PRACTICE Qs [M17] Corticosteroids + Immunosuppressants

26) A young woman who has been taking immunosuppressant therapy says, "I'll be glad to be off these drugs. My husband and I would like to start a family." How should the nurse respond? Select all that apply. 1. "Be sure to wait until you are off the medication to stop using birth control." 2. "Don't plan on breastfeeding, because use of this drug makes your success unlikely." 3. "You should wait at least 4 months after taking this medication before you try to get pregnant." 4. "You may not be able to get pregnant after taking this medication." 5. "You may wish to consider adoption because taking this medication raises the risk of having a baby with congenital defects."

1. "Be sure to wait until you are off the medication to stop using birth control." 3. "You should wait at least 4 months after taking this medication before you try to get pregnant." Explanation: Immunosuppressive medications can cause birth defects. The client should not get pregnant for 4 months after taking these medications.

31) Which client statement indicates that teaching about hydrocortisone replacement therapy has been ineffective? 1. "I should take aspirin if I develop a fever." 2. "I should report any wounds that are slow to heal to the healthcare provider." 3. "I might gain a small amount of weight." 4. "I should avoid alcohol and caffeine."

1. "I should take aspirin if I develop a fever." Explanation: Aspirin can contribute to ulcer development during long-term hydrocortisone therapy and should be avoided.

52) Which client statements indicate that teaching about corticosteroid replacement therapy has been effective? Select all that apply. 1. "I should take this medication with food." 2. "I should avoid alcohol when taking this medication." 3. "I should keep appointments with my healthcare provider for follow-up blood work." 4. "I can stop taking this medication if I feel funny or sick." 5. "I will need to drink more water with this medication because it makes me lose water."

1. "I should take this medication with food." 2. "I should avoid alcohol when taking this medication." 3. "I should keep appointments with my healthcare provider for follow-up blood work." Explanation: Corticosteroid therapy can cause gastrointestinal irritation and should be taken with food. Alcohol can exacerbate the gastrointestinal irritation caused by this medication and should be avoided. This medication affects blood glucose, electrolytes, and white blood cell counts. The client will need to have periodic serum laboratory studies done.

7) A pregnant client asks why a steroid medication cannot be used for an allergic skin disorder. The nurse's most accurate response is: 1. "Steroids have the potential to cross the placenta, and should be avoided during pregnancy." 2. "The cause of your skin disorder is directly linked to your pregnancy. After you deliver, your skin should get better." 3. "Steroids will likely cause you to have an abortion; you'll have to put up with your skin disorder until after delivery." 4. "Steroids can cause liver failure, and are not recommended at this time."

1. "Steroids have the potential to cross the placenta, and should be avoided during pregnancy." Explanation: Steroids have the potential to cross the placenta, and should be avoided in pregnancy and lactation.

49) A client on long-term corticosteroid therapy tells the nurse that the plan is to stop taking the medication when the current prescription is completed. How should the nurse respond? Select all that apply. 1. "You could develop nausea, vomiting, and other problems if you stop this medication abruptly." 2. "Your body will not be able to produce the steroid that you need and you will become very ill." 3. "Why do you plan to stop taking the medication?" 4. "I'm sure you know what is best for your health." 5. "You will feel sick for a short while after stopping the medication, but it will go away."

1. "You could develop nausea, vomiting, and other problems if you stop this medication abruptly." 2. "Your body will not be able to produce the steroid that you need and you will become very ill." 3. "Why do you plan to stop taking the medication?" Explanation: If the corticosteroid medication is abruptly withdrawn, symptoms of adrenal crisis will appear. If the corticosteroid medication is abruptly withdrawn, symptoms of adrenal crisis will appear. The nurse should determine the reasons for the patient's actions.

24) A client is scheduled for kidney transplantation using an allograft. Which instruction should the nurse provide? Select all that apply. 1. "You will be monitored for acute rejection for the first 48 hours." 2. "If your system has not rejected the kidney within 2 weeks of surgery, you will be out of danger." 3. "You will take antirejection medication for at least several months after surgery." 4. "You are in danger of developing chronic rejection for years after your surgery." 5. "Rejection usually occurs immediately after surgery, generally before the client gets out of the recovery room."

1. "You will be monitored for acute rejection for the first 48 hours." 3. "You will take antirejection medication for at least several months after surgery." 4. "You are in danger of developing chronic rejection for years after your surgery." Explanation: Acute rejection occurs in the first 48 hours after transplant. Antirejection medications are given for at least several months and are sometimes continued at a lower dose indefinitely. Chronic rejection of the transplant may occur months or even years after surgery.

20) Which nursing intervention would help minimize side effects in a client receiving antithymocyte (Atgam) therapy? 1. Administering acetaminophen 2. Providing cough syrup 3. Limiting visitors 4. Limiting fluid intake

1. Administering acetaminophen Explanation: Acetaminophen will help prevent the flulike symptoms that accompany cytokine release syndrome.

