diet. The care team should suspect the possibility of what health problem? Cushing's disease acute renal failure adrenal insufficiency chronic renal failure

adrenal insufficiency

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

adrenocortical excess

What is the most prevalent mineralocorticoid that regulates fluid balance?

aldesterone Rationale- The mineralocorticoids (aldosterone is the most prevalent naturally occurring mineralocorticoid) exert a major influence on regulating potassium, sodium, and water balance.

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

atrial fibrillation and treatment with warfarin

A client is being treated with corticosteroids for chronic adrenocortical insufficiency. When should the client be instructed to take the medication?

between 06:00 and 09:00

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

buffalo hump

A client is receiving corticosteroid therapy. The nurse instructs the client about which possible cushingoid effects? Select all that apply.

buffalo hump moon face purple abdominal striae acne Rationale- Signs and symptoms of this Cushing-like (cushingoid) state include a buffalo hump (a hump on the back of the neck), moon face, oily skin and acne, osteoporosis, purple striae on the abdomen and hips, altered skin pigmentation, and weight gain.

A 12-year-old, recently diagnosed with asthma, has been prescribed a corticosteroid to be administered by metered-dose inhaler. This drug achieves a therapeutic effect by which means? by increasing the number of beta-adrenergic receptors by increasing the muscle tone in the smooth muscle of the trachea by increasing the permeability of the alveolar membrane by increasing the number of binding sites on erythrocytes

by increasing the number of beta-adrenergic receptors

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

calcium

When assessing for therapeutic effects of mitotane in a client diagnosed with adrenocortical carcinoma, the nurse should expect to identify which outcome?

decrease in blood pressure

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

delayed growth and development

A nurse is preparing medication information for the spouse of a client diagnosed with cerebral edema. Which medication should the nurse include in this information?

dexamethasone

Mineralocorticoids directly affect:

electrolyte levels

Mineralocorticoids directly affect:

electrolyte levels Rationale- Mineralocorticoids directly affect the levels of electrolytes in the system.

An adult client underwent a short plasma corticotropin (ACTH) stimulation test this morning. What subsequent assessment finding would rule out a diagnosis of adrenal insufficiency?

elevated cortisol levels

The nurse has reinforced the correct administration technique for alendronate in the knowledge that incorrect administration is associated with what increased risk?

esophageal bleeding Rationale- Clients who do not follow the dosing instructions for alendronate are at greater risk for esophagitis, dysphagia, and esophageal ulcers/erosions. There is no direct risk of CAD, stroke, or decreased joint range of motion.

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

fever

Parents of a 10-year-old child with asthma are concerned about their child's lack of growth. The parents say that the child is much shorter than anyone in the class and want to know what could have caused the problem. What medication may this child have taken that contributed to the growth suppression?

glucocorticoid

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

in the morning.

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

infections

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

minimize the suppression of normal adrenal function.

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

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 client's morning blood work reveals a serum calcium level of 3.1 mg/dL (0.78 mmol/L) (normal 8.5-10.5 mg/dL or 2.05-2.55 mmol/L). The nurse should consequently assess this client for which function?

muscle tone Rationale- Low calcium levels can result in tetany. Decreased LOC and altered respiratory function are not characteristic of hypocalcemia.

An adult client diagnosed with Crohn's disease several years ago is experiencing an exacerbation of symptoms. The nurse should anticipate the use of what corticosteroid?

oral prednisone

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

potassium

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

release of epinephrine and norepinephrine

When planning nursing care for a client prescribed long-term therapy for Addison disease, the nurse should address what nursing diagnosis that results from the client's increased risk?

risk for infection related to medication therapy

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

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

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

severity of disease

An older adult client has been diagnosed with osteoporosis and has begun taking alendronate. The nurse should be aware that this drug can increase bone density by which means?

suppressing the function of osteoclasts Rationale- Alendronate suppresses osteoclast activity on newly formed resorption surfaces, which reduces bone turnover. This means that bone formation exceeds resorption at remodeling sites, leading to progressive gains in bone mass. Alendronate does not enhance osteoblast function or affect the renal excretion of calcium. It does not influence the chemical interaction between vitamin D and calcium.

