NURS 317 Unit 3 Chapter 36 Pharm Point Questions

Question 1

The nurse is caring for a client diagnosed with Addison syndrome receiving a corticosteroid medication. What finding would suggest an improvement in the client’s condition?

A) Decrease in serum glucose

B) Increase in serum sodium

C) Increase in serum potassium

D) Increased urine output

Answer 1

B) Increase in serum sodium

Rationale:Addison syndrome is characterized by hyponatremia, hyperkalemia, hypoglycemia, and dehydration. Improvement in any of these findings, such as an increase in serum sodium, would indicate the client’s condition is improving. Increase in serum potassium or decrease in serum glucose would indicate worsening of the condition. Increased urine output would not signal the resolution of Addison syndrome.

Question 2

The nurse is caring for a client who receives a prescription for high-dose prednisone therapy. What is the priority teaching point the nurse will make when providing drug teaching to this client?

A) Take the medication on an empty stomach.

B) Increase carbohydrate intake.

C) Wait 1 hour after taking the pill to eat breakfast.

D) Do not stop taking this drug suddenly

Answer 2

D) Do not stop taking this drug suddenly

Rationale:The priority teaching point for a client starting high-dose prednisone therapy is the need to taper dosages and not stop the drug all at once. They should take the medication with breakfast because it will reduce stomach irritation. There is no need to increase carbohydrate intake.

Question 3

A nurse teaches a client to take a prescribed glucocorticoid first thing in the morning because:

A) the risk of adverse effects is reduced.

B) the drug is absorbed better in the morning.

C) this time mimics the normal peak diurnal concentration levels.

D) this time coincides with naturally high blood glucose levels.

Answer 3

C) this time mimics the normal peak diurnal concentration levels.

Rationale:Typically a glucocorticoid is taken in the morning to mimic the normal peak diurnal concentration levels. Drug absorption is not affected by time of administration. Blood glucose levels are not a primary concern, and morning administration does not prevent adverse effects.

Question 4

A nurse is preparing to administer fludrocortisone. The nurse would administer the drug by which route?

A) Inhalation

B) Subcutaneous

C) Intramuscular

D) Oral

Answer 4

D) Oral

Rationale:Fludrocortisone is administered orally.

Question 5

What drug, if taken with corticosteroids, may lead to possible toxic effects?

A) Aspirin

B) Phenytoin

C) Erythromycin

D) Phenobarbital

Answer 5

C) Erythromycin

Rationale:Therapeutic and toxic effects increase if corticosteroids are given with erythromycin. Serum levels and effectiveness may decrease if corticosteroids are combined with salicylates, phenobarbital, or phenytoin.

Question 6

The client experiences an acute stress reaction causing the release of ADH and adrenocortical hormones. What action will the hormones have? Select all that apply.

A) Blocking of immune and inflammatory response

B) Increased rate of protein production

C) Dehydration

D) Increase in blood volume

E) Release of glucose

Answer 6

A) Blocking of immune and inflammatory response
D) Increase in blood volume
E) Release of glucose

Rationale:These hormones have many actions, including the following: increasing the blood volume (aldosterone effect), causing the release of glucose for energy, slowing the rate of protein production (which preserves energy), and blocking the activities of the inflammatory and immune systems (which preserves a great deal of energy). Dehydration would not occur with an acute stress reaction.

Question 7

The nurse is caring for an African American client who is taking methylprednisolone to suppress immune response to a kidney transplant received last year. What assessment should the nurse prioritize when monitoring for adverse effects in this specific client?

A) Auscultate the client’s lungs for adventitious sounds.

B) Auscultate the client’s apical heart rate frequently.

C) Measure the client’s blood glucose frequently.

D) Assess the client’s strength bilaterally.

Answer 7

C) Measure the client’s blood glucose frequently.

Rationale:African Americans develop increased toxicity to the corticosteroid methylprednisolone—particularly when it is used for immunosuppression after renal transplantation. This toxicity can include severe steroid-induced diabetes mellitus, so vigilant blood glucose monitoring is needed. Cardiac, respiratory, and musculoskeletal assessments do not related to this particular complication.

Question 8

The nurse is teaching some colleagues about the stress response and reactions that occur. What process, described by the colleagues, would indicate the need for further teaching?

A) Glucose release

B) Decreased blood volume

C) Slowed protein production

D) Blocked immune response

Answer 8

B) Decreased blood volume

Rationale:Adrenocortical hormones increase blood volume due to the aldosterone effect. Adrenocortical hormones cause the release of glucose for energy, and protein production is slowed. The activities of the inflammatory and immune responses are blocked.

