Question 1

The nurse is caring for a client taking corticosteroids for immune suppression.Which laboratory value indicates the medication treatment is successful?

Accepted Answer

Corticosteroids suppress the immune system, which would lead to decreased numbers of lymphocytes, eosinophils, and monocytes, indicating successful treatment.

Question 2

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:

Accepted Answer

Prednisone is a corticosteroid that can cause hyperglycemia (elevated blood sugar) in people with diabetes. It is important for the client to monitor their blood sugar closely and adjust their medication as needed with guidance from their healthcare provider.

Question 3

For which purpose is cosyntropin (Cortrosyn)used?

Accepted Answer

Cosyntropin (Cortrosyn) is primarily used to assist in the diagnosis of adrenocortical insufficiency, also known as Addison's disease. It is a synthetic version of adrenocorticotropic hormone (ACTH) that stimulates the production of cortisol from the adrenal gland. If cortisol levels do not increase appropriately after injection with cosyntropin, it may indicate adrenocortical insufficiency.

Question 4

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?

Accepted Answer

Fludrocortisone is a medication used to treat adrenocortical insufficiency. The fact that this medication is documented in the client's record suggests that they have a history of adrenocortical insufficiency, which can be exacerbated by the use of corticosteroids. Isosorbide and metformin, while commonly used medications, do not have a direct relationship to adrenocortical insufficiency. Likewise, ciprofloxacin is an antibiotic that is not related to adrenal function.

Question 5

A client has an ACTH-secreting tumor.The nurse understands that which assessment findings would be consistent with this type of tumor?

Accepted Answer

ACTH-secreting tumors can cause increased levels of cortisol, leading to weight gain and muscle atrophy. Clubbing of the fingers and cyanosis are consistent with respiratory or cardiovascular disorders. Tachycardia and tremors are more commonly associated with hyperthyroidism. Exophthalmos and hot skin are more common with hyperthyroidism or Graves' disease.

Question 6

A pregnant client asks why a steroid medication cannot be used for an allergic skin disorder.The nurse's most accurate response is:

Accepted Answer

Steroids have the potential to cross the placenta and may harm the developing fetus. Therefore, they should be avoided during pregnancy unless the potential benefits outweigh the potential risks.

Question 7

A client with adrenocortical insufficiency has been taking corticosteroids for 9 months.What symptom should be reported to the health care provider immediately?

Accepted Answer

Frequent palpitations could be a sign of adrenal crisis, a life-threatening complication of adrenocortical insufficiency that requires immediate medical attention. Headaches, nasal congestion, and fatigue may be common side effects of corticosteroid use and should be monitored but do not require immediate medical attention.

Question 8

A client with a history of adrenocortical insufficiency is experiencing nausea,vomiting,hypotension,and seizures.The nurse suspects the client discontinued which medication?

Accepted Answer

Adrenocortical insufficiency requires replacement of cortisol, which is provided by hydrocortisone. Discontinuation of hydrocortisone can lead to severe symptoms such as nausea, vomiting, hypotension, and seizures. Fluticasone propionate (Flonase) is a nasal corticosteroid used to treat allergies and asthma, Cosyntropin (Cortrosyn) is a medication used to diagnose adrenocortical insufficiency, and Methadone is an opioid used to treat pain and withdrawal symptoms in opioid addiction.

Question 9

A client taking long-term corticosteroid therapy should be instructed to contact the health care provider before:

Accepted Answer

Long-term corticosteroid therapy can suppress the immune system, decreasing the effectiveness of live vaccines. Therefore, patients should contact their healthcare provider before receiving live vaccines.

Question 10

A client with an adrenal tumor experiences frequent infections.The nurse understands that the frequent infections are secondary to:

Accepted Answer

Adrenal tumors can lead to excessive production of cortisol, which can suppress the immune response and increase the risk of infections. Option A (decreased blood glucose) is not directly related to adrenal tumors, while options B (lipolysis) and C (bone demineralization) are more commonly associated with hyperparathyroidism and hyperthyroidism, respectively.

Question 11

The nurse is administering cortisol to a client.This intervention should result in:

Accepted Answer

Cortisol is a glucocorticoid hormone that is produced and secreted by the adrenal cortex in response to stress. It acts to inhibit the secretion of corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH) from the hypothalamus and pituitary gland, respectively. Therefore, administering cortisol would result in decreased secretion from the pituitary gland.