47) A client is diagnosed with medication-induced hypoaldosteronism. The nurse will assess the client's medication history for which drug use? Select all that apply. 1. Beta blockers 2. NSAIDs 3. Calcium channel blockers 4. Angiotensin-converting enzyme inhibitors 5. Nitrites

1. Beta blockers 2. NSAIDs 3. Calcium channel blockers 4. Angiotensin-converting enzyme inhibitors Explanation: Beta blockers may reduce renin serum levels and suppress the stimulation of aldosterone secretion. NSAIDs may reduce renin serum levels and suppress the stimulation of aldosterone secretion. Calcium channel blockers may reduce renin serum levels and suppress the stimulation of aldosterone secretion. Angiotensin-converting enzyme inhibitors block the formation of angiotensin II, which is the normal signal for aldosterone secretion.

46) A client is experiencing symptoms associated with severe psoriasis. The nurse will prepare to administer which medications for this client? Select all that apply. 1. Betamethasone 2. Hydrocortisone acetate 3. Fludrocortisone 4. Metyrapone 5. Mitotane

1. Betamethasone 2. Hydrocortisone acetate Explanation: Betamethasone is a primary initial treatment for psoriasis. Hydrocortisone acetate is a primary initial treatment for psoriasis.

25) A client reports taking corticosteroid therapy for the last 6 months to treat reactive airway disease. The client says, "My doctor wouldn't refill my prescription so I went to a different doctor and just didn't say anything about taking corticosteroids." The nurse would pay particular attention to which assessment in this client? Select all that apply. 1. Blood pressure 2. Weight 3. Visual acuity 4. Heart rhythm 5. Pedal pulses

1. Blood pressure 2. Weight 3. Visual acuity Explanation: Corticosteroid therapy can cause fluid retention, which would increase blood pressure. Obesity and fluid retention are adverse effects of long-term corticosteroid use. Long-term corticosteroid use may cause cataract formation.

11) Cyclosporine (Sandimmune, Neoral) and tacrolimus (Prograf) represent which category of immunosuppressants? 1. Calcineurin inhibitors 2. Glucocorticoids 3. Antimetabolites 4. Antibodies

1. Calcineurin inhibitors Explanation: Cyclosporine and tacrolimus are calcineurin inhibitors.

51) A client is prescribed dexamethasone. The nurse knows that this medication is indicated for which health problems? Select all that apply. 1. Cerebral edema 2. Acute adrenocortical insufficiency 3. Gastritis 4. Heart failure 5. Spinal stenosis

1. Cerebral edema 2. Acute adrenocortical insufficiency Explanation: Dexamethasone is indicated in the treatment of cerebral edema. Dexamethasone is indicated in the treatment of acute adrenocortical insufficiency.

23) How would the nurse explain to a client the rationale for administering corticosteroids after an organ transplant? 1. Corticosteroids prevent the immune system from rejecting the implant. 2. Corticosteroids enhance perfusion through the transplanted organ. 3. Corticosteroids promote graft-versus-host disease. 4. Corticosteroids provide prophylaxis against opportunistic infection.

1. Corticosteroids prevent the immune system from rejecting the implant. Explanation: Corticosteroids are part of most therapeutic regimens to prevent transplant rejections.

22) The nurse would question an order for corticosteroids for a client diagnosed with which health problem? 1. Exposure to active tuberculosis 2. Long-term asthma 3. Inflammatory bowel disease (IBD) 4. Seasonal allergic rhinitis

1. Exposure to active tuberculosis Explanation: Active tuberculosis is a highly contagious disease. Corticosteroids can suppress the immune system and should not be administered to this client.

23) A client's medical history reveals vaccination with bacillus Calmette-Guérin (BCG) vaccine. The nurse is aware that this client has possibly had which condition? Select all that apply. 1. Exposure to tuberculosis 2. Cervical cancer 3. Bladder cancer 4. Active tuberculosis 5. Hashimoto's thyroiditis

1. Exposure to tuberculosis 3. Bladder cancer Explanation: BCG is used to stimulate immunity against Mycobacterium tuberculosis. A form of BCG is used to treat cancer of the bladder.

42) What would the nurse expect to assess in a client who has been taking long-term corticosteroid replacement therapy? Select all that apply. 1. Fasting blood glucose level 150 mg/dL 2. Reduced muscle mass 3. Elevated blood lipid levels 4. History of pathologic fractures 5. Serum potassium level 5.0 mg/dL

1. Fasting blood glucose level 150 mg/dL 2. Reduced muscle mass 3. Elevated blood lipid levels 4. History of pathologic fractures Explanation: Corticosteroids have a hyperglycemic effect and increase the blood glucose level. Corticosteroids increase the breakdown of proteins to amino acids. Amino acids are then converted to glucose and glycogen in the liver, resulting in protein depletion. Corticosteroids increase the breakdown of lipids. Corticosteroids increase the breakdown of bony matrix, resulting in bone demineralization, which can cause pathologic fractures.

