Nokea
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.
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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.
The nurse is reviewing therapy with glucocorticoid drugs. Which conditions are indications for glucocorticoid drugs?
- A. Glaucoma
- B. Cerebral edema
- C. Chronic obstructive pulmonary disease
- D. Organ transplantation
- E. Varicella
- F. Septicemia
Correct Answer: B,C,D
Rationale: Cerebral edema, chronic obstructive pulmonary disease, and organ transplantation are indications for glucocorticoid therapy. Glaucoma, varicella, and septicemia are all contraindications to glucocorticoid 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.
A patient will be starting therapy with a corticosteroid. The nurse reviews the prescriber's orders and notes that an interaction may occur if the corticosteroid is taken with which of these drug classes?
- A. Nonsteroidal anti-inflammatory drugs
- B. Antibiotics
- C. Opioid analgesics
- D. Antidepressants
Correct Answer: A
Rationale: The use of corticosteroids with aspirin, other NSAIDs, and other ulcerogenic drugs produces additive gastrointestinal effects and an increased chance for the development of gastric ulcers. The other options are incorrect.
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.