Deck 68: Corticosteroids and Drugs Affecting the Adrenal Cortex

Question 1

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

A)Clubbing of the fingers and circumoral cyanosis
B)Extreme tachycardia and tremors
C)Weight gain and muscle atrophy
D)Exophthalmos and skin that is hot to the touch

Answer 1

Weight gain and muscle atrophy

Question 2

For which purpose is cosyntropin (Cortrosyn)used?

A)To treat secondary adrenocortical insufficiency
B)To assist in the diagnosis of adrenocortical insufficiency
C)To treat primary adrenocortical insufficiency
D)To alleviate dermatological pruritus

Answer 2

To assist in the diagnosis of adrenocortical insufficiency

Question 3

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

A)decreased blood glucose.
B)lipolysis.
C)bone demineralization.
D)suppression of the immune response.

Answer 3

suppression of the immune response.

Question 4

A client in anaphylactic shock receives a dose of hydrocortisone (Solu-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.

Question 5

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

A)idiopathic in nature.
B)at the level of the adrenal gland (primary adrenocortical insufficiency).
C)at the level of the hypothalamus.
D)at the level of the pituitary (secondary adrenocortical insufficiency).

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:

A)Steroids have the potential to cross the placenta,and should be avoided during pregnancy."
B)The cause of your skin disorder is directly linked to your pregnancy.After you deliver,your skin should get better."
C)Steroids will likely cause you to have an abortion; you'll have to put up with your skin disorder until after delivery."
D)Steroids can cause liver failure,and are not recommended at this time."

Question 7

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

A)Ibuprofen (Motrin)
B)Ketorolac (Toradol)
C)Acetaminophen (Tylenol)
D)Aspirin (Bayer)

Question 8

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?

A)Colony-stimulating factor
B)Von Willebrand factor
C)Factor VIII
D)Corticotropin-releasing factor

Question 9

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.

Question 10

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

A)Magnetic resonance imaging (MRI)
B)A computed tomography (CT)scan
C)Cosyntropin (Cortrosyn)
D)Dexamethasone (Decadron)

Question 11

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

A)frequent palpitations
B)headache
C)nasal congestion
D)fatigue

Question 12

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?

A)Mineralocorticoids
B)Corticosteroids
C)Adrenocorticotropic hormone (ACTH)
D)Glucocorticoids

Question 13

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:

A)Your blood sugar might drop unexpectedly."
B)Your blood sugar will be unaffected."
C)Your blood sugar might be elevated."
D)Would you like to speak to the health care provider about this?"

Question 14

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?

A)Isosorbide
B)Ciprofloxacin
C)Fludrocortisone
D)Metformin

Question 15

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

A)Intravenous
B)Rectal
C)Oral
D)Intramuscular

Question 16

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

A)Hydrocortisone
B)Fluticasone propionate (Flonase)
C)Cosyntropin (Cortrosyn)
D)Methadone

Question 17

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

A)increased lymphocytes and decreased monocytes
B)increased monocytes and decreased lymphocytes
C)increased numbers of lymphocytes,eosinophils,and monocytes
D)decreased numbers of lymphocytes,eosinophils,and monocytes

Question 18

The nurse is administering cortisol 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.

Question 19

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?

A)Placing four side rails in the up position
B)Application of hand mitts
C)Application of four-point leather restraints
D)Application of a falls risk bracelet

Question 20

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

A)providing a blood specimen.
B)taking an eye exam.
C)receiving live vaccines.
D)providing a urine specimen.

Question 21

The nurse recognizes that mineralocorticoid replacement therapy should be used judiciously in clients with:

A)hypotension.
B)aldosterone insufficiency.
C)heart failure.
D)Addison disease.

Question 22

What is an expected assessment finding in a client recently started on fludrocortisone (Florinef)?

A)+4 peripheral edema
B)Decrease in weight
C)Increase in blood pressure
D)Increase in height

Question 23

Which client statement indicates that instruction about fludrocortisone (Florinef)has been ineffective?

A)If I develop muscle cramps,I will call the office right away."
B)If I notice a lot of swelling in my legs,I'll call the office right away."
C)This drug could lower my potassium,so I'll eat foods rich in potassium."
D)This drug will drop my blood pressure,so I'll go from sitting to standing slowly."

Question 24

How would the nurse explain to a client the rationale for administering corticosteroids after an organ transplant?

A)Corticosteroids prevent the immune system from rejecting the implant.
B)Corticosteroids enhance perfusion through the transplanted organ.
C)Corticosteroids promote graft-versus-host disease.
D)Corticosteroids provide prophylaxis against opportunistic infection.

Question 25

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?

A)Cut your toenails straight across."
B)Avoid wearing socks with shoes."
C)Keep a diary of your blood glucose measurements."
D)Call your health care provider if you are injured or get sick."

Question 26

A client with Cushing syndrome is prescribed ketoconazole (Nizoral).What should the nurse explain as the reason for this medication?

A)This medication will prevent infections."
B)Cushing syndrome is caused by an infection of the adrenal glands,and the medication will reverse the disease process."
C)This drug blocks the formation of glucocorticoids,lowering their level in your blood."
D)This has been prescribed because you have a fungal infection."

Question 27

Which client statement indicates that teaching about hydrocortisone replacement therapy has been ineffective?

A)I should take aspirin if I develop a fever."
B)I should report any wounds that are slow to heal to the health care provider."
C)I might gain a small amount of weight."
D)I should avoid alcohol and caffeine."

Question 28

A client with inflammatory bowel disease is prescribed budesonide (Entocort-EC)and asks why this drug is ordered.The nurse correctly explains:

A)The pharmacist will be making rounds this shift,and will explain the rationale to you at that time."
B)Your health care provider ordered this medication to treat the underlying disease pathology."
C)This is a corticosteroid that is not absorbed and remains in the intestine to treat the inflammation locally,without causing significant systemic effects."
D)This is a systemic corticosteroid that will decrease system wide inflammation."