Question 12

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:

Accepted Answer

The adrenal gland produces two types of steroid hormones - mineralocorticoids and glucocorticoids. Mineralocorticoids are responsible for regulating blood pressure and electrolyte balance, and the hormone aldosterone is an example of a mineralocorticoid. Therefore, with one adrenal gland removed, the body may not produce enough mineralocorticoids to regulate blood pressure adequately. Medication can be given to raise the blood pressure and mimic the effects of mineralocorticoids.

Question 13

A client in anaphylactic shock receives a dose of hydrocortisone (Solu-Cortef).The nurse recognizes that the desired action of this medication is to:

Accepted Answer

Hydrocortisone is a corticosteroid medication that works by inhibiting the body's inflammatory response. In anaphylactic shock, the body's immune response is overactive, resulting in the release of inflammatory mediators that can cause anaphylaxis. Administering hydrocortisone helps to reduce inflammation and prevent further complications from anaphylaxis.

Question 14

A client receives cosyntropin (Cortrosyn).The nurse knows that if plasma cortisol levels fail to rise after an injection of cosyntropin,the pathology is:

Accepted Answer

Cosyntropin (Cortrosyn) is a synthetic form of adrenocorticotropic hormone (ACTH) used in the ACTH stimulation test to assess adrenal function. If plasma cortisol levels do not rise after an injection of cosyntropin, it indicates a problem at the level of the adrenal gland itself, which is primary adrenocortical insufficiency (Addison's disease). This is because cosyntropin directly stimulates the adrenal gland to produce cortisol, and a lack of response suggests the adrenal gland is not functioning properly.

Question 15

A client is taking long-term corticosteroid therapy for adrenal insufficiency.Which medication would be recommended for the relief of minor aches and pains?

Accepted Answer

Acetaminophen (Tylenol) is the preferred choice for pain relief in patients taking corticosteroids as it is safe for them to use and does not interact with the medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin can increase the risk of gastrointestinal bleeding and can also worsen hypertension and fluid retention, which can be a concern in patients on long-term corticosteroid therapy. Ketorolac (Toradol) is also an NSAID and should be avoided in this patient population.

Question 16

Which diagnostic test is the most helpful in distinguishing primary from secondary adrenocortical insufficiency?

Accepted Answer

The Cosyntropin (Cortrosyn) stimulation test is the most helpful in distinguishing primary from secondary adrenocortical insufficiency. This test involves injecting synthetic adrenocorticotropic hormone (ACTH) and then measuring serum cortisol levels. In primary insufficiency, cortisol levels will not increase significantly in response to the ACTH injection, while in secondary insufficiency, cortisol levels should increase. MRI and CT scans may be helpful in identifying structural abnormalities in the adrenal gland, but they cannot differentiate primary from secondary insufficiency. Dexamethasone suppression tests may also be used to diagnose insufficiency, but they are not as specific as the Cosyntropin stimulation test.

Question 17

A client is diagnosed with chronic adrenocortical insufficiency.What would be the best route for medication replacement therapy for this client?

Accepted Answer

Oral medication replacement therapy, such as hydrocortisone or prednisone, is the preferred route of administration for chronic adrenocortical insufficiency. The medication can be taken orally in the form of tablets or capsules, and can be easily managed at home by the client. Intravenous or intramuscular replacement therapy may be used in acute situations, but not for long-term management. Rectal administration is not typically used for adrenal insufficiency medication replacement therapy.

Question 18

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?

Accepted Answer

Adrenocorticotropic hormone (ACTH) is not secreted from the adrenal gland. It is actually released from the pituitary gland and stimulates the secretion of cortisol from the adrenal cortex. The other hormone choices listed (mineralocorticoids, corticosteroids, and glucocorticoids) are all secreted from the adrenal gland.

Question 19

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?

Accepted Answer

The hypothalamus plays a crucial role in regulating the production and release of hormones through signals to the pituitary gland. Corticotropin-releasing factor is produced by the hypothalamus and stimulates the pituitary gland to release adrenocorticotropic hormone (ACTH), which then triggers the release of cortisol from the adrenal glands. Thus, with trauma to the hypothalamus, the regulation of cortisol production and release may be disrupted, leading to an imbalance in the body's stress response.

Question 20

A client with dementia and severe pruritis is receiving intravenous steroids and is constantly scratching the skin.What intervention is best for the client at this time?

Accepted Answer

The application of hand mitts will prevent the client from scratching and causing further damage to the skin. The use of physical restraints or upraised side rails is not in line with ethical principles of promoting client autonomy and should only be used as a last resort in cases of extreme danger to the client or others. A falls risk bracelet is not relevant to the client's current condition.

Quiz 68: Corticosteroids and Drugs Affecting the Adrenal Cortex