12) A client with adrenocortical insufficiency has been taking corticosteroids for 9 months. What symptom should be reported to the healthcare provider immediately? 1. Frequent palpitations 2. Headache 3. Nasal congestion 4. Fatigue

1. Frequent palpitations Explanation: Electrolyte changes are associated with long-term corticosteroid therapy. Frequent palpitations warrant further investigation.

41) A client has been prescribed long-term corticosteroid therapy. What should the nurse instruct the client about the potential effects of this medication regimen? Select all that apply. 1. Have the blood glucose level checked frequently. 2. Avoid crowds and being around others with respiratory infections. 3. Avoid falling or any other type of injury to the bones. 4. Increase the intake of green leafy vegetables. 5. Increase the daily intake of fiber.

1. Have the blood glucose level checked frequently. 2. Avoid crowds and being around others with respiratory infections. 3. Avoid falling or any other type of injury to the bones. Explanation: Corticosteroids increase the level of blood glucose, leading to hyperglycemia. Corticosteroids suppress the immune response. Corticosteroids increase the breakdown of bony matrix, resulting in bone demineralization.

13) A client with a history of adrenocortical insufficiency is experiencing nausea, vomiting, hypotension, and seizures. The nurse suspects the client discontinued which medication? 1. Hydrocortisone 2. Fluticasone propionate (Flonase) 3. Cosyntropin (Cortrosyn) 4. Methadone

1. Hydrocortisone Explanation: If a client with a history of adrenocortical insufficiency stops taking prescribed medications, the atrophied adrenal glands will not be able to secrete sufficient corticosteroids, and symptoms of adrenal crisis will appear.

21) Methylprednisolone is added to a client's chemotherapeutic regimen. Which effects would the nurse expect if the drug is taken long term? Select all that apply. 1. Hyperglycemia 2. Fluid retention 3. Hypotension 4. Osteoporosis 5. Mental status changes

1. Hyperglycemia 2. Fluid retention 4. Osteoporosis 5. Mental status changes Explanation: Hyperglycemia could occur due to increased glucose metabolism. Fluid retention could occur due to sodium and water retention. Osteoporosis can occur due to bone resorption. Mental changes can occur due to fluid retention.

17) What is the expected outcome for the client receiving filgrastim (Neupogen)? 1. Increased white blood cell count 2. Reduction in tumor size 3. Reduction in paresthesia 4. Increased platelet count

1. Increased white blood cell count Explanation: Filgrastim increases white blood cell counts.

30) Which medication will the nurse administer to a client who is being tested for Cushing's syndrome? 1. Metyrapone (Metopirone) 2. Mitotane (Lysodren) 3. Acetylcysteine (Mucomyst) 4. Ketoconazole (Nizoral)

1. Metyrapone (Metopirone) Explanation: Metyrapone is an antiadrenal drug used to diagnose Cushing's syndrome.

22) A client will be taking interferon alfa-2b (Intron A) as treatment for hairy cell leukemia. The nurse advises this client about which common adverse effects? Select all that apply. 1. Nausea 2. Fever 3. Dizziness 4. Headache 5. Rash

1. Nausea 2. Fever 3. Dizziness 4. Headache Explanation: Nausea is a common adverse effect of interferon alfa-2b. Fever is a common adverse effect of interferon alfa-2b. Dizziness is a common adverse effect of interferon alfa-2b. Headache is a common adverse effect of interferon alfa-2b.

44) A client with a foot wound is prescribed short-term, high-dose corticosteroid therapy. What will the nurse assess as indications that the medication is effective? Select all that apply. 1. Reduction in swelling 2. Reduced purulent drainage 3. Increased bleeding 4. Increased warmth to the area 5. Buildup of necrotic tissue

1. Reduction in swelling 2. Reduced purulent drainage Explanation: Corticosteroids decrease the numbers of circulating lymphocytes, eosinophils, monocytes, and basophils. They inhibit the movement of macrophages and leukocytes to areas of inflammation. They also decrease the production of inflammatory cytokines, including histamine, bradykinin, interferons, interleukins, and granulocyte-macrophage colony stimulating factor, and decrease the formation of prostaglandins. Corticosteroids decrease the numbers of circulating lymphocytes, eosinophils, monocytes, and basophils. They inhibit the movement of macrophages and leukocytes to areas of inflammation. They also decrease the production of inflammatory cytokines, including histamine, bradykinin, interferons, interleukins, and granulocyte-macrophage colony stimulating factor, and decrease the formation of prostaglandins.

45) A client is experiencing severe musculoskeletal pain. The nurse is aware that corticosteroid therapy would be indicated for which musculoskeletal disorders? Select all that apply. 1. Rheumatoid arthritis 2. Osteoarthritis 3. Osteoporosis 4. Fibromyalgia 5. Myasthenia gravis

1. Rheumatoid arthritis 2. Osteoarthritis Explanation: Corticosteroid therapy is used in the treatment of rheumatoid arthritis to reduce pain and inflammation. Corticosteroid therapy is used in the treatment of osteoarthritis to reduce pain and inflammation.