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.

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

the importance of gradually reducing rather than abruptly stopping the drug

Clients taking a corticosteroid medication should be asked about any history of:

ulcers.

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

warfarin

Which statement is included in the care plan of a client prescribed etomidate for Cushing's disease?

"It blocks the production of cortisol."

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

Decreased cortisol levels

The nurse is teaching a pt who is receiving prednisone about the drug's possible adverse effects. The pt demonstrates understanding when identifying what possible effect? A) Anorexia B) Hypoglycemia C) Weight loss D) Abdominal distension

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

infections

For which pt would the use of glucocorticoids most likely be contraindicated? A) A pt with functional urinary incontinence B) A pt with hypothyroidism who take levothyroxine C) A pt who has a short bowel disease D) A pt with bacterial pneumonia

D; contraindicated with acute infection

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 client how this medication decreases the immune response. What mechanism of action of the drug causes this?

Decrease in the number of eosinophils

Monitoring blood glucose levels frequently

A nurse is caring for a patient with Cushing's disease who asks why he is receiving ketoconazole (Nizoral), an antifungal medication. What is an appropriate response by the nurse?

"The medication will decrease cortisol levels."

A client being treated with oral prednisone is also prescribed furosemide. The nurse should prioritize assessment of what laboratory value? blood urea nitrogen potassium hemoglobin neutrophils

potassium

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

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

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

Abdomen

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

"It controls cortisol secretions."

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

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

A nurse is providing health education to a client who will be discharged home with a prescription for hydrocortisone. What instruction should the nurse convey to the client? "Make sure that you take this medication with food." "Take your medication in divided doses at each meal and at bedtime." "It's important to remember that dairy products will negate the benefits of this medication." "Make sure that you avoid taking over-the-counter calcium supplements while taking this medication."

"Make sure that you take this medication with food."

A nurse is providing health education to a client who will be discharged home with a prescription for hydrocortisone. What instruction should the nurse convey to the client?

"Make sure that you take this medication with food." Rationale- Hydrocortisone should be taken with food to minimize gastric upset. Calcium supplements are acceptable and even recommended. Dairy products do not reduce therapeutic effects. The drug should be taken prior to 09:00 each day.

When providing client education relative to an inhaled glucocorticoid, the nurse should include which instruction to prevent a common side effect of the medication? "Do not eat or drink anything for 20 minutes after using the inhaler." "While using the inhaler, inhale as quickly as possible." "Rinse your mouth completely after using the inhaler." "Forcefully exhale after using the inhaler."

"Rinse your mouth completely after using the inhaler."

A 45-year-old woman has been taking a corticosteroid and calls the clinic reporting the development of acne-like lesion on her face as well as facial hair. What is the nurse's best response?

"Sadly, this is an adverse effect seen in women. It should improve when you finish the medication."

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

"Take your medications in the morning."

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

"Take your medications in the morning."

While the nurse is preparing the client for discharge, the client asks why the health care provider has prescribed prednisone every other day instead of daily. What would be the nurse's best response?

"Taking it every other day minimizes adverse effects."

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

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

A client just completed the test for adrenocortical insufficiency. The nurse reviews the labs and notes that there is no increase in the serum cortisol level. The client is asking the nurse about the laboratory results. What is the nurse's best response to the client?

"There is no change in the levels." Rationale- The nurse should report the level to the client to relax the anxiety of the client. No increase in the serum cortisol indicates the presence of adrenocortical insufficiency. The nurse cannot diagnose the client but can provide the laboratory test information. Telling the client of the uncertainty of the labs or looking at them again can cause additional fear in the client.

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

"What herbal therapy are you taking?"

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

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

"You will likely gain some weight after you start taking this drug." Rationale- An initial weight gain is likely to occur with steroid treatment and is usually attributed to increased appetite. Organic foods are not necessary, and a consistent schedule of administration is imperative. Bleeding is not expected.

The nurse is caring for a patient with primary adrenal insufficiency. What statement is appropriate for the nurse to make to this patient? a) "No medication therapy is necessary for your condition." b) "This is a temporary condition." c) "Your body will adjust to your hormonal deficiency." d) "You will need hormonal replacement for life."

