Adrenocortical Agents

Adrenocortical Agents 1. A client has been prescribed a corticosteroid for the treatment of chronic adrenocortical insufficiency. The nurse’s instructions for administration should include taking the medication under what condition? a. In the morning i. A major adverse reaction is suppression of the hypothalamic-pituitary-adrenal (HPA) axis and subsequent loss of adrenocortical function. Morning dosing is often recommended for clients with chronic adrenocortical insufficiency because the schedule stimulates normal endogenous corticosteroid secretion. 2. The nursing instructor is discussing short-term versus long-term corticoid steroid therapy to nursing students. What would be the most appropriate teaching for a client on long-term corticoid therapy? a. Taper doses when discontinuing drug. i. 3. Gives the adrenal gland a chance to recover and produce adrenocorticoids. A nurse should monitor a client taking short-term high-dose methylprednisolone (Medrol) for signs and symptoms of Cushing’s syndrome that include what signs or symptoms? (SATA) a. Buffalo hump b. Moon Face c. Osteoporosis i. Signs and symptoms of Cushing’s syndrome: buffalo hump, moon face, oily acne, osteoporosis, purple striae on abdomen and hips, altered skin pigmentation and weight gain. 4. A nurse is providing discharge instructions to a client who will be taking fludrocortisone at home. The nurse will encourage the client to eat a diet that is: a. Low in sodium, high in potassium. i. Low sodium, high potassium, rich in protein. Long-term fludrocortisone therapy promotes the deposition of liver glycogen and induces a negative nitrogen balance. 5. Based on the metabolic action of glucocorticoids, a client who is on long-term glucocorticoid therapy is at risk of developing what disease? a. Osteoporosis i. 6. Due to the reduction in new bone synthesis. The nurse is caring for an 84yo client with diabetes who is receiving hydrocortisone daily PO for treatment of arthritic flare-up. When writing a plan of care for this client, which nursing intervention would be most appropriate? a. Monitoring blood glucose levels frequently. i. 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 or aggravation of preexisting diabetes. 7. 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? a. What herbal therapy are you taking? i. Certain herbs, such as Echinacea interact with hydrocortisone, which can increase the drugs effects. Echinacea is commonly taken to decrease effects of cold and flu. 8. Mineralocorticoids directly affect: 9. A client learning to self-administer desmopressin subQ should be taught to administer the a. Electrolyte levels injection at which site? a. Abdomen 10. A 45yo woman has been taking a corticosteroid and calls the clinic reporting the development of acne-like lesion on her face as well as facial hair. What is the nurse’s best response? a. Sadly, this is an adverse effect seen in women. It should improve when you finish the medication. 11. A child is to receive a topical corticosteroid agent. Which statement by the parents indicates need for additional teaching? a. We need to cover the area snugly with plastic wrap to prevent scratching. i. Covering the area increases the risk for systemic absorption of the drug and should be avoided. 12. 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? a. Supervising and monitoring the administration of the drug. i. Because of potentially serious adverse effects, especially with oral drugs, it is extremely important the corticosteroids be used as prescribed. A major responsibility of home care nurses is to demonstrate, supervise, monitor, or do whatever is needed to facilitate correct use. 13. A nurse taking a medical history on a client prescribed a corticosteroid medication should focus on which condition? a. Infection. i. Corticosteroids are contraindicated in systemic fungal infections, clients who are hypersensitive to drug formulations, clients at risk for infections and clients with infections, diabetes, peptic ulcer disease, Inflammatory bowel disorders, HTN, CHF, and renal insufficiency. 14. A client being treated with oral prednisone is also prescribed furosemide. The nurse should prioritize assessment of what lab value? a. Potassium. i. The combination constitutes a risk for hypokalemia. 15. 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 need for further clarification? a. The drug will eradicate my tumor and cure my cancer. i. The drug is administered for inoperable tumors and does not cure the cancer. It helps to shrink the tumor and decrease the production of cortisol. 1. This drug causes CNS depression, taking with alcohol would increase its effects and could cause serious problems with lethargy, dizziness, and gait disturbances. The client should not drive or operate machinery d/t depression of CNS. If the client has a traumatic injury or goes into shock, the drug should temporarily be stopped so the client may receive steroid therapy. 