Chapter 36: Adrenocortical Agents prepU (GRADED A) Questions and Answers | 100% VERIFIED.

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Chapter 36: Adrenocortical Agents Question 1 See full question29s Report this Question A client is on daily doses of prednisone. To minimize adrenal suppression, the nurse's instructions for admini... stration should include to take the medication: You Selected: in the morning. Correct response: in the morning. Explanation: Scheduling of drug administration is more important with corticosteroids than with most other drug classes. A major adverse reaction is suppression of the HPA axis and subsequent loss of adrenocortical function. Scheduling of medication (morning dosing) is often recommended to prevent or minimize HPA suppression. Daily administration is required in cases of chronic adrenocortical insufficiency. The entire daily dose can be taken each morning, between 6 and 9 a.m. This schedule simulates normal endogenous corticosteroid secretion. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents, Box 36.3 Focus on Drug Therapy across the Lifespan, p. 597. Chapter 36: Adrenocortical Agents - Page 597 Add a Note Question 2 See full question51s Report this Question A client is receiving hydrocortisone 40 mg by mouth daily for treatment of severe autoimmune inflammation. Which nursing intervention is appropriate to implement? You Selected: Assess daily blood glucose. Correct response: Assess daily blood glucose. Explanation: Corticosteroids create a risk for infection due to immune suppression; infection control measures are a priority. When taking hydrocortisone daily, the client should not increase dietary sodium because of a risk for fluid retention. The client should maintain a diet high in protein to assist with healing and body repair. Renal function may or may not be an assessment priority depending on the client’s original renal status. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents, Table 36.3 Drugs in Focus: Adrenocortical Agents, p. 599. Chapter 36: Adrenocortical Agents - Page 599 Add a Note Question 3 See full question45s Report this Question A patient reports increasing the intake of herbal therapy because it is "cold and flu season." The patient is currently receiving hydrocortisone therapy for asthma. What is the first question for the nurse to ask the patient related to this statement? You Selected: “What herbal therapy are you taking?” Correct response: “What herbal therapy are you taking?” Explanation: Certain herbs, such as Echinacea, interact with hydrocortisone, which can increase the drug's effects. The nurse should ask the patient which herbs are being taken, because Echinacea is commonly taken to decrease the effects of colds and the flu. This would be the best question to ask first. The other questions would be appropriate to ask, but it would be best to find out if the patient is taking any herb that interferes with hydrocortisone therapy. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents. Add a Note Question 4 See full question34s Report this Question A nurse is caring for a patient with Cushing’s disease who asks why he is receiving ketoconazole (Nizoral), an antifungal medication. What is an appropriate response by the nurse? You Selected: “The medication will decrease cortisol levels.” Correct response: “The medication will decrease cortisol levels.” Explanation: The medication will prevent the conversion of 11-deoxycortisol to cortisol and decrease cortisol levels. The medication is not given to treat a secondary infection, prevent infections, or cure the patient. Reference: Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents, The Adrenal Glands, pp. 595-596. Chapter 36: Adrenocortical Agents - Page 595-596 Add a Note Question 5 See full question16s Report this Question Glucocorticoids should be used with caution in patients with what disease process? You Selected: Hepatic disease Correct response: Diabetes mellitus Explanation: Glucocorticoids should be used with caution in patients with diabetes because the drugs have glucose- elevating effects that can disrupt glucose control. Question 1 See full question 19s Report this Question While learning about corticosteroids in pharmacology class, a student asks the instructor what a clinical indication for the use of corticosteroids would be. What would be the instructor's best response? You Selected: • A disease with an inflammatory component Correct response: • A disease with an inflammatory component Explanation: Indications: Replacement therapy in adrenal cortical insufficiency, short-term management of various inflammatory and allergic disorders, hypercalcemia associated with cancer, hematological disorders, ulcerative colitis, acute exacerbations of multiple sclerosis, palliation in some leukemias, trichinosis