"You will need hormonal replacement for life."

The nurse is caring for a patient with primary adrenal insufficiency. What statement is appropriate for the nurse to make to this patient? "Your body will adjust to your hormonal deficiency." "You will need hormonal replacement for life." "This is a temporary condition." "No medication therapy is necessary for your condition."

"You will need hormonal replacement for life." Explanation: Primary adrenal insufficiency results from destruction of the adrenal cortex. The patient will need hormonal replacement for life.

The nurse is assessing a female pt who has a moon-like face, central obesity, and prominent facial hair. The nurse should identify theses as signs of what adrenal disorder? A) Cushing's disease B) Addison's syndrome C) Hypopituitarism D) Arachnoiditis

The nurse is caring for a pt who has been prescribed a mineralocorticoid therapy for adrenal replacement therapy. The nurse is reviewing the pt's most recent lab results. What finding best suggests a therapeutic effect? A) Sodium 138 mEq/L B) Red blood cell counts 5.1 X10^6/ed C) Chloride 99.3 mEq/L D) Prothrombin time 12.1 seconds

The nurse is caring for a pt who receives a prescription for high-dose prednisone therapy. What is the priority teaching point the nurse will make when providing drug teaching to this pt? A) "Do not stop taking this drug suddenly" B) "Wait 1 hr after taking the pill to eat breakfast" C) "Take the med on an empty stomach" D) "Increase carbohydrate intake"

The pt has taken corticosteroids for an extended period of time to treat an inflammatory condition. When the inflammatory condition subsides, what will happen if the pt stops taking the medication? A) Adrenal insufficiency B) Return of the inflammatory condition, likely worse than before C) Nothing will happen D) Hyperadrenal function

The pt is to receive Budesonide. The nurse should anticipate administering this drug by which route? A) Intranasal B) Intravenous C) Intramuscular D) Oral

Which client demonstrates the clearest indication for treatment with prednisone?

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

SATA. Pts who are taking corticosteroids would be expected to report which of the following? A) Weight gain B) Round or "moon face" appearance C) Feeling of well-being D) Weight loss E) Excessive hair growth F) Fragile skin

A B C F

SATA. Corticosteroid hormones are released during a sympathetic stress reaction. They would act to do which of the following? A) Increase blood volume B) Cause the release of glucose for energy C) Increase the rate of protein production D) Block the effects of the inflammatory and immune systems E) Store glucose to preserve energy F) Block protein production to save energy

A B D F

SATA. The pt experiences an acute stress reaction causing the release of ADH and adrenocortical hormones. What actions will the hormones have? A) Increase in blood volume B) Dehydration C) Blocking of immune and inflammatory response D) Increased rate of protein production E) Release of glucose

A C E

SATA. What events should the nurse monitor in the pt for potential adrenal insufficiency? A) Adrenal gland is damaged B) Excessive production of ACTH C) Surgical removal of the gland D) Reduced production of androgens E) Prolonged use of corticosteroid hormones

A C E

AST, ALT, and GGT Rationale- The FDA has issued a black box warning stating that ketoconazole can cause hepatotoxicity. As a result, monitoring of liver function with AST, ALT, and GGT testing may be a priority over assessment of white cells, red cells, and renal function.

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

Abdomen

A client learning to self-administer desmopressin subcutaneously should be taught to administer the injection at which site? a) Abdomen b) Ventrogluteal c) Forearm d) Deltoid

Abdomen

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

Abdomen Rationale- The abdomen is a subcutaneous injection site. The forearm is an intradermal injection site. The deltoid and ventrogluteal areas are intramuscular injection sites.

Which finding is most characteristic of Paget's disease?

Abnormal bone remodeling Rationale- Paget's disease is described as a chronic bone disorder with abnormal bone remodeling. Arthritis is joint inflammation. Osteoarthritis, or degenerative joint disease, is noninflammatory degeneration of the articular cartilage. Hypercalcemia of malignancy is an advanced-stage, malignant disease.

