Chapter 36  Adrenocortical Agents

Chapter 36  Adrenocortical Agents

Complete Chapter Questions And Answers
 

Sample Questions

1. The nurse administers fludrocortisone (Florinef) to a patient diagnosed with salt-losing adrenogenital
syndrome and then assesses for what therapeutic action?

A) Development of hypokalemia and elevated serum glucose level

B) An increase in sodium and water reabsorption and potassium excretion

C) Headache, edema, weakness, arrhythmias, and hypertension

D) Sodium and water depletion along with potassium retention

Ans: B

Feedback:

Fludrocortisone’s therapeutic effects include an increase in sodium and water reabsorption with
potassium excretion. Headache, edema, weakness, arrhythmias, and hypertension are adverse, and not
therapeutic, effects. Hypokalemia is possible but glucose levels should not be impacted.

2. When developing a plan of care for the patient receiving a glucocorticoid, what nursing diagnosis
would be of highest priority?

A) Deficient fluid volume related to water retention

B) Risk for injury related to muscle weakness

C) Imbalanced nutrition: less than body requirements

D) Risk for infection related to immunosuppression

Ans: D

Feedback:

Risk for infection related to immunosuppression would be the appropriate nursing diagnosis because
steroids suppress the immune system, which puts the patient at risk for infection. Nutritional imbalance
is more likely to be ​more than body requirements​ than ​less than body requirements.​ Excess fluid
volume is more appropriate than deficient fluid volume. Glucocorticoids are not associated with muscle
weakness.

3. What glucocorticoids could the nurse only administer orally?

Test Bank – Focus on Nursing Pharmacology (7th Edition by Amy Karch) 585

A) Cortisone (Cortone Acetate)

B) Hydrocortisone (Cortef)

C) Prednisone (Deltasone)

D) Triamcinolone (Aristocort)

Ans: C

Feedback:

Prednisone is available in oral form only and is used for replacement therapy for adrenal insufficiency,
and treatment of allergic and inflammatory disorders. Cortisone can be administered orally or
intramuscularly and is used for replacement therapy. Hydrocortisone, used for replacement therapy, is
administered by the oral, IV, intramuscular, topical, ophthalmic, rectal, and intra-articular routes.
Triamcinolone is administered by the oral, intramuscular, inhalant, intra-articular, and topical routes
and is used for treatment of allergic and inflammatory disorders and in the management of asthma.

4. The mother asks the nurse for a steroid cream to put on her infant’s diaper rash. What teaching will the
nurse provide the mother? (Select all that apply.)

A) ​Topical corticosteroids are very effective treatment for diaper rash.​

B) ​Topical corticosteroid application should not be occluded with a diaper.​

C) ​Topical corticosteroids should not be applied to open lesions.​

D) ​Use of topical corticosteroids should be limited in children.​

E) ​Topical corticosteroids should be applied in a thick coat to the rash.​

Ans: B, C, D

Feedback:

Topical use of corticosteroids should be limited in children because their body surface area is
comparatively large and the amount of the drug absorbed in relation to weight is greater than in an
adult. When the medication is used in children, it should be applied sparingly and the area should not
be occluded with a diaper. The nurse should not make a judgment nor should he or she allow a patient
or family member to dictate a treatment just because he or she wants it. More effective treatments for
diaper rash than corticosteroids are available.

5. An older adult patient taking high-dose corticosteroids to treat arthritis requests a pneumonia vaccine.
What is the nurse’s best response?

Test Bank – Focus on Nursing Pharmacology (7th Edition by Amy Karch) 586

A) ​Pneumonia vaccines are only given if you are at risk for serious pulmonary problems.​

B) ​Live virus vaccines cannot be given to people who are significantly immunosuppressed.​

C) ​Patients taking corticosteroids are well protected from viruses and do not need vaccines.​

D) ​Corticosteroids interact with the pneumococcal vaccine to create serious adverse effects.​

Ans: B

Feedback:

Corticosteroids block the inflammatory response and are very helpful in conditions such as arthritis.
However, they also block the immune response, making a person immunosuppressed. The vaccine
would not be given to this patient because of the increased risk for infection. An older adult would be
considered at high risk for pneumonia so getting the vaccine would be encouraged if not for taking
corticosteroids. Corticosteroids do not protect against viruses. The vaccine is contraindicated because
of risk for infection and not because of a potential drug​drug interaction.