with systemic involvement. Reference: • Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents. Add a Note Question 2 See full question 29s Report this Question The nurse is assessing the patient on mitotane therapy. Which assessment finding requires action by the nurse? You Selected: • The patient has gained 10 pounds. Correct response: • The patient's blood pressure is 140/90 mm Hg sitting and 90/50 mm Hg standing. Explanation: The patient with orthostatic hypotension needs additional teaching. The other findings require no action on the part of the nurse. The medication will not cure the patient. Reference: • Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents. Add a Note Question 3 See full question 18s Report this Question Mineralocorticoids directly affect: You Selected: • electrolyte levels. Correct response: • electrolyte levels. Explanation: Mineralocorticoids directly affect the levels of electrolytes in the system. Reference: • Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents, Mineralocorticoids, p. 604. Chapter 36: Adrenocortical Agents - Page 604 Add a Note Question 4 See full question 37s Report this Question A hospitalized client’s serum glucose level is 160mg/dL. Which hormone is most likely being secreted and leading to this elevated lab value? You Selected: • Glucocorticoid Correct response: • Glucocorticoid Explanation: During times of stress, glucocorticoid levels rise, thus leading to elevated glucose levels. TSH, LH, and GH are not directly related to elevations in glucose levels. Reference: • Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents, Glucocorticoids, p. 597. Chapter 36: Adrenocortical Agents - Page 597 Add a Note Question 5 See full question 43s Report this Question A male client is diagnosed with Addison’s disease. What daily medication would the nurse expect to be administered? You Selected: • Prednisone Correct response: • Prednisone Explanation: Daily administration of corticosteroids and mineralocorticoids is required in cases of chronic adrenocortical insufficiency (Addison’s disease). Reference: • Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents, Prototype Summary: Prednisone, p. 601. Chapter 36: Adrenocortical Agents - Page 601 Add a Note Question 6 See full question 42s Report this Question An adult client is preparing to begin corticosteroid treatment for rheumatoid arthritis. When teaching this client about the appropriate use of corticosteroids, the nurse should include what teaching point? You Selected: • “You will likely gain some weight after you start taking this drug.” Correct response: • “You will likely gain some weight after you start taking this drug.” Explanation: An initial weight gain is likely to occur with steroid treatment and is usually attributed to increased appetite. Organic foods are not necessary, and a consistent schedule of administration is imperative. Bleeding is not expected. Reference: • Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents, THE SITUATION, p. 602. Chapter 36: Adrenocortical Agents - Page 602 Add a Note Question 7 See full question 16s Report this Question To minimize adrenal suppression, when should the nurse encourage a client to take his or her daily dose of prescribed prednisone? You Selected: • “Take your medications in the morning.” Correct response: • “Take your medications in the morning.” Explanation: A major adverse reaction associated with corticosteroid therapy is suppression of the hypothalamic–pituitary–adrenal, or HPA, axis and subsequent loss of adrenocortical function. Scheduling of medication (morning dosing) is often recommended to prevent or minimize HPA suppression. Daily administration is required in cases of chronic adrenocortical insufficiency. The entire daily dose can be taken each morning, between 06:00 and 09:00. This schedule simulates normal endogenous corticosteroid secretion. Reference: • Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents, The Adrenal Glands, p. 594. Chapter 36: Adrenocortical Agents - Page 594 Add a Note Question 8 See full question 40s Report this Question A client with a diagnosis of asthma has responded well to treatment with oral corticosteroids, and a switch to inhaled corticosteroids is planned. What strategy for managing this change in treatment should be implemented? You Selected: • The inhaled drug should be started during tapering of the oral drug. Correct response: • The inhaled drug should be started during tapering of the oral drug. Explanation: When a client is being switched from an oral to an inhaled corticosteroid, the inhaled drug should be started during tapering of the oral drug, approximately 1 or 2 weeks before discontinuing or reaching the lowest anticipated dose of the oral drug. Reference: • Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents, Box 36.1 