16. A client who has been prescribed hydrocortisone states, “I know quire a few different people who have had unpleasant adverse effects from steroids.” How should the nurse best respond to the client’s concern? a. Your health care team will monitor you thoroughly for indications of adverse reactions. i. Hydrocortisone has significant adverse effects impacting a wide range of body systems. Effective health care team acknowledges and treats these potential risks. 17. A nurse 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? a. I recently lost my health care coverage and need to look for another job. i. Dosage must be increased during periods of stress or illness. 18. Which statement is included in the care plan of a client prescribed etomidate for Cushing’s disease? a. It blocks the production of cortisol. i. Etomidate blocks production of cortisol and is used for ectopic secretion of ACTH in Cushing’s. 19. A child diagnosed with adrenal insufficiency takes PO hydrocortisone daily. The client is followed regularly by a nurse who assesses the child every 3 months. What assessment data should the nurse prioritize during these assessments? a. Height and weight. i. Long term hydrocortisone use can significantly impair growth and development in pediatric clients. 20. The health care provider has prescribed alternate-day therapy (ADT) for a client who is receiving corticosteroid. When reinforcing teaching with the client, the nurse will explain that the goal of ADT is to minimize what process related to corticosteroid use? a. Suppression of normal adrenal function. i. Alternate-day therapy involves taking a double dose every other morning. This allows rest periods so that suppression of the hypothalamic-pituitary-adrenal axis is minimized while anti-inflammatory effects continue. 21. A nurse tells a patient to take a prescribed glucocorticoid in the morning based on the understanding that: a. This time mimics the normal peak diurnal concentration levels. 22. A female client has been taking prednisone for her asthma for 1 month. The nurse will gradually decrease her dose of prednisone to avoid: a. Adrenal insufficiency. i. The client may develop adrenal insufficiency (Addisonian crisis), which is characterized by glucocorticoid insufficiency without mineralocorticoid insufficiency. 23. A female client is admitted to the hospital with hypoglycemia, nausea, muscle weakness and depression. What is the most likely cause? a. Addison Disease i. Addison disease characteristics include those related to glucocorticoid deficiency: hypoglycemia, anorexia, nausea, vomiting, flatulence, diarrhea, hyperpigmentation, anxiety, depression, and loss of mental acuity. Also, symptoms related to mineralocorticoid deficiency: F&E imbalance, orthostatic hypotension, hyponatremia, hyperkalemia, general malaise, muscle weakness, muscle pain, and cardiac arrhythmias. 24. The nurse is administering hydrocortisone cypionate (Cortef) to an elderly patient. Which assessment finding requires immediate action? a. The patients blood pressure has decreased to 90/50 from 130/90 mmHg. i. The patient may be experiencing shock, which is a potential adverse effect from hydrocortisone. This would be the priority finding. 25. The nurse is caring for a patient who has been prescribed fludrocortisone and furosemide. Which assessment is essential to monitor for potential complications with this patient? a. Electrolytes i. Loop diuretics can enhance the hypokalemic effect of fludrocortisone. 26. Which assessment finding indicates to the nurse that ketoconazole (Nizoral therapy is effective? a. The patient has a decreased BGL. i. This medication decreases the conversion of 11-deoxycortisol to cortisol. Once cortisol level is decreased, the patient should have lowered blood glucose levels. 27. A nurse is assessing a patient with Addison disease and finds the patient to have poor skin turgor and a weight loss of 5 pounds in the last 2 weeks. What is the primary action of the nurse? a. Discuss the patient’s medication therapy with the health care provider. i. The patient may need adjustment to his or her medication b/c it may not be effective to treat the disease. 28. Which endocrine gland produces corticosteroids? a. Adrenal 29. A hospitalized client’s serum glucose level is 160mg/dL. Which hormone is most likely being secreted and leading to this elevated lab value? a. Glucocorticoid. i. During times of stress, glucocorticoid levels rise, elevating glucose levels. 30. A female client is diagnosed with adrenal insufficiency. She presents to the emergency department with hypotension. What would the nurse expect her to be prescribed? a. Corticosteroids. i. In adrenal insufficiency, hypotension is a common symptom in critically ill clients, and hypotension caused by adrenal insufficiency may mimic either hypovolemic or septic shock. 