Nokea
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.
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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.
A patient is concerned about the body changes that have resulted from long-term prednisone therapy for the treatment of asthma. Which expected effect of this drug therapy would cause a change in the patient's appearance?
- A. Weight loss
- B. Weight gain
- C. Pale skin color
- D. Hair loss
Correct Answer: B
Rationale: Facial erythema, weight gain, hirsutism, and 'moon face' (characteristic of Cushing's syndrome) are possible body changes that may occur with long-term prednisone therapy.
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.
When monitoring a patient who is taking a systemically administered glucocorticoid, the nurse will monitor for signs of which condition?
- A. Dehydration
- B. Hypokalemia
- C. Hyponatremia
- D. Hypoglycemia
Correct Answer: B
Rationale: Systemic glucocorticoid drugs may cause potassium depletion, hyperglycemia, and hypernatremia. The other options are incorrect.