Question 29

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:

A)remain unchanged.
B)be increased.
C)be decreased.
D)be rapidly withdrawn.

Question 30

The nurse is caring for a client taking long-term hydrocortisone replacement therapy.Which assessment finding indicates a masked infection?

A)A complaint of hiccups
B)Deformity of the left upper extremity
C)Purulent drainage from a puncture wound
D)A low-grade oral temperature

Question 31

A young adult client with Cushing syndrome is prescribed ketoconazole (Nizoral).What should the nurse ask before providing the client with this medication?

A)What is your height and weight?"
B)Are you allergic to shellfish?"
C)Do you have a family history of cancer?"
D)When was your last menstrual period?"

Question 32

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.

A)Have the blood glucose level checked frequently.
B)Avoid crowds and being around others with respiratory infections.
C)Avoid falling or any other type of injury to the bones.
D)Increase the intake of green leafy vegetables.
E)Increase the daily intake of fiber.

Question 33

What should a client receiving lifelong therapy with corticosteroids be instructed to report immediately to the health care provider?

A)A change in prescription bottles
B)A change in health insurance plans
C)Cravings for sweet or salty foods
D)Weight gain of over 2 pounds in one day

Question 34

When caring for a client with Addison disease,the nurse will prepare to administer which medication as the treatment of choice?

A)Ketoconazole (Nizoral)
B)Cosyntropin (Cortrosyn)
C)Hydrocortisone
D)Fludrocortisone (Florinef)

Question 35

Which medication will the nurse administer to a client who is being tested for Cushing syndrome?

A)Metyrapone (Metopirone)
B)Mitotane (Lysodren)
C)Acetylcysteine (Mucamyst)
D)Ketoconazole (Nizoral)

Question 36

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:

A)Visitors are not required to wash their hands when they enter the room."
B)The germs of the client put all visitors at risk for infection."
C)The client is very sick,and needs rest."
D)The germs of visitors put the client at risk for infection."

Question 37

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.

A)the shutting down of ACTH secretion.
B)the failure of the adrenal cortex to secrete corticosteroids.
C)rebound ACTH secretion.
D)excessive secretion of ACTH.
E)toxic levels of mineralocorticoids.

Question 38

What should the nurse explain to a client with Addison disease as the reason for needing mineralocorticoid replacement therapy?

A)Mineralocorticoids will reduce excessive serum glucose levels.
B)Mineralocorticoids will mimic the action of cortisol.
C)Mineralocorticoids will mimic the action of aldosterone.
D)Mineralocorticoids will reduce harmful bronzing of the skin.

Question 39

The nurse would an order for corticosteroids for a client diagnosed with which health problem?

A)Exposure to active tuberculosis
B)Long-term asthma
C)Inflammatory bowel disease
D)Seasonal allergic rhinitis

Question 40

The nurse would the administration of mineralocorticoid replacement therapy for which client?

A)Client with a defect in the stimulation of aldosterone secretion
B)Client with a defect in aldosterone sensitivity
C)Client with a defect in the secretion of aldosterone
D)Client with Conn syndrome

Question 41

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.

A)Beta blockers
B)NSAIDs
C)Calcium channel blockers
D)Angiotensin-converting enzyme inhibitors
E)Nitrites

Question 42

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.

A)Rheumatoid arthritis
B)Osteoarthritis
C)Osteoporosis
D)Fibromyalgia
E)Myasthenia gravis

Question 43

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.

A)You could develop nausea,vomiting,and other problems if you stop this medication abruptly."
B)Your body will not be able to produce the steroid that you need and you will become very ill."
C)Why do you plan to stop taking the medication?"
D)I'm sure you know what is best for your health."
E)You will feel sick for a short while after stopping the medication,but it will go away."

Question 44

The nurse caring for a client with Cushing syndrome will prepare to administer which medications to this client?
Select all that apply.

A)Tapering doses of prescribed corticosteroid
B)Ketoconazole (Nizoral)
C)Fludrocortisone
D)Spironolactone (Aldactone)
E)Budesonide (Entocort-EC)

Question 45

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.

A)glaucoma.
B)cataracts.
C)detached retina.
D)retinopathy.
E)macular degeneration.

Question 46

Which client statements indicate that teaching about corticosteroid replacement therapy has been effective?
Select all that apply.

A)I should take this medication with food."
B)I should avoid alcohol when taking this medication."
C)I should keep appointments with my health care provider for follow-up blood work."
D)I can stop taking this medication if I feel funny or sick."
E)I will need to drink more water with this medication because it makes me lose water."

Question 47

A client is experiencing symptoms associated with severe psoriasis.The nurse will prepare to administer which medications for this client?
Select all that apply.

A)Betamethasone
B)Hydrocortisone acetate
C)Fludrocortisone
D)Metyrapone
E)Mitotane

Question 48

A client is prescribed dexamethasone.The nurse knows that this medication is indicated for which health problems?
Select all that apply.

A)Cerebral edema
B)Acute adrenocortical insufficiency
C)Gastritis
D)Heart failure
E)Spinal stenosis

Question 49

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.

A)Reduction in swelling
B)Reduced purulent drainage
C)Increased bleeding
D)Increased warmth to the area
E)Buildup of necrotic tissue

Question 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.

A)Go to your pharmacy to get annual influenza immunization and a varicella vaccine."
B)Restrict your salt intake."
C)Take vitamin D supplements as prescribed."
D)Do not stop taking this medication."
E)Stop taking this medication if you have headaches,confusion,or insomnia."