48) The nurse caring for a client with Cushing's syndrome will prepare to administer which medications to this client? Select all that apply. 1. Tapering doses of prescribed corticosteroid 2. Ketoconazole (Nizoral) 3. Fludrocortisone 4. Spironolactone (Aldactone) 5. Budesonide (Entocort-EC)

1. Tapering doses of prescribed corticosteroid 2. Ketoconazole (Nizoral) Explanation: If the cause of Cushing's syndrome is corticosteroid therapy, gradual discontinuation of this medication is a treatment option. Ketoconazole (Nizoral) has become a preferred drug for long-term therapy of Cushing's syndrome because this drug rapidly blocks the synthesis of glucocorticoids, lowering serum levels.

19) A client is beginning aldesleukin (Proleukin) therapy for advanced renal carcinoma. The nurse should monitor the client for: 1. capillary leak syndrome. 2. hypertension. 3. hyperglycemia. 4. hyperuricemia.

1. capillary leak syndrome. Explanation: Capillary leak syndrome is a significant side effect of aldesleukin and can be fatal.

43) The nurse instructs a client receiving long-term corticosteroid replacement therapy to have annual eye examinations because of the risk of developing: Select all that apply. 1. glaucoma. 2. cataracts. 3. detached retina. 4. retinopathy. 5. macular degeneration.

1. glaucoma. 2. cataracts. Explanation: Open-angle glaucoma is a frequent adverse effect of long-term corticosteroid therapy. Cataracts are a frequent adverse effect of long-term corticosteroid therapy.

40) A client on long-term corticosteroid therapy is demonstrating signs of acute adrenocortical insufficiency. The nurse knows that these symptoms are caused by: Select all that apply. 1. the shutting down of ACTH secretion. 2. the failure of the adrenal cortex to secrete corticosteroids. 3. rebound ACTH secretion. 4. excessive secretion of ACTH. 5. toxic levels of mineralocorticoids.

1. the shutting down of ACTH secretion. 2. the failure of the adrenal cortex to secrete corticosteroids. Explanation: Consistent high amounts of corticosteroid medications provide continuous negative feedback to the hypothalamus and pituitary, shutting down the secretion of ACTH. Without stimulation by ACTH, the adrenal cortex shrinks and stops secreting endogenous corticosteroids.

38) The nurse is planning care for a client with diabetes who is prescribed lifelong therapy for adrenal insufficiency. Which advice should not be given to this client? 1. "Cut your toenails straight across." 2. "Avoid wearing socks with shoes." 3. "Keep a diary of your blood glucose measurements." 4. "Call your healthcare provider if you are injured or get sick."

2. "Avoid wearing socks with shoes." Explanation: A client with diabetes might have peripheral neuropathy. The addition of corticosteroids can prolong wound healing if a wound develops from friction of the shoe against bare skin.

50) A client is being started on corticosteroid replacement therapy. What should the nurse teach the client about taking this medication? Select all that apply. 1. "Go to your pharmacy to get annual influenza immunization and a varicella vaccine." 2. "Restrict your salt intake." 3. "Take vitamin D supplements as prescribed." 4. "Do not stop taking this medication." 5. "Stop taking this medication if you have headaches, confusion, or insomnia."

2. "Restrict your salt intake." 3. "Take vitamin D supplements as prescribed." 4. "Do not stop taking this medication." Explanation: There is a risk of fluid retention with this medication. By restricting sodium, the amount of fluid retained can be reduced. Because of the risk of osteoporosis, the client should be instructed to take vitamin D supplements as prescribed. The client should be instructed to not abruptly stop taking this medication.

6) Which interferons have the greatest clinical utility? 1. Gamma interferons 2. Alpha interferons 3. Beta interferons 4. Mu interferons

2. Alpha interferons Explanation: The alpha interferons have the greatest clinical utility.

5) The nurse is teaching a course in pathophysiology. The students understood the material correctly if they identify which options as properties of interferons? Select all that apply. 1. Antifungal 2. Antiviral 3. Anti-inflammatory 4. Antineoplastic 5. Antibiotic

2. Antiviral 3. Anti-inflammatory 4. Antineoplastic Explanation: Interferons have antiviral properties and aid in the fight against disease. Interferons have anti-inflammatory properties and aid in the fight against inflammatory processes such as multiple sclerosis. Interferons have antineoplastic properties and aid in the fight against cancer.

8) A client with dementia and severe pruritus is receiving intravenous steroids and is constantly scratching the skin. What intervention is best for the client at this time? 1. Placing four side rails in the up position 2. Application of hand mitts 3. Application of four-point leather restraints 4. Application of a falls-risk bracelet

2. Application of hand mitts Explanation: Applying hand mitts will protect the skin from breakdown secondary to scratching of the skin. The client is at risk for infection from the steroid medication, so the nurse should make every attempt to keep the client's skin clean, dry, and intact.