Question 9

The client receives a prescription for a corticosteroid and is instructed to take one tablet every other day. The client asks the nurse, “Can I take half a pill every day instead so I don’t forget to take it on the right day?” What is the nurse’s best response?

A) “It is best to take the pill the way it is ordered if you want to avoid many of the undesirable effects of corticosteroids.”

B) “There is no reason you can’t take half a tablet every day because you will still get the same dosage and effect.”

C) “It was ordered that way because taking it every other day will keep your adrenal gland from shutting down.”

D) “Your body can’t tolerate receiving that medication every day, so you need to take it the way it was ordered.”

Answer 9

C) “It was ordered that way because taking it every other day will keep your adrenal gland from shutting down.”

Rationale:Alternate-day maintenance therapy with short-acting drugs decreases the risk of adrenal shutdown. It does not prevent adverse effects, and it is not intolerable to the body to receive a daily dose. The client should be told to take the prescription as ordered.

Question 10

What would a nurse expect to assess in a client with an adrenocortical hormone deficiency? Select all that apply.

A) Purpura

B) Renal calculi

C) Hyponatremia

D) Confusion

E) Hyperkalemia

Answer 10

C) Hyponatremia
D) Confusion
E) Hyperkalemia

Rationale:Manifestations of hypoadrenal function include confusion, hyponatremia, and hyperkalemia. Purpura and renal calculi are associated with hyperadrenal function

Question 11

Following what events should the nurse monitor the client for potential adrenal insufficiency? Select all that apply.

A) Excessive production of ACTH.

B) Surgical removal of the gland.

C) Reduced production of androgens.

D) Adrenal gland is damaged.

E) Prolonged use of corticosteroid hormones.

Answer 11

B) Surgical removal of the gland.
D) Adrenal gland is damaged.
E) Prolonged use of corticosteroid hormones.

Rationale:Some clients experience a shortage of adrenocortical hormones and develop signs of adrenal insufficiency. This can occur when a client does not produce enough ACTH, when the adrenal glands are not able to respond to ACTH, when an adrenal gland is damaged and cannot produce enough hormones (as in Addison disease), or secondary to surgical removal of the glands. A more common cause of adrenal insufficiency is prolonged use of corticosteroid hormones. Excessive production of ACTH would produce Cushing disease due to too much stimulation. Androgen production does not cause adrenal insufficiency.

Question 12

What should a nurse include when explaining the actions of glucocorticoids?

A) They promote the production of antibodies.

B) Prostaglandin formation decreases.

C) Leukotriene formation increases.

D) They enhance the action of arachidonic acid.

Answer 12

B) Prostaglandin formation decreases.

Rationale:Glucocorticoids block arachidonic acid, which leads to a decrease in the formation of prostaglandins and leukotrienes. Glucocorticoids block the production of antibodies.

Question 13

What would the nurse include when describing the possible adverse effects associated with a mineralocorticoid? Select all that apply.

A) Headache

B) Hyperkalemia

C) Edema

D) Hypernatremia

E) Fluid loss

Answer 13

A) Headache
C) Edema
D) Hypernatremia

Rationale:Sodium is retained by mineralocorticoids. Headache is associated with mineralocorticoids. Edema is associated with mineralocorticoids. Fluid retention, not loss, is associated with mineralocorticoids. Hypokalemia, not hyperkalemia, is associated with mineralocorticoids.

Question 14

The nurse admits a child to the clinic who is taking long-term corticosteroids. The parent brought the child to receive a measles, mumps, and rubella vaccine. What teaching will the nurse provide? Select all that apply.

A) Live virus immunizations cannot be given to people receiving long-term corticosteroids.

B) Administer acetaminophen if the child develops a fever after receiving the vaccine.

C) Long-term corticosteroid administration reduces immune response.

D) Call the provider if the child develops a fever after receiving the vaccine.

E) Children receiving corticosteroids cannot receive injectable medications.

Answer 14

A) Live virus immunizations cannot be given to people receiving long-term corticosteroids.
C) Long-term corticosteroid administration reduces immune response.

Rationale:Clients receiving long-term corticosteroids cannot be given live virus vaccines because of the likelihood they will develop an infection due to their suppressed immune system. As a result, the nurse would not advise regarding fever management if the child does not receive the vaccine. There is no reason the child cannot receive an injection if it is administered using aseptic technique. It is only the vaccine they cannot receive if it is a live virus.