Focus on the Evidence, p. 594. Chapter 36: Adrenocortical Agents - Page 594 Add a Note Question 9 See full question 1m 50s Report this Question The nurse is educating an adult client diagnosed with adrenocortical carcinoma about the prescribed mitotane 6 g PO in divided doses. Which statement made by the client establishes the need for further clarification? You Selected: • “I should not drink alcoholic beverages while taking the drug.” Correct response: • “The drug will eradicate my tumor and cure my cancer.” Explanation: The nurse needs to clarify the statement that the client made regarding the drug eliminating the tumor and curing the cancer. The drug is administered for inoperable tumors and does not cure the cancer. It helps to shrink the tumor and decrease the production of cortisol. The drug causes central nervous system (CNS) depression, so taking it with alcohol would increase its effects and could cause serious problems with lethargy, dizziness, and gait disturbances. The client should not drive or operate machinery because of CNS depression. If the client has a traumatic injury or goes into shock, the drug should be temporarily stopped so the client may receive steroid therapy. Reference: • Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents, Adrenal Excess, p. 959. Chapter 36: Adrenocortical Agents - Page 959 Add a Note Question 10 See full question 55s Report this Question What medication creates a safety risk when combined with long-term fludrocortisone therapy? You Selected: • warfarin Correct response: • warfarin Explanation: The concurrent use of hydrocortisone and anticoagulants creates a risk for bleeding. There are not notable potential interactions with beta-blockers, calcium supplements, and levothyroxine. Question 1 See full question 24s Report this Question The nurse has just completed client education relative to chronic adrenocortical insufficiency and corticosteroid medication treatment. What statement indicates the client requires further instruction? You Selected: • I will start this medication when I am feeling ill or tired. Correct response: • I will start this medication when I am feeling ill or tired. Explanation: Daily administration is required in cases of chronic adrenocortical insufficiency. Clients should be instructed to call their health care provider if a fever above 101°F develops, minimize exposure to anyone who may be ill, and report any weight gain above 5 pounds in 1 week. Reference: • Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents, CRITICAL THINKING SCENARIO Adrenocortical Agents, p. 604. Chapter 36: Adrenocortical Agents - Page 604 Add a Note Question 2 See full question 14s Report this Question A nurse tells a patient to take a prescribed glucocorticoid in the morning based on the understanding that: You Selected: • This time mimics the normal peak diurnal concentration levels. Correct response: • This time mimics the normal peak diurnal concentration levels. Explanation: Typically a glucocorticoid is taken in the morning to mimic the normal peak diurnal concentration levels and thereby minimize suppression of the hypothalamic-pituitary axis. A glucocorticoid is taken in the morning to mimic the normal peak diurnal concentration levels and thereby minimize suppression of the hypothalamic-pituitary axis. Drug absorption is not affected by time of administration. The rationale for morning administration is to mimic the normal peak diurnal concentration levels. Reference: • Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents, Implementation with Rationale, p. 602. Chapter 36: Adrenocortical Agents - Page 602 Add a Note Question 3 See full question 25s Report this Question Which patient action requires immediate intervention by the nurse? You Selected: • The patient stopped taking hydrocortisone this morning because he does not like taking pills. Correct response: • The patient stopped taking hydrocortisone this morning because he does not like taking pills. Explanation: The patient should not stop taking hydrocortisone abruptly. This can shock the adrenal glands and cause cardiovascular collapse. The other actions are appropriate for administering hydrocortisone. Reference: • Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents, Adrenocortical Agents, p. 596. Chapter 36: Adrenocortical Agents - Page 596 Add a Note Question 4 See full question 38s Report this Question Which patient should not receive ketoconazole (Nizoral) as ordered for Cushing’s disease? You Selected: • The patient with elevated liver function tests Correct response: • The patient with elevated liver function tests Explanation: The medication has a Black Box Warning: It can cause hepatotoxicity and should be given with caution to patients with known liver dysfunction. The medication may cause a headache or fatigue; however, this