7) Adding polyethylene glycol (PEG) to an interferon has which pharmacologic effect on the interferon? 1. Increased protein binding 2. Increased drug half-life 3. Decreased cellular permeability 4. Decreased first-pass effect

2. Increased drug half-life Explanation: The addition of PEG increases the interferon's half-life.

3) The nurse is establishing outcomes for a client with rheumatoid arthritis. What would be an appropriate outcome following 3 days of immunosuppressant therapy? 1. Decreased serum calcium 2. Reduced joint inflammation 3. Increased erythrocyte sedimentation rate 4. Increased white blood cell count

2. Reduced joint inflammation Explanation: Immunosuppressants are used to reduce joint inflammation.

16) For which purpose is cosyntropin (Cortrosyn) used? 1. To treat secondary adrenocortical insufficiency 2. To assist in the diagnosis of adrenocortical insufficiency 3. To treat primary adrenocortical insufficiency 4. To alleviate dermatologic pruritus

2. To assist in the diagnosis of adrenocortical insufficiency Explanation: The primary use of cosyntropin is to diagnose adrenal disorders.

17) A client receives cosyntropin (Cortrosyn). The nurse knows that if plasma cortisol levels fail to rise after an injection of cosyntropin, the pathology is: 1. idiopathic in nature. 2. at the level of the adrenal gland (primary adrenocortical insufficiency). 3. at the level of the hypothalamus. 4. at the level of the pituitary (secondary adrenocortical insufficiency).

2. at the level of the adrenal gland (primary adrenocortical insufficiency). Explanation: If plasma cortisol levels fail to rise after an injection of cosyntropin, the pathology is at the level of the adrenal gland (primary).

35) A client on lifelong replacement therapy with hydrocortisone is scheduled for surgery. The nurse anticipates that prior to surgery, the client's hydrocortisone dose will: 1. remain unchanged. 2. be increased. 3. be decreased. 4. be rapidly withdrawn

2. be increased. Explanation: Maintenance dosages of corticosteroids for adrenal insufficiency need to be increased during times of infection, surgery, or injury to adapt to the increased stress.

14) An advantage of the use of monoclonal antibodies over polyclonal antibodies is that monoclonal antibodies: Select all that apply. 1. can be administered in the presence of fever. 2. have fewer side effects. 3. are administered by intramuscular administration. 4. are administered in a single dose. 5. can be administered in smaller doses.

2. have fewer side effects. 5. can be administered in smaller doses. Explanation: Monoclonal antibodies target a single type of cell, reducing side effects. Because of their specificity, smaller doses of monoclonal antibodies can be given.

20) A client in anaphylactic shock receives a dose of hydrocortisone (Solu-Cortef). The nurse recognizes that the desired action of this medication is to: 1. raise serum oncotic pressure. 2. inhibit the inflammatory process. 3. stimulate the sympathetic nervous system. 4. raise circulating glucose levels.

2. inhibit the inflammatory process. Explanation: Corticosteroids frequently are used to suppress the inflammatory and immune responses.

3) A client has had one adrenal gland removed. The nurse anticipates the need to administer medication to raise the blood pressure and closely mimic the effects of: 1. gonadocorticoids. 2. mineralocorticoids. 3. glucocorticoids. 4. cortisone.

2. mineralocorticoids. Explanation: Aldosterone is the predominant mineralocorticoid. Its primary function is to conserve sodium and water, thereby maintaining blood pressure.

28) A client with Cushing's syndrome is prescribed ketoconazole (Nizoral). What should the nurse explain as the reason for this medication? 1. "This medication will prevent infections." 2. "Cushing's syndrome is caused by an infection of the adrenal glands, and the medication will reverse the disease process." 3. "This drug blocks the formation of glucocorticoids, lowering their level in your blood." 4. "This has been prescribed because you have a fungal infection."

3. "This drug blocks the formation of glucocorticoids, lowering their level in your blood." Explanation: Ketoconazole rapidly blocks the synthesis of glucocorticoids, lowering serum levels. It is considered an antiadrenal agent and is the preferred drug for clients with Cushing's disease needing long-term therapy.

24) A client with inflammatory bowel disease is prescribed budesonide (Entocort-EC) and asks why this drug is ordered. The nurse correctly explains: 1. "The pharmacist will be making rounds this shift, and will explain the rationale to you at that time." 2. "Your healthcare provider ordered this medication to treat the underlying disease pathology." 3. "This is a corticosteroid that is not absorbed and remains in the intestine to treat the inflammation locally, without causing significant systemic effects." 4. "This is a systemic corticosteroid that will decrease system-wide inflammation."

3. "This is a corticosteroid that is not absorbed and remains in the intestine to treat the inflammation locally, without causing significant systemic effects." Explanation: Budesonide is a locally acting anti-inflammatory without significant systemic effects.

