Deck 69: Corticosteroids and Drugs Affecting the Adrenal Cortex

Question 1

A patient arrives at the Emergency Department in anaphylactic shock.As part of the treatment plan, the physician orders intravenous solumedrol.The nurse is aware that the desired action of the solumedrol is to:
1)Inhibit the inflammatory process.
2)Stimulate the sympathetic nervous system.
3)Raise circulating glucose levels.
4)Raise serum oncotic pressure.

Answer 1

1

Question 2

Which of the following agents will be most helpful in distinguishing primary versus secondary adrenocortical insufficiency?
1)Magnetic resonance imaging (MRI)
2)A positron emission tomography (PET)scan
3)A computed tomography (CT)scan
4)cosyntropin (Cortrosyn)

Answer 2

4

Question 3

A patient is taking long-term corticosteroid therapy for adrenal insufficiency.Which medication does the nurse recommend the patient take for the relief of minor aches and pains?
1)Acetaminophen (Tylenol)
2)Ibuprofen (Motrin)
3)Aspirin (Bayer)
4)Ketorolac (Toradol)

Answer 3

1

Question 4

A patient with adrenocortical insufficiency has been taking corticosteroids for nine months.Which of the following should be reported to the health care provider immediately?
1)Frequent palpitations
2)Fatigue
3)Nasal congestion
4)Headache

Question 5

A nurse is ordered to administer cortisol to a patient.The outcome of this intervention should result in:
1)Increased secretion from the pituitary.
2)Decreased secretion from the pituitary.
3)Increased secretion from the hypothalamus.
4)Decreased level of consciousness.

Question 6

During patient testing, a nurse administers cosyntropin (Cortrosyn)to a patient.If plasma cortisol levels fail to rise after an injection of cosyntropin, the pathology is:
1)At the level of the pituitary or hypothalamus (secondary adrenocortical insufficiency).
2)Caused by cosyntropin (Cortrosyn).
3)Idiopathic in nature.
4)At the level of the adrenal gland (primary adrenocortical insufficiency).

Question 7

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

Question 8

A patient had one adrenal gland removed.The nurse anticipates administration of medication to raise blood pressure, which will most closely mimic the effects of:
1)Glucocorticoids.
2)Mineralocorticoids.
3)Gonadocorticoids.
4)Cortisone.

Question 9

A patient is diagnosed with adrenocortical insufficiency.Which of the following will be the best route of administration of replacement therapy for this patient?
1)Intravenous
2)Oral
3)Intramuscular
4)Rectal

Question 10

A patient with an allergic skin disorder becomes pregnant, and asks why she can't be placed on a steroid taper like she usually is.The nurse's best response is:
1)"The cause of your skin disorder is directly linked to your pregnancy.After you deliver, your skin should get better."
2)"Steroids will likely cause you to have an abortion; you'll have to put up with your skin disorder for about ten months."
3)"Steroids can cause liver failure, and are not recommended at this time."
4)"Steroids have the potential to cross the placenta, and should be avoided during pregnancy."

Question 11

A diabetic patient is being placed on a prednisone taper for an acute asthma exacerbation.The patient asks if this medication will affect his blood sugar.The nurse's best response is:
1)"Your blood sugar will be unaffected."
2)"Your blood sugar might drop unexpectedly."
3)"Your blood sugar might be elevated."
4)"Would you like to speak to the physician about this?"

Question 12

Which of the following is not secreted from the adrenal gland?
1)Glucocorticoids
2)Adrenocorticotropic hormone (ACTH)
3)Corticosteroids
4)Mineralocorticoids

Question 13

A patient taking long-term corticosteroid therapy is starting a new job.The occupational nurse recommends that the patient speak to her primary health care provider prior to:
1)Providing a urine specimen.
2)Receiving live vaccines.
3)Providing a blood specimen.
4)Taking an eye exam.

Question 14

A nurse is ordered to pick up cosyntropin (Cortrosyn)from the pharmacy.The nurse will administer this drug to:
1)Assist in the diagnosis of adrenocortical insufficiency.
2)Treat primary adrenocortical insufficiency.
3)Alleviate dermatological pruritis.
4)Treat secondary adrenocortical insufficiency.

Question 15

A nurse is caring for a client who suffered a traumatic head injury.On report, the nurse was informed that there was trauma to the patient's hypothalamus.The nurse identifies that which endocrine regulatory factor will be most affected?
1)Factor VIII
2)Von Willebrand's factor
3)Colony-stimulating factor
4)Corticotropin-releasing factor

Question 16

A nurse is caring for a patient taking corticosteroids for immune suppression.Which of the following lab values would indicate the medication treatment is successful?
1)Increased numbers of lymphocytes, eosinophils, and monocytes
2)Increased lymphocytes and decreased monocytes
3)Decreased numbers of lymphocytes, eosinophils, and monocytes
4)Increased monocytes and decreased lymphocytes

Question 17

A nurse is reviewing a patient's records, and notes that the patient is taking corticosteroids.The nurse suspects that the patient has a history of adrenocortical insufficiency when the use of which other medication is documented on the record?
1)Metformin
2)Ciprofloxacin
3)Isosorbide
4)Florinef

Question 18

A patient is admitted to your unit with a diagnosis of dementia and severe pruritis.The nurse on the previous shift reports that the patient began intravenous steroids, and is constantly scratching his skin.Which of the following interventions is best for this patient at this time?
1)Application of four-point leather restraints
2)Application of a falls risk bracelet
3)Application of hand mitts
4)Placing four side rails in the up position

Question 19

A patient with a newly diagnosed adrenal adenoma suffers from frequent infections.The nurse understands that the rationale for the frequent infections is secondary to:
1)Suppression of the immune response.
2)Decreased blood glucose.
3)Lipolysis.
4)Bone demineralization.