A client is receiving hydrocortisone 40 mg by mouth daily for treatment of severe autoimmune inflammation. Which nursing intervention is appropriate to implement? Increase dietary sodium. Limit dietary protein. Limit fluid intake. Assess daily blood glucose.

Assess daily blood glucose.

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

Assess daily blood glucose.

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

Assess daily blood glucose. Rationale-Corticosteroids create a risk for infection due to immune suppression; infection control measures are a priority. When taking hydrocortisone daily, the client should not increase dietary sodium because of a risk for fluid retention. The client should maintain a diet high in protein to assist with healing and body repair. Renal function may or may not be an assessment priority depending on the client's original renal status.

The nurse teaches the pt how to administer the newly prescribed drug by inhalation when what drug is ordered? A) Methylprednisolone B) Beclomethasone C) Prednisone D) Cortisone

What drug, if taken with corticosteroids, may lead to possible toxic effects? A) Phenytoin B) Erythromycin C) Phenobarbital D) Aspirin

What should the nurse include when explaining the actions of glucocorticoids? A) They enhance the action of arachidonic acid B) Prostaglandin formation decreases C) Leukotriene formation increases D) They promote the production of antibodies

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

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 female pt has been diagnosed w/ Cushing's syndrome. What assessment finding should the nurse attribute to his diagnosis? A) The pt has gastroesophageal reflux B) The pt required cataract surgery C) The pt has central obesity D) The pt is oriented to person and place but not time

The nurse is caring for a pt diagnosed with Addison's syndrome who is receiving a corticosteroid medication. What finding would suggest an improvement in the pt's condition? A) Increase in serum potassium B) Decrease in serum glucose C) Increase in serum sodium D) Increased urine output

The nurse is caring for a pt who has adrenal insufficiency. What medication would be most appropriate? A) Prednisolone B) Beclomethasone C) Fludrocortisone D) Budesonide

The nurse is diagnosed with Addison's disease and is given a prescription for a corticosteroid. The nurse works two 12-hour night shifts per week and never works 2 days together, always taking a few nights off between shifts. What time should the nurse take the medication prescribed? A) It doesn't matter as long as it is taken at the same time every day B) Halfway between the day time wake-up time and the night shift wake-up time C) In the morning when it is normally time to get up on days off D) At the time when the nurse normally gets up when working night shift

Which symptom, if found in the patient being treated for Cushing's disease, indicates medication therapy is therapeutic?

Decreased peripheral edema Rationale- Decreased peripheral edema indicates the patient has decreased fluid retention. The other assessments are symptoms of the disease, not improvements.

The pt receives a prescription for a corticosteroid and is instructed to take one tablet every other day. The pt asks the nurse, "can I take half a pill every day instead, so I don't forget to take it on the right day?" What is the nurse's best response? A) It is best to take the pill the way it is ordered if you ant to avoid many of the undesirable effects of corticosteroids B) Your body can't tolerate receiving that medication every day, so you need to take it the way it was ordered C) It was ordered that way because taking it every other day will keep your adrenal gland from shutting down D) There is no reason you can't take half a tablet every day because you will still get the same dosage and effect

What cardiac adverse effects should the nurse assess for when caring for a client prescribed hydrocortisone? Select all that apply.

Cardiac arrest Changes in blood pressure

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

Changes in appearance will reverse once the therapy is tapered off. Rationale- If the patient can taper off the steroid therapy, soft tissue changes are reversible. Many patients are on steroid therapy long term for chronic illnesses, which can cause stereotypical changes in fat distribution (among other symptoms). The patient needs to be taught about potential changes in order to cope.

The nurse is providing care for several pts who are being treated with corticosteroids. Which pt should the nurse assess first? A) A pt who is taking fludrocortisone and whose sodium level is rising B) A pt who needs to learn how to use budesonide spray before discharge C) A pt who is in the process of tapering down her dose of prednisone D) A pt taking dexamethasone whose temp was 101.1 being treated 1 hour ago

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.

The nurse is assessing a patient with adrenocortical insufficiency. What presenting symptom supports the patient's diagnosis?

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

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

Decreased cortisol levels Rationale- The patient with Cushing's disease receives mitotane to stop the conversion of 11-deoxycortisol to cortisol, resulting in decreased cortisol levels. Blood pressure should be decreased and blood glucose levels should be decreased. ACTH would be increased as the blood cortisol levels decreased or stabilized.