9) A client with diabetes is prescribed prednisone for acute asthma exacerbation. The client asks if this medication will affect the blood sugar. The nurse's best response is: 1. "Your blood sugar might drop unexpectedly." 2. "Your blood sugar will be unaffected." 3. "Your blood sugar might be elevated." 4. "Would you like to speak to the healthcare provider about this?"

3. "Your blood sugar might be elevated." Explanation: Administration of corticosteroids, such as prednisone, is likely to cause an increase in blood glucose levels. The client should check blood glucose levels more frequently and report abnormal values to the healthcare provider.

10) A client is taking long-term corticosteroid therapy for adrenal insufficiency. Which medication would be recommended for the relief of minor aches and pains? 1. Ibuprofen (Motrin) 2. Ketorolac (Toradol) 3. Acetaminophen (Tylenol) 4. Aspirin (Bayer)

3. Acetaminophen (Tylenol) Explanation: Acetaminophen is an analgesic that will not inhibit the production of protective prostaglandins.

2) The nurse is reviewing with a client the steroid hormones that are released from the adrenal glands. Which hormone is not secreted from the adrenal gland? 1. Mineralocorticoids 2. Corticosteroids 3. Adrenocorticotropic hormone (ACTH) 4. Glucocorticoids

3. Adrenocorticotropic hormone (ACTH) Explanation: ACTH is not secreted by the adrenal gland.

1) The nurse demonstrates understanding of the appropriate use of immunostimulant therapy by anticipating its use in the client with which disorder? 1. Exophthalmus 2. Gout 3. Cancer 4. Rheumatoid arthritis

3. Cancer Explanation: Immunostimulants are used to treat clients with cancer.

18) Which diagnostic test is the most helpful in distinguishing primary from secondary adrenocortical insufficiency? 1. Magnetic resonance imaging (MRI) 2. A computed tomography (CT) scan 3. Cosyntropin (Cortrosyn) 4. Dexamethasone (Decadron)

3. Cosyntropin (Cortrosyn) Explanation: The primary use of cosyntropin (Cortrosyn) is to diagnose adrenal disorders.

15) A client has been taking corticosteroids. The nurse suspects that the client has a history of adrenocortical insufficiency when the use of which other medication is documented in the record? 1. Isosorbide 2. Ciprofloxacin 3. Fludrocortisone 4. Metformin

3. Fludrocortisone Explanation: Clients requiring replacement therapy usually take corticosteroids their entire lifetime, and concurrent therapy with a mineralocorticoid such as fludrocortisone is necessary.

36) When caring for a client with Addison's disease, the nurse will prepare to administer which medication as the treatment of choice? 1. Ketoconazole (Nizoral) 2. Cosyntropin (Cortrosyn) 3. Hydrocortisone 4. Fludrocortisone (Florinef)

3. Hydrocortisone Explanation: Hydrocortisone is the treatment of choice for Addison's disease.

37) What is an expected assessment finding in a client recently started on fludrocortisone (Florinef)? 1. +4 peripheral edema 2. Decrease in weight 3. Increase in blood pressure 4. Increase in height

3. Increase in blood pressure Explanation: A mild-to-moderate increase in blood pressure would be expected.

27) What should the nurse explain to a client with Addison's disease as the reason for needing mineralocorticoid replacement therapy? 1. Mineralocorticoids will reduce excessive serum glucose levels. 2. Mineralocorticoids will mimic the action of cortisol. 3. Mineralocorticoids will mimic the action of aldosterone. 4. Mineralocorticoids will reduce harmful bronzing of the skin

3. Mineralocorticoids will mimic the action of aldosterone. Explanation: Mineralocorticoids, in addition to glucocorticoids, are indicated for use in clients with adrenocortical insufficiency.

14) A client is diagnosed with chronic adrenocortical insufficiency. What would be the best route for medication replacement therapy for this client? 1. Intravenous 2. Rectal 3. Oral 4. Intramuscular

3. Oral Explanation: Clients with adrenocortical insufficiency require lifelong therapy for the condition. The safest and easiest route of medication administration for this client is oral administration.

5) A client has an ACTH-secreting tumor. The nurse understands that which assessment findings would be consistent with this type of tumor? 1. Clubbing of the fingers and circumoral cyanosis 2. Extreme tachycardia and tremors 3. Weight gain and muscle atrophy 4. Exophthalmos and skin that is hot to the touch

3. Weight gain and muscle atrophy Explanation: Weight gain and muscle wasting are clinical manifestations seen in clients with hypersecretion of corticosteroids. This is consistent with an ACTH-secreting hormone.

4) The cells of the immune system secrete substances that mediate the immune response that are called: 1. antigens. 2. masts. 3. cytokines. 4. antibodies.

3. cytokines. Explanation: The cells of the immune system secrete cytokines.

12) The nurse would recognize that additional teaching is necessary if the nurse finds the client taking cyclosporine while: 1. drinking milk. 2. eating fish. 3. drinking grapefruit juice. 4. eating leafy green vegetables.