Question 15

For which client would the use of glucocorticoids most likely be contraindicated?

A) A client with functional urinary incontinence

B) A client who has short bowel disease

C) A client with bacterial pneumonia

D) A client with hypothyroidism who takes levothyroxine

Answer 15

C) A client with bacterial pneumonia

Rationale:Acute infection is a contraindication for glucocorticoid use; the infection could become severe and possibly fatal with the blockage of the immune and inflammatory responses. Glucocorticoids client are not normally contraindicated in clients with urinary incontinence or GI disorders. Coexistence of another endocrine disorder would warrant caution, but glucocorticoids would not necessary be contraindicated.

Question 16

A client has been diagnosed with Cushing syndrome. What assessment finding should the nurse attribute to this diagnosis?

A) The client required cataract surgery.

B) The client has central obesity.

C) The client has gastroesophageal reflux.

D) The client is oriented to person and place but not time.

Answer 16

B) The client has central obesity.

Rationale:Cushing syndrome is associated with a moon-like face, central obesity, hypertension, protein breakdown, osteoporosis, and females develop hirsutism. Cataracts, cognitive deficits, and reflux are not associated with the disorder.

Question 17

The nurse is caring for a client who has been prescribed hydrocortisone IV for adrenal replacement therapy. The nurse is reviewing the client’s most recent laboratory results. What finding best suggests a therapeutic effect?

A) Red blood cell count 5.1 × 106/µL (5.1 × 1012/L)

B) Chloride 99.3 mEq/L (99.3 mmol/L)

C) Sodium 138 mEq/L (138 mmol/L)

D) Prothrombin time (PT) 12.1 seconds

Answer 17

C) Sodium 138 mEq/L (138 mmol/L)

Rationale:A goal of mineralocorticoid therapy is the maintenance of therapeutic sodium levels. This client’s sodium level is within expected norms. Each of the other listed values is also within range, but none is the direct focus of mineralocorticoid therapy.

Question 18

The nurse teaches the client how to administer their newly prescribed drug by inhalation when what drug is ordered?

A) Methylprednisolone

B) Cortisone

C) Beclomethasone

D) Prednisone

Answer 18

C) Beclomethasone

Rationale:Beclomethasone is administered by inhalation. Prednisone is administered orally. Cortisone is administered orally or by IM injection. Methylprednisolone is available by various routes, but inhalation is not included among these.

Question 19

The nurse is teaching a client who is receiving prednisone about possible adverse effects. The client demonstrates understanding when identifying what possible effect?

A) Weight loss

B) Anorexia

C) Hypoglycemia

D) Abdominal distension

Answer 19

D) Abdominal distension

Rationale:Abdominal distention is associated with prednisone use. Weight gain, hyperglycemia, and increased appetite are associated with prednisone use.

Question 20

The nurse is providing care for several clients who are being treated with corticosteroids. Which of these clients should the nurse assess first?

B) A client taking dexamethasone whose temperature was 101.1°F (38.4°C) 1 hour ago

C) A client who is taking fludrocortisone and whose sodium level is rising

D) A client who needs to learn how to use budesonide spray before discharge

Answer 20

B) A client taking dexamethasone whose temperature was 101.1°F (38.4°C) 1 hour ago

Rationale:A client who is taking corticosteroids and who is showing signs of infection would be a priority for assessment, due to the client’s reduced immune response. Discharge teaching would be less time-dependent. Tapering off of prednisone does not create an immediate need for assessment. A client taking fludrocortisone is expected to have an increased sodium level.

Question 21

A client has been prescribed prednisone 0.15 mg/kg PO to treat a hypersensitivity reaction to poison ivy. The client weighs 176 lbs. How many milligrams of prednisone should the nurse administer?
____________mg

Answer 21

12 mg

Rationale:The client’s weight in kilograms is 80 kg (176 ÷ 2.2). 80 kg × 0.15 mg = 12 mg.

Question 22

The nurse is assessing a female client who has a moon-like face, central obesity, and prominent facial hair. The nurse should identify the signs of what adrenal disorder?

A) Cushing disease

B) Hypopituitarism

C) Arachnoiditis

D) Addison syndrome

Answer 22

A) Cushing disease

Rationale:Cushing disease is manifested by a moon-like face, central obesity, hypertension, protein breakdown, osteoporosis, and hirsutism in females. The other listed disorders do not have this particular presentation.

Question 23

A client is to receive budesonide. The nurse would anticipate administering this drug by which route?