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

Diabetes mellitus

Glucocorticoids should be used with caution in patients with what disease process? Hypotension Hepatic disease Diabetes mellitus Pneumonia

Diabetes mellitus

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

Diabetes mellitus Rationale- Glucocorticoids should be used with caution in patients with diabetes because the drugs have glucose-elevating effects that can disrupt glucose control.

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

Erythromycin Rationale- Therapeutic and toxic effects increase if corticosteroids are given with erythromycin. Serum levels and effectiveness may decrease if corticosteroids are combined with salicylates. Serum levels and effectiveness may decrease if corticosteroids are combined with phenobarbital. Serum levels and effectiveness may decrease if corticosteroids are combined with phenytoin.

A woman with an inflammatory skin disorder has begun taking prednisone in an effort to control the signs and symptoms of her disease. The nurse who is providing care for this client should prioritize which potential nursing diagnoses in the organization of the client's care? Fluid volume excess Constipation Acute confusion Impaired gas exchange

Fluid volume excess

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

Glucocorticoid

A group of students are reviewing material about the action of the adrenal glands and the stress response. The students demonstrate understanding of the material when they identify what as a result of adrenocortical hormones?

Glucose release for energy Rationale- Adrenocortical hormones cause the release of glucose for energy, increase the blood volume (aldosterone effect), slow the rate of protein production, and block the activities of the inflammatory and immune systems.

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 sodium reabsorption Water retention Increased calcium 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.

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

Osteoporosis

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

Osteoporosis

A patient receiving hydrocortisone has started estrogen hormonal replacement therapy. What is the nurse's best intervention? Do not administer the hydrocortisone on the days the patient receives estrogen. Administer the hydrocortisone prior to any estrogen. Administer the hydrocortisone and estrogen at 8 a.m. Monitor the patient's blood glucose levels frequently.

Monitor the patient's blood glucose levels frequently.

A nurse is administering hydrocortisone cypionate (Cortef) to a child. What nursing intervention is essential? a) Maintain the patient on bed rest. b) Keep the patient in intensive care. c) Monitor the patient's height and weight. d) Ensure the patient has a central line.

Monitor the patient's height and weight.

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 should monitor a client taking short-term high-dose methylprednisolone (Medrol) for signs and symptoms of Cushing's syndrome that include what sign or symptom? (Select all that apply.)

Moon face Buffalo hump Osteoporosis

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's disease. What daily medication would the nurse expect to be administered? a) Warfarin b) Apresoline c) Prednisone d) Hydrochlorothiazide

Prednisone

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

Prednisone

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

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

A 7-year-old child is diagnosed with adrenocortical insufficiency and has been prescribed prolonged steroid therapy. Which is a steroid used for prolonged therapy?

Prednisone Rationale- Prednisone, hydrocortisone, and prednisolone are examples of steroids used for prolonged therapy mainly to treat diseases such as adrenocortical insufficiency. Insulin is the hormone used for regulating the blood glucose level. Penicillins and cephalosporins are examples of bactericidal agents used to fight infections.

Supervising and monitoring the administration of the drug

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

Supervising and monitoring the administration of the drug

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

Supervising and monitoring the administration of the drug

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

Supervising and monitoring the administration of the drug

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

Supervising and monitoring the administration of the drug 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 client being treated with desmopressin exhibits confusion and drowsiness, and reports a headache. What is the nurse's best action?

Take the client's vital signs.

A client being treated with desmopressin exhibits confusion and drowsiness, and reports a headache. What is the nurse's best action? Administer the next dose of desmopressin. Take the client's vital signs. Encourage increased oral fluid intake. Hold the prescribed diuretic.

Take the client's vital signs.

A client being treated with desmopressin exhibits confusion, drowsiness, and complains of a headache. What is the nurse's best action? a) Encourage increased oral fluid intake. b) Administer the next dose of desmopressin. c) Take the client's vital signs. d) Hold the prescribed diuretic.

Take the client's vital signs.

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

Take the medication with food.