3. drinking grapefruit juice. Explanation: Drinking grapefruit juice concurrently can increase cyclosporine levels by 50% to 200%.

33) The nurse recognizes that mineralocorticoid replacement therapy should be used judiciously in clients with: 1. hypotension. 2. aldosterone insufficiency. 3. heart failure. 4. Addison's disease.

3. heart failure. Explanation: Mineralocorticoid therapy should be used cautiously if a client has any disorders in which fluid accumulation could be hazardous.

11) A client taking long-term corticosteroid therapy should be instructed to contact the healthcare provider before: 1. providing a blood specimen. 2. taking an eye exam. 3. receiving live vaccines. 4. providing a urine specimen.

3. receiving live vaccines. Explanation: A client on long-term corticosteroid therapy might be immunosuppressed and should speak to the healthcare provider prior to receiving a vaccination.

21) The nurse posts a sign limiting visitors on the door of a hospitalized client receiving high-dose intravenous corticosteroids. When the family inquires why visitors are limited, the nurse's best response would be: 1. "Visitors are not required to wash their hands when they enter the room." 2. "The germs of the client put all visitors at risk for infection." 3. "The client is very sick, and needs rest." 4. "The germs of visitors put the client at risk for infection."

4. "The germs of visitors put the client at risk for infection." Explanation: Corticosteroids suppress the immune response. Visitors, in particular visitors who are ill, should be limited at this time.

34) Which client statement indicates that instruction about fludrocortisone (Florinef) has been ineffective? 1. "If I develop muscle cramps, I will call the office right away." 2. "If I notice a lot of swelling in my legs, I'll call the office right away." 3. "This drug could lower my potassium level, so I'll eat foods rich in potassium." 4. "This drug will drop my blood pressure, so I'll go from sitting to standing slowly."

4. "This drug will drop my blood pressure, so I'll go from sitting to standing slowly." Explanation: This medication is likely to cause the client's blood pressure to rise, not drop.

29) A young adult client with Cushing's syndrome is prescribed ketoconazole (Nizoral). What question should the nurse ask before providing the client with this medication? 1. "What is your height and weight?" 2. "Are you allergic to shellfish?" 3. "Do you have a family history of cancer?" 4. "When was your last menstrual period?"

4. "When was your last menstrual period?" Explanation: Ketoconazole should not be used during pregnancy because it has been shown to be teratogenic and embryotoxic at high doses in animals.

25) The nurse would question the administration of mineralocorticoid replacement therapy for which client? 1. A client with a defect in the stimulation of aldosterone secretion 2. A client with a defect in aldosterone sensitivity 3. A client with a defect in the secretion of aldosterone 4. A client with Conn's Syndrome

4. A client with Conn's Syndrome Explanation: A client with Conn's syndrome already has oversecretion of aldosterone and does not require mineralocorticoid replacement therapy.

32) The nurse is caring for a client taking long-term hydrocortisone replacement therapy. Which assessment finding indicates a masked infection? 1. A complaint of hiccups 2. Deformity of the left upper extremity 3. Purulent drainage from a puncture wound 4. A low-grade oral temperature

4. A low-grade oral temperature Explanation: Corticosteroids suppress the immune response. A low-grade fever in a client taking hydrocortisone replacement therapy is evidence that an infection is being masked.

18) Concurrent use of azathioprine and an ACE inhibitor could result in which adverse effect? 1. Flulike symptoms 2. Hypercholesteremia 3. Hematuria 4. Anemia and leukopenia

4. Anemia and leukopenia Explanation: Concurrent use of azathioprine and an ACE inhibitor could result in anemia and severe leukopenia.

26) Which assessment finding would be associated with a client requiring mineralocorticoid replacement therapy? 1. Respiratory rate 13 breaths/min 2. Oral temperature 100.0°F 3. Pulse 48 beats/min 4. Blood pressure 78/58 mmHg

4. Blood pressure 78/58 mmHg Explanation: Clients requiring mineralocorticoid therapy typically have a lack of aldosterone. Aldosterone is the primary hormone regulating sodium and potassium in the body. Losses of aldosterone generally result in a drop in blood pressure and a rise in pulse.

4) A client has sustained a traumatic head injury with trauma to the hypothalamus. The nurse recognizes that which endocrine regulatory factor will be most affected? 1. Colony-stimulating factor 2. Von Willebrand factor 3. Factor VIII 4. Corticotropin-releasing factor

4. Corticotropin-releasing factor Explanation: Corticotropin-releasing factor is secreted by the hypothalamus, and could be affected by trauma to the hypothalamus.

