Pharmacology: Chapter 36: Adrenocortical Agents

The clinic nurse receives a call from the parent of a 2-year-old child on long-term corticosteroid therapy saying the child woke up with a cold and is pulling on his ear. What instructions should the nurse provide? a."Encourage fluids and monitor your child's temperature." b."The safest thing to do is to take him to the emergency room (ER) immediately." c."Bring him to the clinic to be seen today." d."This is likely an adverse effect of the steroids, so just monitor it closely and keep us posted."

"Bring him to the clinic to be seen today."

The nurse, caring for a client experiencing stress, knows that activation of the stress reaction will initially cause the release of what? a.Glucose b.Aldosterone c.Adrenocorticotropic hormone (ACTH) d.Oxytocin

Adrenocorticotropic hormone (ACTH)

The nurse is caring for a client who is diagnosed with protein-deficient malnutrition. Why would an order to administer androgens to this client be appropriate? a.Androgens reduce the body's requirement for protein. b.Androgens increase the body's absorption of protein from the bowel. c.Androgens stimulate protein production and decrease protein breakdown. d.Androgens reduce carbohydrate metabolism and promote lipid absorption.

Androgens stimulate protein production and decrease protein breakdown.

Nursing care for the postoperative client requiring long-term glucocorticoid therapy will be directed at overcoming what adverse effect of the drug? a.Impaired wound healing b.Inflammation c.Autoimmune response d.Lack of mobility

Ans: A Feedback: Patients 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.

The nurse administers prednisone orally at 08:00. When would the nurse expect the drug to reach peak effect? a.09:00 to 10:00 b.12:00 to 13:00 c.08:30 to 09:00 d.14:00 to 15:00

Ans: A Feedback: Prednisone's peak effect occurs 1 to 2 hours after administering the drug. If given at 8 am, the expected peak would occur between 9 and 10 am.

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 it first thing in the morning." b."Take 1 hour before meals." c."Take before bedtime." d."Split the dose into two equal doses."

Ans: A Feedback: Steroids, taken on an empty stomach, would exacerbate the nausea. If the patient takes only one dose per day, it should be taken immediately after breakfast. If spaced throughout the day, eating something before taking the pill will reduce risk of nausea. 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.

What would be important for the nurse to teach the parents of a pediatric client about the use of topical corticosteroids? a."Apply the medication sparingly." b."Apply directly to open lesions." c."After applying cover with a bandage." d."Reapply as often as needed to keep the rash coated with the medication."

Ans: A Feedback: Topical use of corticosteroids should be limited in children, because their body surface area is comparatively large, so that the amount of the drug absorbed in relation to weight is greater than in an adult. Apply sparingly and do not use in the presence of open lesions. Do not occlude treated areas with dressings or diapers, which may increase the risk of systemic absorption.

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 large crowds of people in confined spaces." b."Avoid working in areas with other people." c."Avoid exercising to reduce risk of injury." d."Avoid touching other people who may carry germs."

Ans: A Feedback: With long-term therapy, the importance of avoiding exposure to infectioncrowded areas, people with colds or the flu, activities associated with injuryshould be stressed. If an injury or infection should occur, the patient should be encouraged to seek medical care. These patients do not need to avoid work, exercise, or touching others but they should use good hand hygiene to avoid infection from these sources.

The nurse is caring for a client with a heightened stress response following a series of difficult circumstances. When assessing this client, what findings will the nurse attribute to this response? Select all that apply. a.Elevated serum blood glucose b.Reduced inflammatory response c.Heightened immune response d.Increased blood volume e.Extreme hunger

Ans: A, B, D Feedback: The stress response causes an increase in blood volume and a release of glucose for energy. It also slows the rate of protein production and blocks the activities of the inflammatory and immune systems, which reserves energy. This patient is unlikely to be hungry.

A client with adrenal insufficiency has been admitted to the intensive care unit in adrenal crisis. What assessment findings support this diagnosis? Select all that apply. a.Physiological exhaustion b.Hypertension c.Fluid shift d.Shock e.Septicemia

Ans: A, C, D Feedback: Symptoms of adrenal crisis include physiological exhaustion, hypotension, fluid shift, shock, and even death. Hypotension rather than hypertension would be expected. Septicemia is a possible cause of adrenal crisis, not a symptom.