A patient reports nausea when taking ketoconazole (Nizoral). What is the best advice for the nurse to give the patient? a) Take the medication with food. b) Take an antacid after taking the medication. c) Take an antacid before taking the medication. d) Take the medication with grapefruit juice.

Take the medication with food.

What is important for the nurse to teach the patient about taking ketoconazole (Nizoral)?

Take the medication with orange juice.

What is important for the nurse to teach the patient about taking ketoconazole (Nizoral)?

Take the medication with orange juice. Coffee, tea, and fruit juice would enhance the absorption by making the stomach more acidic.

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?

Taper doses when discontinuing drug

A client, admitted with an acute asthma attack, has been using inhaled corticosteroids two times daily for several years. Based on this information in the client's history, what should the nurse anticipate will be required in the client's care?

The client will require high doses of systemic drugs.

A client with a diagnosis of breast cancer is administered a corticosteroid in addition to chemotherapy agents. What effect will the corticosteroids have on this client's course of recovery?

The corticosteroid will decrease signs and symptoms of cancer. Rationale- The administration of corticosteroid agents in cancer therapy will assist in decreasing symptoms associated with cancer, destroying cancer cells, and increasing the general effectiveness of the chemotherapy. The administration of the corticosteroid will not alter the action of the chemotherapy agent. The corticosteroid will not affect metastasis. The corticosteroid will not decrease hepatic effects.

A client with a diagnosis of asthma has responded well to treatment with oral corticosteroids, and a switch to inhaled corticosteroids is planned. What strategy for managing this change in treatment should be implemented?

The inhaled drug should be started during tapering of the oral drug.

Which patient should not receive mitotane as ordered? a) The patient feeling dizzy b) The patient diagnosed with adrenocarcinoma c) The patient experiencing shock d) The patient with a heart rate of 100 beats per minute

The patient experiencing shock

Which patient should not receive mitotane as ordered? The patient with a heart rate of 100 beats per minute The patient experiencing shock The patient diagnosed with adrenocarcinoma The patient feeling dizzy

The patient experiencing shock

Which patient should not receive mitotane as ordered?

The patient experiencing shock Rationale- The patient experiencing shock should not receive mitotane as ordered and should receive steroid supplementation. A heart rate of 100 beats per minute is not a contraindication to receiving this medication. Because the medication is given to treat adrenocarcinoma, this is not a contraindication. Dizziness may be caused by this medication, but it is not a dose-limiting side effect.

Which assessment finding indicates to the nurse that ketoconazole (Nizoral) therapy is effective? The patient has increased urination at night. The patient has weight gain. The patient has decreased pain. The patient has a decreased blood glucose level.

The patient has a decreased blood glucose level.

Which assessment finding indicates to the nurse that ketoconazole (Nizoral) therapy is effective?

The patient has a decreased blood glucose level. Rationale-

Which assessment finding indicates to the nurse that ketoconazole (Nizoral) therapy is effective?

The patient has a decreased blood glucose level. Rationale- This medication decreases the conversion of 11-deoxycortisol to cortisol. Once cortisol levels are decreased, the patient should have lowered blood glucose levels. The medication does not affect pain. Increased urination and weight gain would be symptoms of increased cortisol.

A nurse is assessing a patient receiving fludrocortisone acetate replacement therapy. What finding requires immediate action by the nurse? The patient has a blood pressure of 140/90 mm Hg. The patient has a heart rate of 60 beats per minute. The patient is reporting a headache. The patient is reporting gastric pain.

The patient is reporting gastric pain.

Which patient action requires immediate intervention by the nurse?

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

The nurse is assessing patients who use herbal therapy. About which patient is the nurse most concerned about the increase in the effect of the prescribed medication?

The patient taking ketoconazole (Nizoral) and Echinacea

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

The patient with elevated liver function tests

Which patient should not receive ketoconazole (Nizoral) as ordered for Cushing's disease? a) The patient with a headache b) The patient with elevated liver function tests c) The patient reporting fatigue d) The patient recently diagnosed with hepatitis C

The patient with elevated liver function tests

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

The patient with elevated liver function tests Rationale- The medication has a Black Box Warning: It can cause hepatotoxicity and should be given with caution to patients with known liver dysfunction. The medication may cause a headache or fatigue; however, this is not a contraindication. The patient recently diagnosed with hepatitis C needs to have liver function tests performed to see if liver function is an issue at this time.

