Question 1

A child is to begin long-term glucocorticoid therapy. The parents ask the nurse about the effects of this drug on the child's growth. Which response by the nurse is correct?&#10;A) &#34;A smaller dose may be indicated for your child.&#34;&#10;B) &#34;Ask your provider about every other day dosing.&#34;&#10;C) &#34;Long-acting glucocorticoid preparations should prevent growth suppression.&#34;&#10;D) &#34;Oral glucocorticoids rarely cause growth suppression.&#34;

Accepted Answer

Growth retardation can be minimized with alternate day dosing of glucocorticoids. Giving smaller doses does not prevent this effect with long-term therapy. Long-acting glucocorticoids do not prevent this effect. Oral glucocorticoids have the same side effects.

Question 2

A patient who is a long-distance runner has been diagnosed with rheumatoid arthritis in both knees and will begin glucocorticoid therapy. When teaching the patient about the medication, the nurse will include what information?

A) "By reducing inflammation, this drug will slow the progression of your disease."
B) "Glucocorticoids are used as adjunctive therapy during acute flare-ups."
C) "Oral glucocorticoids cause less toxicity than intra-articular injections."
D) "You may resume running when the pain and swelling improve."

"Glucocorticoids are used as adjunctive therapy during acute flare-ups."

Accepted Answer

Glucocorticoids are used as adjunctive therapy to treat acute exacerbations of rheumatoid arthritis. Glucocorticoids reduce pain and inflammation but do not alter the course of the disease. Oral glucocorticoids produce side effects similar to those of all glucocorticoids, but they are absorbed more rapidly and completely than intra-articular injections. Patients should be warned against overactivity even though their pain has been reduced, because they can further injure their joints.

Question 3

Which disorders may be treated with glucocorticoids? (Select all that apply.)&#10;A) Allergic rhinitis&#10;B) Anaphylaxis&#10;C) Bronchiolitis&#10;D) Gout&#10;E) Ulcerative colitis

Accepted Answer

Glucocorticoids are used topically for allergic rhinitis and are given systemically for gout and ulcerative colitis. They are not useful in anaphylactic reactions, for which epinephrine is the drug of choice, or in bronchiolitis, which generally is induced by a virus, not by an immune response.

Question 4

A patient is about to receive prednisone for tendonitis. The nurse reviewing the chart would be concerned about which of the following in the patient's medical history?&#10;A) Asthma and allergic rhinitis&#10;B) Gouty arthritis&#10;C) Seborrheic dermatitis&#10;D) Systemic fungal infection

Accepted Answer

Glucocorticoids are contraindicated in patients with a history of systemic fungal infections. Glucocorticoids are used to treat asthma, allergic rhinitis, gout, and seborrheic dermatitis.

Question 5

A nurse is discussing glucocorticoids with a group of nursing students. Which statement by a student indicates understanding of the teaching?&#10;A) &#34;Glucocorticoids have both endocrine and nonendocrine uses.&#34;&#10;B) &#34;Patients treated for adrenocortical insufficiency receive pharmacologic doses.&#34;&#10;C) &#34;Pharmacologic effects are achieved with low doses of glucocorticoids.&#34;&#10;D) &#34;Physiologic doses are used to treat inflammatory disorders.&#34;

Accepted Answer

Glucocorticoids have applications for both endocrine and nonendocrine disorders. Adrenocortical insufficiency requires physiologic, or low-dose, treatment. Pharmacologic doses are used when large doses are required, such as to suppress inflammation. Physiologic doses are used to treat endocrine disorders.

Question 6

A clinic patient who has been taking a glucocorticoid for arthritis for several months remarks to the nurse, "It's a good thing my symptoms are better, because my mother has been quite ill, and I have to take care of her." The patient's blood pressure is 100/60 mm Hg. The nurse will report this to the provider and ask about:

A) reducing the patient's dose.
B) using every other day dosing.
C) increasing the patient's dose.
D) tapering the dose.

Accepted Answer

Because of their adrenal suppression, patients taking glucocorticoids long term require increased doses at times of stress and even for a time after stopping the drug until adrenal function returns. This patient's lower blood pressure is an indication that glucocorticoid levels may be depleted. Reducing the dose would only exacerbate the patient's problems. Every other day dosing is used early in glucocorticoid therapy to reduce adrenal suppression, but it would not be useful now. Tapering of doses is used to allow adrenal function to recover as the drug is discontinued.

