Chapter 15 Drug Therapy With Corticosteroids

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Chapter 15  Drug Therapy With Corticosteroids

 

 

Complete chapter Questions And Answers
 

Sample Questions

 

 

1. A patient is in the admission department prior to outpatient surgery, and she states that she is exceptionally nervous. Which of the following actions increases this patient’s stress-related release of cortisol?

  1. A)  Negative feedback mechanism
  2. B)  Stimulation of the hypothalamus
  3. C)  Release of epinephrine and norepinephrine
  4. D)  Atrophy of the adrenal cortex

Ans: C
Feedback:
The stress response activates the sympathetic nervous system to produce more epinephrine and norepinephrine and the adrenal cortex to produce as much as 10 times the normal amount of cortisol. The negative feedback mechanism does not accelerate the stress response. Cortisol production is not based on the stimulation of the hypothalamus. The stress response will not cause atrophy of the adrenal cortex.

2. A patient is diagnosed with an adrenal tumor. With which of the following abnormalities of the adrenal gland will the patient most likely be diagnosed?

  1. A)  Primary adrenocortical insufficiency
  2. B)  Secondary adrenocortical insufficiency
  3. C)  Adrenocortical hyperfunction
  4. D)  Hyperaldosteronism

Ans: C Feedback:

Adrenocortical hyperfunction (Cushing’s disease) may be a result of a primary adrenal tumor. Primary adrenocortical insufficiency is associated with destruction of the adrenal cortex by disorders such as tuberculosis, cancer, or hemorrhage. Secondary adrenocortical insufficiency is produced by inadequate secretion of corticotropin. Hyperaldosteronism is a rare disorder caused by adenoma or hyperplasia of the adrenal cortex cells that produce aldosterone.

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3. A patient is seen in the primary care provider’s office with complaints of polydipsia and polyuria without polyphagia. He has very edematous ankles, and his blood pressure is elevated. From which disorder of the adrenal cortex is the patient suffering?

  1. A)  Hyperaldosteronism
  2. B)  Adrenocortical hyperfunction
  3. C)  Androgen-producing tumors
  4. D)  Adrenal hyperplasia

Ans: A

Feedback:

Hyperaldosteronism is characterized by hypokalemia, hypernatremia, hypertension, thirst, and polyuria. Adrenocortical hyperfunction causes the secretion of several corticosteroids. Androgen-producing tumors of the adrenal cortex, which are usually benign, produce masculinizing effects. Adrenal hyperplasia results from deficiencies in one or more enzymes required for cortisol production.

4. A patient is receiving hydrocortisone 40 mg PO daily for treatment of severe autoimmune inflammation. Which of the following nursing interventions is most important to implement?

  1. A)  Increase dietary sodium.
  2. B)  Limit dietary protein.
  3. C)  Assess BUN and creatinine regularly.
  4. D)  Implement infection control measures.

Ans: D
Feedback:
Corticosteroids create a risk for infection due to immune suppression; infection control measures are a priority. When taking hydrocortisone daily, the patient should limit dietary sodium due to fluid retention. The patient should maintain a diet high in protein. The patient should not alter fluid intake unless the patient shows signs of fluid volume overload. Renal function may or may not be an assessment priority.

5. A male patient has been on chronic corticosteroid therapy for several years and has been scheduled for a colonoscopy. How should the patient’s corticosteroid therapy be altered to accommodate this impending stressful event?

  1. A)  The patient should stop taking the corticosteroid 7 days prior to the procedure.
  2. B)  The patient should continue taking the regular dose of his corticosteroid.
  3. C)  The patient should temporarily change to IV administration of his corticosteroid.
  4. D)  The patient should temporarily take a higher dose of his corticosteroid.

Ans: D
Feedback:
For people receiving chronic corticosteroid therapy, dosage must be increased during periods of stress or illness. Some common sources of stress for most people include surgery and anesthesia, infections, anxiety, and extremes of temperature.

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6. A 50-year-old male is admitted to the emergency room with a head injury after a motorcycle crash. He is unconscious with one eye dilated and one constricted. He has a widened pulse pressure. What corticosteroid will most likely be administered parenterally?

  1. A)  Cortisone
  2. B)  Prednisone
  3. C)  Dexamethasone (Decadron)
  4. D)  Fluticasone (Flonase)

Ans: C
Feedback:
Dexamethasone is considered the corticosteroid of cerebral edema. It is thought to penetrate the blood–brain barrier more readily and achieve higher concentrations in cerebrospinal fluid. Cortisone is the drug of choice for adrenal insufficiency. Prednisone is the glucocorticoid of choice in nonendocrine disorders in which anti-inflammatory, antiallergic, antistress, and immunosuppressive effects are desired. Fluticasone (Flonase) is administered by oral inhalation.

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