An older adult client taking high-dose corticosteroids to treat arthritis requests a measles vaccine. What is the nurse's best response? a."Measles vaccines are only given if you are at risk for serious complications of the disease." b."Live virus vaccines cannot be given to people whose immune systems are suppressed." c."Clients taking corticosteroids are well protected from viruses and do not need vaccines." d."Corticosteroids interact with the measles vaccine to create serious adverse effects."

Ans: B Feedback: Corticosteroids block the inflammatory response and are very helpful in conditions such as arthritis. However, they also block the immune response, making a person immunosuppressed. The vaccine would not be given to this patient because of the increased risk for infection. An older adult would be considered at high risk for pneumonia so getting the vaccine would be encouraged if not for taking corticosteroids. Corticosteroids do not protect against viruses. The vaccine is contraindicated because of risk for infection and not because of a potential drugdrug interaction.

The nurse administers fludrocortisone to a client diagnosed with salt-losing adrenogenital syndrome and then assesses for evidence of what therapeutic action? a.Increased level of consciousness and elevated serum glucose level b.Increased sodium and water reabsorption and potassium excretion c.Increased output of dilute urine and resolution of peripheral edema d.Potassium retention and increased serum calcium levels

Ans: B Feedback: Fludrocortisone's therapeutic effects include an increase in sodium and water reabsorption with potassium excretion. Headache, edema, weakness, arrhythmias, and hypertension are adverse, and not therapeutic, effects. Hypokalemia is possible but glucose levels should not be impacted.

A client is taking low-dose corticosteroids on a long-term basis for chronic obstructive pulmonary disease. The nurse assesses this client knowing prolonged use of corticosteroids puts the client at risk for what? a.Adrenal storm b.Adrenal atrophy c.Stunted growth d.Hypothalamic insufficiency

Ans: B Feedback: Prolonged use of corticosteroids suppresses the normal hypothalamicpituitary axis and leads to adrenal atrophy from lack of stimulation. The other options are all distracters for this question with no connection to long-term use of corticosteroids.

What hormones does the adrenal medulla secrete? a.Renin and erythropoietin b.Norepinephrine and epinephrine c.Epinephrine and dopamine d.Dopamine and serotonin

Ans: B Feedback: The adrenal medulla is actually part of the sympathetic nervous system (SNS). It is a ganglion of neurons that releases the neurotransmitters norepinephrine and epinephrine into circulation when the SNS is stimulated.

The parent of an infant asks the nurse for a steroid cream for the treatment of diaper rash. What teaching should the nurse provide the parent? Select all that apply. a."Topical corticosteroids have actually been found to make diaper rashes worse, not better." b."The area where you apply a topical corticosteroid should not be tightly covered with a diaper." c."Topical corticosteroids should not be applied to any open sores or broken skin." d."In general, the use of topical corticosteroids should be limited in children." e."Topical corticosteroids should be applied in a thick coat to the rash in order to be effective."

Ans: B, C, D Feedback: Topical use of corticosteroids should be limited in children because their body surface area is comparatively large and the amount of the drug absorbed in relation to weight is greater than in an adult. When the medication is used in children, it should be applied sparingly and the area should not be occluded with a diaper. The nurse should not make a judgment nor should he or she allow a patient or family member to dictate a treatment just because he or she wants it. More effective treatments for diaper rash than corticosteroids are available.

The nurse is caring for a client who works night shift from 22:00 to 06:00 and normally sleeps from 08:00 (8 AM) until 16:00 (4 PM) each day. The nurse should teach this client to take the prescribed corticosteroid at what time of the day? a.06:00 b.08:00 c.16:00 d.22:00

Ans: C Feedback: If a person works all night and goes to bed at 8 am, arising at 4 pm to carry on the day's activities before going to work at 10 pm, the hypothalamus will release corticotropin-releasing hormone at about 4 pm in accordance with the new sleepwake cycle. It usually takes 2 or 3 days for the hypothalamus to readjust. A patient on this schedule who is taking replacement corticosteroids would then need to take them at 4 pm, or on arising. All other options would not be optimal.