Question 7

A 60-year-old female patient is about to begin long-term therapy with a glucocorticoid. Which of the following will be important for minimizing the risk of osteoporosis?&#10;A) Baseline vitamin D level&#10;B) Calcium and vitamin D supplements&#10;C) Estrogen therapy&#10;D) Skeletal x-rays before treatment

Accepted Answer

Calcium and vitamin D supplements can help minimize the patient's risk of developing osteoporosis. A baseline vitamin D level is not recommended. Estrogen therapy can help in postmenopausal women, but its risks outweigh its benefits. Patients should undergo evaluation of the bone mineral density of the lower spine, not skeletal x-rays.

Question 8

A nurse tells a nursing student that the glucocorticoids given for rheumatoid arthritis are nearly identical to substances produced naturally by the body. The student remarks that the drug must be very safe. Which response by the nurse is correct?

A) "As long as the drug is taken as prescribed, side effects usually do not occur."
B) "By interrupting the inflammatory process, these drugs inhibit side effects."
C) "Side effects can occur and are dependent on the dose and duration of treatment."
D) "The negative feedback loop prevents side effects."

Accepted Answer

When taken in pharmacologic doses, as for inflammatory disorders, glucocorticoids can cause an array of serious adverse effects. When glucocorticoids are given in pharmacologic doses, side effects can occur even when the drugs are taken as prescribed. Interruption of the inflammatory process causes some of the adverse effects. The negative feedback loop does not inhibit side effects.

Question 9

A nurse is teaching a patient who has taken glucocorticoids for over a year about glucocorticoid withdrawal. Which statement by the patient indicates a need for further teaching?&#10;A) &#34;I should reduce the dose by half each day until I stop taking the drug.&#34;&#10;B) &#34;I will need to have cortisol levels monitored during the withdrawal process.&#34;&#10;C) &#34;The withdrawal schedule may take several months.&#34;&#10;D) &#34;If I have surgery, I may need to take the drug for a while, even after I have stopped.&#34;

Accepted Answer

Glucocorticoid therapy can suppress adrenal function, so withdrawal should be done slowly to allow recovery of adrenal function. Reducing the dose of a glucocorticoid by half each day is not recommended. Patients should have their cortisol levels monitored to determine when therapy can be stopped. The withdrawal schedule may take several months. Patients who have stopped the drug may still experience adrenal insufficiency in times of physiologic stress, such as surgery.

Question 10

A patient taking high doses of a glucocorticoid develops weakness in the muscles of the upper arms and in the legs. What will the nurse do?&#10;A) Contact the provider to ask about reducing the dose.&#10;B) Encourage the patient to restrict sodium intake.&#10;C) Reassure the patient that this is an expected side effect.&#10;D) Tell the patient to stop taking the drug.

Accepted Answer

High-dose glucocorticoid therapy can cause myopathy, manifesting as weakness. If muscle weakness occurs, the dose should be reduced. Reducing the sodium intake is recommended to minimize sodium and water retention. Muscle weakness is not an expected side effect, because it indicates myopathy. It is incorrect to tell the patient to stop taking the drug, because a glucocorticoid must be withdrawn slowly to allow time for recovery of adrenal function.

Question 11

A nurse is teaching a group of nursing students why glucocorticoids are preferred over nonsteroidal anti-inflammatory drugs in the treatment of inflammation. Which statement by a student indicates a need for further teaching?

A) "Glucocorticoids act by multiple mechanisms and have more anti-inflammatory effects than NSAIDs."
B) "Glucocorticoids have fewer side effects than nonsteroidal anti-inflammatory drugs."
C) "Glucocorticoids help avert damage to tissues from lysosomal enzymes."
D) "Glucocorticoids reduce the immune component of inflammation."

Accepted Answer

The answer of A nurse is teaching a group of...

Question 12

The prescriber orders 20 mg of hydrocortisone orally once each day. The nurse will make sure the drug is scheduled to be administered at what time?&#10;A) 8:00 AM&#10;B) 12:00 PM&#10;C) 4:00 PM&#10;D) 9:00 PM

Accepted Answer

The answer of The prescriber orders 20 mg of hydrocortisone...

Question 13

A patient who has been taking a glucocorticoid for several months arrives in the clinic. The nurse notes that the patient's cheeks appear full and that a prominent hump of fat is present on the upper back. The nurse will ask the provider to order which test(s)?

A) Liver function tests
B) Serum electrolytes
C) Tuberculin skin test
D) Vitamin D levels

Accepted Answer

The answer of A patient who has been taking a...

Question 14

A patient taking a glucocorticoid for arthritis reports feeling bloated. The nurse notes edema of the patient's hands and feet. Which action by the nurse is correct?&#10;A) Ask the patient about sodium intake.&#10;B) Obtain a blood glucose level.&#10;C) Suggest the patient limit potassium intake.&#10;D) Tell the patient to stop taking the drug.

Accepted Answer

The answer of A patient taking a glucocorticoid for arthritis...

Deck 72: Glucocorticoids in Nonendocrine Disorders