31. The nurse just completed client education relative to chronic adrenocortical insufficiency and corticosteroid medication treatment. Which statement indicates the client requires further instruction? a. I will start this medication as soon as I am feeling ill or tired. i. Daily administration is required in cases of chronic adrenocortical insufficiency. 32. The results of a client’s plasma corticotropin (ACTH) stimulation test has confirmed a diagnosis of Addison disease. The nurse has consequently provided health education around the necessary for 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? a. To manage this condition, you will need to take these for the rest of your life. i. Lifetime hormone replacement is necessary in persons with Addison disease. 33. 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 Disease? a. Serum Sodium 128 mEq/L i. Hyponatremia is a characteristic of adrenal insufficiency. 1. Potassium levels are typically elevated greater than approximately 5.0-5.5 in adults. Hypoglycemia is also common. 34. The nurse is planning care for a client who has been prescribed long-term therapy for Addison disease. The nurse should address what nursing diagnosis that results form the client’s increased risk? a. Risk for infection related to medication therapy. i. Long term use of corticosteroids can result in immunosuppression. 35. A nurse is caring for a client with Addison disease who is receiving fludrocortisone with hydrocortisone. Which statements should be included when teaching appropriate medication administration? (SATA) a. Take both medications by 0900 b. Measure your weight daily, and report a 5-pound weight gain in one week c. Keep all laboratory and provider appointments. i. The nurse should teach the client to assess for therapeutic and adverse effects of the medication. 36. A client newly diagnosed with Cushing’s disease asks how ketoconazole works. What is the nurses best response? a. It controls cortisol secretions. i. Ketoconazole inhibits the first step in cortisol biosynthesis and the conversion of deoxycortisol to cortisol. 37. A client prescribed alternate-day administration of corticosteroids asks the nurse why the drug isn’t administered every day. How would the nurse describe the benefit of alternate-day therapy? a. It minimizes suppression of adrenal function. i. High doses of corticosteroids can suppress the hypothalamic-pituitary-adrenal (HPA) axis resulting in decreased production of endogenous corticosteroids. 38. 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? a. Weight gain i. Clients taking fludrocortisone should be taught to monitor weigh, BP and muscle weakness. 39. Which laboratory value monitored in a patient receiving fludrocortisone acetate requires immediate action by the nurse? a. Sodium 150 mEq/L i. Patients receiving fludrocortisone acetate should have an increased sodium. However, 150 is an elevated level which may lead to complications. 40. All corticosteroids are derived from cholesterol and are released directly into the bloodstream. What is a hematological adverse effect from the use of corticosteroids? a. Increased serum cholesterol i. Hematological effects include sodium and fluid retention, hypokalemia, hypocalcemia, increased blood sugar, increased serum cholestereol and decreased thyroid hormone. 41. 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 lcient’s care? a. Fluid volume excess i. Treatment with glucocorticoids such as prednisone is associated with numerous adverse effects including risk for fluid volume excess 42. What dietary intervention will best help the patient being treated for Cushing’s disease? a. Maintain an American Diabetic Association diet. i. A patient with Cushing’s disease has weight gain and hyperglycemia. Sticking to the ADA diet will help the patient maintain a restricted calorie diet while being treated for the disease. 43. A female client asks the nurse why her 4yo son is not receiving corticosteroids. The client read in an article that they are more effective to prevent transplant rejection than the medication he is currently prescribed. What is the appropriate response by the nurse? a. Corticosteroids impair growth in children. i. Some transplantation centers avoid prednisone therapy until a rejection episode occurs. 44. The nurse has performed a general assessment of a hospitalized client who has been prescribed fludrocortisone, including auscultation of the client’s apical heart rate. How should the nurse best follow up assessment of an audible S3? a. Contact the HCP promptly i. S3 is suggestive of heart failure and warrants prompt medical attention.