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."You might find that your child is sleepier than usual, especially near the beginning of treatment." b."The child may receive immunizations while on this drug, but keep them to a minimum." c."Don't stop this medication suddenly; you will have to taper dosage gradually." d."Monitor your child closely for any difficulty swallowing or signs of gastric reflux."

Ans: C Feedback: 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. This is the priority instruction. Parents should also be told to wait to get the child immunizations until after drug therapy is completed. There is no need to alter carbohydrate or protein intake.

The adrenal cortex responds to adrenocorticotropic hormone (ACTH), which responds to corticotropin-releasing hormone (CRH) from the hypothalamus in a daily pattern called what? a.Pituitary rhythm b.Hypothalamic-pituitary axis c.Diurnal rhythm d.Circadian rhythm

Ans: C Feedback: The adrenal cortex responds to ACTH released from the anterior pituitary. ACTH, in turn, responds to CRH released from the hypothalamus. This happens regularly during a normal day in what is called diurnal rhythm. Pituitary rhythm is a distracter; the term does not exist. The hypothalamicpituitary axis involves the interaction between the two glands. Circadian rhythm involves when people prefer to be most active, such as people who say they are morning people.

A client who is steroid dependent due to adrenocortical insufficiency calls the clinic and is very upset, reporting stressful circumstances. What does the nurse expect the health care provider will order concerning his or her medication? a.The dosage may continue as ordered. b.The medication may be discontinued until stress declines. c.The dosage of the medication may be increased. d.The dosage of the medication may be decreased.

Ans: C Feedback: The patient's body will initiate a stress reaction. Normally, activation of the stress reaction can cause release of adrenocorticotropic hormone (ACTH) and secretion of the adrenocortical hormones. A patient with adrenocortical insufficiency may not be able to supplement the increased 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 increased demands for corticosteroids in the body under stress.

When caring for a client receiving long-term therapy with corticosteroids, the nurse would plan care incorporating interventions aimed at preventing what? a.Allergies b.Cognitive changes c.Infection d.Anemia

Ans: C Feedback: When planning care for a patient taking long-term corticosteroid therapy, the nurse needs to incorporate interventions aimed at reducing risk of infection because the patient's immune system will be suppressed, which places the patient at increased risk. The nurse would not try to prevent the anti- inflammatory effects of the drug. The drug is not associated with causing allergies or anemia.

The nurse is caring for an African American client who received a kidney transplant and receives methylprednisolone for immunosuppression. What is the nurse's priority assessment specific to this client? a.Assessing capillary refill time b.Assessing cardiac rhythm c.Assessing red blood cell count d.Assessing blood glucose levels

Ans: D Feedback: African Americans develop increased toxicity to the corticosteroid methylprednisoloneparticularly when it is used for immunosuppression after renal transplantation. This toxicity can include severe steroid-induced diabetes mellitus. A priority intervention with this patient is monitoring blood glucose levels. Assessment of capillary refill time and cardiac rhythm would not be indicated by the data supplied about this patient. White blood cell counts should be monitored on any patient receiving long

For what reason might a nurse administer androgen injections to a 9-year-old boy? a.Ovarian atrophy b.Dwarfism c.Acromegaly d.Hypogonadism

Ans: D Feedback: Androgens are used pharmacologically to treat hypogonadism or to increase protein growth and red blood cell production. Androgens are not used in a male to treat ovarian atrophy. Androgens are not used to treat dwarfism or acromegaly.

The nurse is providing dietary teaching to the client on long-term mineralocorticoid therapy. What should the nurse teach the client? a."Try to identify and avoid hidden sources of sodium in your diet." b."Make sure to include dairy products, leafy green vegetables, and other high-calcium foods in your diet." c."Include vitamin D supplements in your diet if you're not getting a lot of sunlight." d."Eat plenty of bananas, avocados, and other foods that are high in potassium."

Ans: D Feedback: Mineralocorticoids cause sodium and water retention and potassium excretion. These patients benefit from a diet with increased potassium. They would not decrease sodium intake as the drug is often administered for the purpose of increasing serum sodium levels. Calcium and vitamin D intake would be the same for this patient as any other patient of similar age and gender.

