Nokea
A glucocorticoid is prescribed for a patient. The nurse checks the patient's medical history knowing that glucocorticoid therapy is contraindicated in which disorder?
- A. Cerebral edema
- B. Peptic ulcer disease
- C. Tuberculous meningitis
- D. Chronic obstructive pulmonary disease
Correct Answer: B
Rationale: Contraindications to the administration of glucocorticoids include drug allergy and may include cataracts, glaucoma, peptic ulcer disease, mental health problems, and diabetes mellitus. The other options are indications for glucocorticoids.
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A patient has been admitted for an exacerbation of chronic obstructive pulmonary disease and will be receiving methylprednisolone 30 mg intravenously every 6 hours. The medication is available in 40 mg/mL vials. Identify how many milliliters will the nurse draw up for this dose.
Correct Answer: 0.75 mL
Rationale: 40 mg : 1 mL :: 30 mg : x mL; (40 * x) = (1 * 30); 40x = 30; x = 30/40 = 0.75 mL.
The nurse is administering an adrenal drug to a patient. Which action by the nurse is appropriate for this patient?
- A. Administering oral adrenal drugs on an empty stomach to maximize absorption
- B. Rinsing the oral cavity after using corticosteroid inhalers
- C. Administering the corticosteroids before bedtime to minimize adrenal suppression
- D. Discontinuing the medication immediately if weight gain of 5 pounds or more in 1 week occurs
Correct Answer: B
Rationale: After the patient has used corticosteroid inhalers, cleaning the oral cavity helps to prevent possible oral fungal infections from developing. Adrenal drugs need to be taken with meals to minimize gastrointestinal upset and in the mornings to minimize adrenal suppression, and they need to be discontinued by weaning, not abruptly.
The nurse expects that a patient is experiencing undersecretion of adrenocortical hormones when which conditions are found upon assessment?
- A. Dehydration
- B. Weight loss
- C. Steroid psychosis
- D. Increased potassium levels
- E. Increased blood glucose levels
- F. Decreased serum sodium levels
Correct Answer: A,B,D,F
Rationale: The undersecretion (hyposecretion) of adrenocortical hormones causes a condition known as Addison's disease, which is associated with decreased blood sodium and glucose levels, increased potassium levels, dehydration, and weight loss. Steroid psychosis is an effect of glucocorticoid excess.
A patient is taking fludrocortisone for Addison's disease, and his wife is concerned about all of the problems that may occur with this therapy. When teaching them about therapy with this drug, the nurse will include which information?
- A. It may cause severe postural hypotension.
- B. It needs to be taken with food or milk to minimize gastrointestinal upset.
- C. The medication needs to be stopped immediately if nausea or vomiting occurs.
- D. Weight gain of 5 pounds or more in 1 week is an expected adverse effect.
Correct Answer: B
Rationale: Patients receiving fludrocortisone need to take it with food or milk to minimize gastrointestinal upset. Weight gain of 5 pounds or more in 1 week needs to be reported to the physician, abrupt withdrawal is not recommended because it may precipitate an adrenal crisis. Adverse effects are related to fluid retention and may include heart failure and hypertension.
A patient who has been on long-term corticosteroid therapy has had surgery to correct an abdominal hernia. The nurse keeps in mind that which potential effect of this medication may have the most impact on the patient's recovery?
- A. Hypotension
- B. Osteoporosis
- C. Muscle weakness
- D. Delayed wound healing
Correct Answer: D
Rationale: Muscle weakness and osteoporosis may also result from long-term therapy, but delayed wound healing would have the most impact on the patient's recovery from abdominal surgery at this time. Hypertension, not hypotension, may result from long-term corticosteroid therapy.