A) Intravenous

B) Oral

C) Intranasal

D) Intramuscular

Answer 23

C) Intranasal

Rationale:Budesonide is administered intranasally.

Question 24

The nurse is diagnosed with Addison disease and is given a prescription for a corticosteroid. The nurse works two 12-hour night shifts per week and never works 2 days together, always taking a few nights off between shifts. What time should this nurse take the medication prescribed?

A) At the time when the nurse normally gets up when working night shift.

B) Halfway between the day time wake-up time and the night shift wake-up time.

C) It doesn’t matter as long as it is taken at the same time every day.

D) In the morning when it is normally time to get up on days off.

Answer 24

D) In the morning when it is normally time to get up on days off.

Rationale:The nurse does not work 5 out of 7 days each week, so the medication should be taken in the morning on days off and at the same time on working days. It takes 2 to 3 days for the hypothalamus to adjust to a change in sleep–wake cycle, so working only one night every few days would not require a change in dosage schedule.

Question 25

The nurse should recognize both mineralocorticoid and glucocorticoid effects after long-term administration of what drug?

A) Hydrocortisone

B) Dexamethasone

C) Triamcinolone

D) Betamethasone

Answer 25

A) Hydrocortisone

Rationale:Hydrocortisone, cortisone, and prednisone have glucocorticoid and mineralocorticoid activity and effects. Betamethasone, dexamethasone, and triamcinolone are glucocorticoids without mineralocorticoid activity.

Question 26

A client with adrenal insufficiency has been prescribed fludrocortisone. What assessment finding by the nurse would most clearly indicate adverse effects of this medication?

A) The client’s blood pressure is 133/81 mm Hg.

B) The client’s sclerae appear slightly jaundiced.

C) The client has pitting edema to the feet and lower legs.

D) The client reports gas pain and is belching often.

Answer 26

C) The client has pitting edema to the feet and lower legs.

Rationale:Adverse effects commonly associated with the use of mineralocorticoids are related to the increased fluid volume seen with sodium and water retention. Edema would be a common example. Jaundice is associated with liver damage, which does not normally occur with mineralocorticoids. Gastrointestinal adverse effects are not common. This client’s blood pressure is not elevated beyond reference ranges, though hypertension would be an adverse effect.

Question 27

The nurse is reviewing the medication administration record of a new client, which includes budesonide. When identifying the client’s underlying health problem, the nurse should identify what nursing diagnosis?

A) Risk for injury related to central nervous system depression

B) Impaired gas exchange related to bronchospasm

C) Impaired physical mobility related to joint inflammation

D) Risk for impaired skin integrity related to adrenal excess

Answer 27

B) Impaired gas exchange related to bronchospasm

Rationale:Budesonide is often prescribed as a treatment for asthma. Consequently, the client would face a risk of impaired gas exchange because of the bronchospasm that characterizes the disease. Impaired skin integrity, immobility, and CNS depression are not suggested, either by the client’s underlying diagnosis or the corticosteroid treatment.

Question 28

The client has taken corticosteroids for an extended period of time to treat an inflammatory condition. When the inflammatory condition subsides, what will happen if the client stops taking the medication?

A) Nothing will happen

B) Return of the inflammatory condition, likely worse than before

C) Adrenal insufficiency

D) Hyperadrenal function

Answer 28

C) Adrenal insufficiency

Rationale:When exogenous corticosteroids are used, they act to negate the regular feedback systems. The adrenal glands begin to atrophy because ACTH release is suppressed by the exogenous hormones, so the glands are no longer stimulated to produce or secrete hormones. It takes several weeks to recover, not just a few days, from the atrophy caused by this lack of stimulation. If the medication were just stopped, the client would experience adrenal insufficiency.

Question 29

The nurse is caring for a client who has adrenal insufficiency. What medication would be most appropriate?

A) Fludrocortisone

B) Prednisolone

C) Beclomethasone

D) Budesonide

Answer 29

A) Fludrocortisone

Rationale:Fludrocortisone is a mineralocorticoid, and it is used to treat primary and secondary adrenocortical insufficiency in Addison disease and for the treatment of salt-losing adrenogenital syndrome. Budesonide is indicated for the relief of symptoms of seasonal and allergic rhinitis with few side effects, as a maintenance drug to treat asthma, or as an oral agent for the treatment of mild to moderate active Crohn disease. Beclomethasone is indicated to block inflammation in the respiratory tract. Prednisolone is used for allergic and inflammatory disorders.