10) A nurse caring for a client who has been on cyclosporine for 6 months following a renal allograft reviews the laboratory data and notes that the blood urea nitrogen and serum creatinine have shown a consistent elevation in the past 2 weeks. The nurse would correctly identify these findings as indicating which problem? 1. Metabolic acidosis 2. Metastatic carcinoma 3. An anaphylactic reaction 4. Cyclosporine side effects

4. Cyclosporine side effects Explanation: Side effects of cyclosporine include nephrotoxicity.

19) The nurse is caring for a client taking corticosteroids for immune suppression. Which laboratory value indicates the medication treatment is successful? 1. Increased lymphocytes and decreased monocytes 2. Increased monocytes and decreased lymphocytes 3. Increased numbers of lymphocytes, eosinophils, and monocytes 4. Decreased numbers of lymphocytes, eosinophils, and monocytes

4. Decreased numbers of lymphocytes, eosinophils, and monocytes Explanation: Decreased numbers of circulating lymphocytes, eosinophils, and monocytes would indicate immune suppression.

9) The nurse is explaining to a nursing student that allograft transplant clients need some form of immunosuppressant therapy. Which statement describes the pathophysiologic reasoning behind this? 1. The treatment is indicated only if signs of transplant rejection are present. 2. The treatment is a precaution; rejection in allografts seldom occurs. 3. The treatment is designed to target chronic rejection, which does not occur for several weeks. 4. Despite accurate tissue matching, allografts contain antigens that trigger the client's immune response.

4. Despite accurate tissue matching, allografts contain antigens that trigger the client's immune response. Explanation: Allografts always contain certain antigens that trigger the immune response and rejection, and immunosuppressants help prevent this response.

13) What is the primary advantage of using monoclonal antibodies (MABs) rather than polyclonal antibodies? 1. Oral administration 2. Single dosing 3. Broad-spectrum use 4. Fewer side effects

4. Fewer side effects Explanation: Fewer adverse effects are the primary advantage of MABs.

16) The nursing student correctly identifies what advantage of cyclosporine for the prevention of allograft rejection? 1. Increases white blood cell count 2. Can be administered subcutaneously 3. Decreases the risk of infection 4. Is less harmful to bone marrow

4. Is less harmful to bone marrow Explanation: Cyclosporine is less harmful to bone marrow cells.

39) What should a client receiving lifelong therapy with corticosteroids be instructed to report immediately to the healthcare provider? 1. A change in prescription bottles 2. A change in health insurance plans 3. Cravings for sweet or salty foods 4. Weight gain of over 2 pounds in one day

4. Weight gain of over 2 pounds in one day Explanation: Weight gain of over 2 pounds per day should be reported immediately to the healthcare provider because this finding likely reflects fluid retention.

6) The nurse is administering cortisol to a client. This intervention should result in: 1. increased secretion from the pituitary. 2. decreased level of consciousness (LOC). 3. increased secretion from the hypothalamus. 4. decreased secretion from the pituitary.

4. decreased secretion from the pituitary. Explanation: When the serum level of cortisol rises, it provides negative feedback to the hypothalamus and pituitary to shut off further release of glucocorticoids.

8) The nurse preparing to administer the initial dose of an immunosuppressant agent for a client recovering from organ transplantation would make certain that screening has been performed to rule out: 1. electrolyte imbalance. 2. cardiomegaly. 3. anemia. 4. infectious processes.

4. infectious processes. Explanation: The priority would be to rule out infectious processes because administration of an immunosuppressant could exacerbate an infection.

1) A client with an adrenal tumor experiences frequent infections. The nurse understands that the frequent infections are secondary to: 1. decreased blood glucose. 2. lipolysis. 3. bone demineralization. 4. suppression of the immune response.

4. suppression of the immune response. Explanation: A tumor of the adrenal gland can cause hypersecretion of glucocorticoids. This leads to suppression of the inflammatory and immune responses and contributes to frequent infections.

A client in anaphylactic shock receives a dose of hydrocortisone (Cortef). The nurse recognizes that the desired action of this medication is to: A. raise serum oncotic pressure. B. inhibit the inflammatory process. C. stimulate the sympathetic nervous system. D. raise circulating glucose levels.

B. inhibit the inflammatory process.

A client has had one adrenal gland removed. The nurse anticipates the need to administer medication to raise the blood pressure and closely mimic the effects of: A. gonadocorticoids. B. mineralocorticoids. C. glucocorticoids. D. cortisone.

B. mineralocorticoids.

The nurse demonstrates understanding of the appropriate use of immunosuppressant therapy by anticipating its use in the client with which disorder? A. Gout B. Exophthalmus C. Rheumatoid arthritis D. Cancer

C. Rheumatoid arthritis

The nurse is administering hydrocortisone (Cortef) to a client. This intervention should result in: A. increased secretion from the pituitary. B. decreased level of consciousness. C. increased secretion from the hypothalamus. D. decreased secretion from the pituitary.

D. decreased secretion from the pituitary.

The nurse preparing to administer the initial dose of an immunosuppressant agent for a client recovering from organ transplantation would make certain that screening has been performed to rule out: A. electrolyte imbalance. B. cardiomegaly. C. anemia. D. infectious processes.

D. infectious processes.