An 8-year-old with asthma will be prescribed triamcinolone. What should the nurse teach the client and family about the use of this medication? a.The client will be required to take one inhalation, first thing in the morning b.The client will be unable to receive any vaccinations while taking triamcinolone c.The client will need to be on protective isolation until the completion of treatment d.The dose and frequency will be individualized, based on the client's needs

Ans: D Feedback: Pediatric dosage is individualized based on severity and response. However, children between 6 and 12 years of age are prescribed one to two inhalations t.i.d. or q.i.d. The other options are incorrect based on the recommended dosage

When developing a plan of care for the client receiving a glucocorticoid, what nursing diagnosis should be of highest priority? a.Deficient fluid volume related to water retention b.Risk for injury related to muscle weakness c.Imbalanced nutrition: less than body requirements d.Risk for infection related to immunosuppression

Ans: D Feedback: Risk for infection related to immunosuppression would be the appropriate nursing diagnosis because steroids suppress the immune system, which puts the patient at risk for infection. Nutritional imbalance is more likely to be more than body requirements than less than body requirements. Excess fluid volume is more appropriate than deficient fluid volume. Glucocorticoids are not associated with muscle weakness

The nurse anticipates an order for a glucocorticoid when caring for a client with what condition? a.Hypoglycemia b.Appendicitis c.Arthritis d.Septicemia

Arthritis Feedback: 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

A nurse is providing client education to a client who has had corticosteroids prescribed. What drug should the nurse teach the client to avoid while taking the corticosteroids? a.Aspirin b.Dimenhydrinate c.Ibuprofen d.Famotidine

Aspirin

The nurse is providing education to a client taking a glucocorticoid. The nurse should advise the client to take the medication at what time of the day, unless otherwise instructed? a.At bedtime b.With the noon meal c.Midafternoon d.Immediately on awakening in the morning

Immediately on awakening in the morning

The nurse is developing a plan of care for an 84-year-old client with diabetes who is receiving oral hydrocortisone 40 mg daily for treatment of arthritis. What is the nurse's priority? a.Increasing carbohydrates in the client's diet b.Restricting the client's protein intake c.Increasing fluids to 2,000 mL/day unless contraindicated d.Monitoring blood glucose levels frequently

Monitoring blood glucose levels frequently

What glucocorticoid is limited to oral administration? a.Cortisone b.Hydrocortisone c.Prednisone d.Triamcinolone

Prednisone

The nurse is caring for a client who is being treated with mineralocorticoids. When reviewing the client's latest laboratory findings, what should the nurse focus on? Select all that apply. a.Sodium b.Phosphorus c.Chloride d.Potassium e.Calcium

Sodium Potassium

A 66-year-old client is on long-term oral glucocorticoid therapy to treat chronic obstructive pulmonary disease. When providing drug teaching, the nurse will inform this client that there is a particularly high risk for what? a.Hyponatremia b.Spontaneous fractures c.Respiratory depression d.Ineffective temperature regulation

Spontaneous fractures

The nurse is providing care for a client who has been taking fludrocortisone for the treatment of hypotension. What assessment finding would suggest that the client is experiencing adverse effects? a.The client has fine crackles on lung auscultation. b.The client's potassium levels is 3.7 mmol/L (3.7 mEq/L). c.The client has been having frequent, loose bowel movements for the past several days. d.The client's neutrophil levels is 7.0 × 109/L (7,000/μL).

The client has fine crackles on lung auscultation.

The nurse is providing discharge teaching for a client prescribed prednisone to be taken on alternate days. The client asks why he cannot just take half a pill every day. What rationale should the nurse describe? a.To eliminate adverse side effects b.To prolong therapeutic effects c.To prevent steroid tolerance d.To decrease adrenal suppression

To decrease adrenal suppression

When doing a shift assessment on the client, the nurse would report what symptoms as a possible adverse effect of intranasal methylprednisolone? Select all that apply. a.Headache b.Impaired wound healing c.Epistaxis d.Hypotension e.Nasal irritation

a.Headache c.Epistaxis e.Nasal irritation