Question 20

A patient with a history of adrenocortical insufficiency presents to the Emergency Department with nausea, vomiting, hypotension, and seizures.The nurse obtains a history from the patient's husband.The health care team suspects the patient discontinued which medication?
1)Hydrocortisone
2)Corticotropin (Cosyntropin)
3)Fluticasone propionate (Flonase)
4)Methadone

Question 21

Which of the following is an expected assessment finding for a patient recently placed on fludrocortisone (Florinef)?
1)Decrease in weight
2)Increase in height
3)Increase in blood pressure
4)+4 peripheral edema

Question 22

Which of the following vital signs would be associated with a patient requiring mineralocorticoid replacement therapy?
1)Oral temperature of 100.0°F
2)Blood pressure of 78/58
3)Pulse of 48 beats per minute
4)Respiratory rate of 13 breaths per minute

Question 23

A patient has been prescribed hydrocortisone replacement therapy.Which of the following patient education information is incorrect?
1)A slight weight gain could occur.
2)Alcohol and caffeine should be eliminated from the diet.
3)Aspirin should be taken if you develop a fever.
4)Slow wound healing should be reported to the health care provider.

Question 24

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

Question 25

You are caring for a 24-year-old female patient diagnosed with Cushing's disease.Prior to prescribing mifepristone (Mifeprex), which of the following questions should be asked?
1)"What is your height and weight?"
2)"When was your last menstrual period?"
3)"Are you allergic to shellfish?"
4)"Do you have a family history of cancer?"

Question 26

A nurse is planning care for a patient taking long-term hydrocortisone replacement therapy.Which of the following findings is indicative of a masked infection?
1)A low-grade oral temperature
2)Deformity of the left upper extremity
3)Purulent drainage from a puncture wound
4)A complaint of hiccups

Question 27

Which of the following patients should not receive mineralocorticoid replacement therapy?
1)A patient with a defect in the stimulation of aldosterone secretion
2)A patient with Conn's syndrome
3)A patient with a defect in the secretion of aldosterone
4)A patient with a defect in aldosterone sensitivity

Question 28

Describe the rationale for the use of mineralocorticoid replacement therapy for a patient with Addison's disease.
1)Mineralocorticoids will reduce harmful bronzing of the skin.
2)Mineralocorticoids will mimic the action of cortisol, which this patient will be lacking.
3)Mineralocorticoids will mimic the action of aldosterone, which this patient will be lacking.
4)Mineralocorticoids will reduce excessive serum glucose levels.

Question 29

A nurse is caring for a patient admitted to rule out Cushing's disease.Identify which of the following agents is used for diagnostic purposes:
1)Metyrapone (Metopirone)
2)Ketoconazole (Nizoral)
3)Mifepristone (Mifeprex)
4)Acetylcysteine (Mucamyst)

Question 30

The treatment of choice for a patient with Addison's disease is:
1)Fludrocortisone (Florinef).
2)Hydrocortisone.
3)Ketoconazole (Nizoral).
4)Cosyntropin (Cortrosyn).

Question 31

A nurse is planning care for a diabetic patient who is about to begin taking lifelong therapy for adrenal insufficiency.Which of the following advice should not be given to this patient?
1)Always wear socks with shoes.
2)Cut your toenails straight across.
3)Call your health care provider if your get injured, or are sick.
4)Keep a diary of your blood glucose measurements.

Question 32

A patient diagnosed with Cushing's syndrome is ordered to take ketoconazole (Nizoral).The patient asks why she is being prescribed an antifungal drug.The nurse's best response is:
1)"Although this is an antifungal drug, the drug also blocks the formation of glucocorticoids, lowering their level in your blood."
2)"You are at a great risk for fungal infections at this time."
3)"Cushing's syndrome is caused by a fungal infection of the adrenal glands, and the medication will reverse the disease process."
4)"You were given some false information about this medication.Tell me who told you this."

Question 33

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

Question 34

Identify the rationale for administering corticosteroids to a patient for transplant rejection prophylaxis.
1)To promote graft-versus-host disease
2)To prevent the patient's immune system from rejecting the implant
3)To provide prophylaxis against opportunistic infection
4)To enhance perfusion through the transplanted organ

Question 35

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

Question 36

A nurse is performing patient teaching regarding the initiation of fludrocortisone (Florinef).The nurse determines that more education is required when the patient states:
1)"This drug will drop my blood pressure, so I'll go from sitting to standing slowly."
2)"This drug could lower my potassium, so I'll eat foods rich in potassium."
3)"If I develop muscle cramps, I will call the office right away."
4)"If I notice a lot of swelling in my legs, I'll call the office right away."

Question 37

A nurse would question an order for corticosteroids in a patient diagnosed with which of the following?
1)Inflammatory bowel disease
2)Asthma
3)Active tuberculosis
4)Allergic rhinitis

Question 38

Mineralocorticoid replacement therapy should be used judiciously in patients with:
1)Heart failure.
2)Hypotension.
3)Addison's disease.
4)Aldosterone insufficiency.

Question 39

A patient receiving lifelong therapy with corticosteroids should immediately report which of the following to the health care provider?
1)Ravenous appetite, insomnia, and weight gain
2)A change in prescription bottles
3)Cravings for sweet or salty foods
4)A change in health insurance plans