Which patient should not start hydrocortisone therapy as ordered at 8 a.m.? The patient with sepsis The patient with asthma The patient with chronic obstructive pulmonary disease (COPD) The patient with a neuromuscular disease

The patient with sepsis

The patient with sepsis Explanation: One contraindication to hydrocortisone therapy includes a serious infection. The patient with sepsis should not start hydrocortisone therapy until the infection is treated. Hydrocortisone therapy is typically given for the other disorders and is not a contraindication.

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

The patient with sepsis Rationale- One contraindication to hydrocortisone therapy includes a serious infection. The patient with sepsis should not start hydrocortisone therapy until the infection is treated. Hydrocortisone therapy is typically given for the other disorders and is not a contraindication.

The nurse is administering hydrocortisone cypionate (Cortef) to an elderly patient. Which assessment finding requires immediate action? The patient reports feeling a little "nervous." The patient reports being dizzy. The patient's blood pressure has decreased to 90/50 from 130/90 mm Hg. The patient states, "I really am so tired today."

The patient's blood pressure has decreased to 90/50 from 130/90 mm Hg.

The nurse is evaluating the therapeutic effects of fludrocortisone acetate (Florinef acetate). Which assessment finding best indicates that the medication is working? The patient's blood pressure has decreased from 130/90 to 100/90 mm Hg. The patient has +2 pitting edema of the ankles. The patient has no headaches. The patient's blood pressure is 130/90 mm Hg seated and 128/89 mm Hg when standing.

The patient's blood pressure is 130/90 mm Hg seated and 128/89 mm Hg when standing.

adrenal insufficiency Rationale- Any client with unexplained severe hypoglycemia requires assessment for adrenal insufficiency. Cushing's disease and kidney disease do not result in hypoglycemia.

Which corticosteroid is classified as a mineralocorticoid?

aldosterone Rationale- 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.

A client has been placed on daily glucocorticoid therapy. The nurse should teach the client to take the medication at which time of day?

early morning

A nurse is caring for a client with adrenocortical deficiency. The health care provider has prescribed a fludrocortisone drug to the client. Which adverse reaction should the nurse monitor for in the client?

edema Adverse Reactions: -edema -hypertension -heart failure -enlargement of the heart -increased sweating -allergic skin rash

Mineralocorticoids directly affect a) blood glucose levels. b) electrolyte levels. c) cholesterol levels. d) blood gas values.

electrolyte levels.

Mineralocorticoids directly affect: blood glucose levels. blood gas values. electrolyte levels. cholesterol levels.

electrolyte levels.

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 Rationale- 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.

fluid volume excess

fluid volume excess Rationale- 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 caring for a school-age child who is receiving long-term hydrocortisone therapy to treat adrenal insufficiency. When providing ongoing care for the child, what assessment should the nurse prioritize?

growth and development

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

hyperglycemia peptic ulcers cataracts mood disorders

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 Rationale- 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.

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

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

inhibiting the enzymes that contribute to cortisol synthesis

A nurse is providing discharge instructions to a client who will be taking fludrocortisone at home. The nurse will encourage the client to eat a diet that is:

low in sodium, high in potassium.

A nurse is providing discharge instructions to a client who will be taking fludrocortisone at home. The nurse will encourage the client to eat a diet that is: low in sodium and potassium. low in sodium, high in potassium. high in iron. low in proteins.

low in sodium, high in potassium.

When learning about thyroid hormones in pharmacology, the nursing students learn that when the thyroid gland is stimulated by thyroid-stimulating hormone (thyrotropin or TSH) from the anterior pituitary gland, thyroid hormones are:

released into the bloodstream. Rationale- Thyroid hormones are released into the circulation when the thyroid gland is stimulated by thyroid-stimulating hormone (thyrotropin or TSH) from the anterior pituitary gland.

Chapter 36 Adrenocortical Agents PrepU

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