is not a contraindication. The patient recently diagnosed with hepatitis C needs to have liver function tests performed to see if liver function is an issue at this time. Reference: • Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents, Box 36.2, p. 595. Chapter 36: Adrenocortical Agents - Page 595 Add a Note Question 5 See full question 23s Report this Question A client learning to self-administer desmopressin subcutaneously should be taught to administer the injection at which site? You Selected: • Abdomen Correct response: • Abdomen Explanation: The abdomen is a subcutaneous injection site. The forearm is an intradermal injection site. The deltoid and ventrogluteal areas are intramuscular injection sites. Reference: • Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents. Add a Note Question 6 See full question 10s Report this Question At which time would a nurse expect peak levels of adrenocorticotropic hormone to occur? You Selected: • 6 AM to 9 AM Correct response: • 6 AM to 9 AM Explanation: A peak response of increased adrenocorticotropic hormone and adrenocortical hormones occurs sometime early in the morning, about 6 AM to 9 AM. The corticosteroid levels fall to low levels by evening. Then, the hypothalamus and pituitary sense low levels of the hormones and begin the production and release of corticotropin- releasing hormone usually during sleep, around midnight. Reference: • Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents, The Adrenal Glands, pp. 594- 595. Chapter 36: Adrenocortical Agents - Page 594-595 Add a Note Question 7 See full question 27s Report this Question The nurse is assessing patients who use herbal therapy. About which patient is the nurse most concerned about the increase in the effect of the prescribed medication? You Selected: • The patient taking ketoconazole (Nizoral) and St. John’s wort Correct response: • The patient taking ketoconazole (Nizoral) and Echinacea Explanation: Echinacea puts the patient prescribed ketoconazole at risk for hepatotoxicity. The patient is not at increased risk with vitamin C, ginger, or St. John’s wort with Nizoral. Reference: • Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents, Clinically Important Drug–Drug Interactions, p. 601. Chapter 36: Adrenocortical Agents - Page 601 Add a Note Question 8 See full question 48s Report this Question The results of a client’s plasma corticotropin (ACTH) stimulation test have confirmed a diagnosis of Addison's disease. The nurse has consequently provided health education around the necessity of hormone replacement therapy. The client has asked the nurse, “How long am I going to have to take these medications?” How should the nurse best respond? You Selected: • “In order to manage this condition, you'll need to take these for the rest of your life.” Correct response: • “In order to manage this condition, you'll need to take these for the rest of your life.” Explanation: Lifetime hormone replacement is necessary in persons with Addison's disease. This knowledge eliminates all the remaining options. Reference: • Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents, Controls, p. 594. Chapter 36: Adrenocortical Agents - Page 594 Add a Note Question 9 See full question 19s Report this Question A child has received a diagnosis of Addison's disease, and the nurse is providing health education to the child's family around hormone replacement therapy. When planning this child's care, the nurse should know that hormone replacement therapy constitutes a risk for what nursing diagnosis? You Selected: • delayed growth and development Correct response: • delayed growth and development Explanation: Hydrocortisone may affect growth velocity. It is unlikely to affect allergy response, or respiration. Fluid volume excess, not deficit, is a possibility. Reference: • Karch, A. M., Focus on Nursing Pharmacology, 8th ed., Philadelphia, Wolters Kluwer, 2020, Chapter 36: Adrenocortical Agents, Adrenal Insufficiency, p. 595. Chapter 36: Adrenocortical Agents - Page 595 Add a Note Question 10 See full question 1m 7s Report this Question A nurse is caring for a client who is receiving a corticosteroid for arthritic pain. Which statement made by the client would raise concern about medication dosage revision? You Selected: • “I recently lost my health care coverage and need to look for another job.” Correct response: • “I recently lost my health care coverage and need to look for another job.” Explanation: For people receiving chronic corticosteroid therapy, dosage must be increased during periods of stress or illness. The nurse should recognize that the client has mentioned losing health care coverage and looking for a job. All the other statements are not related to stress or illness. [Show More]

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