Chapter 38: Corticosteroids My Nursing Test Banks

Chapter 38: Corticosteroids

Test Bank

MULTIPLE CHOICE

1. A patient has been on high dose corticosteroid therapy for the treatment of lupus erythematosus. In addition to monitoring electrolyte levels, which laboratory studies will the nurse monitor?

a.

Complete blood count

b.

Partial thromboplastin time

c.

Liver function panel

d.

Blood glucose levels

ANS: D

Corticosteroid therapy may induce hyperglycemia, particularly in prediabetic or diabetic patients. All patients must be monitored for the development of hyperglycemia, particularly during the early weeks of therapy. Steroids do not affect blood count, bleeding time, or liver function.

DIF: Cognitive Level: Application REF: p. 606 OBJ: 4

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

2. A patient who has been taking glucocorticoids over the past 3 months for Crohns disease comes in for a follow up visit. On assessment, the nurse notes facial edema, thinning extremities, and a fatty deposition (buffalo hump) on the scapular area. The patient reports the symptoms of the Crohns disease are somewhat better. What will the nurse expect the treatment to be?

a.

Decrease the steroid dosage by one half.

b.

Increase the steroid dosage.

c.

Maintain the steroid dosage.

d.

Immediately stop the steroid dosage.

ANS: C

Glucocorticoids are primarily used as anti inflammatory agents. Because the symptoms are improving, the physician will most likely maintain the steroid dosage. Adverse effects are anticipated with corticosteroid therapy. Decreasing the dose will not help the condition. Increasing the dose will exacerbate the adverse effects, and the condition is improving with the current dosage. Stopping the dosage will not help the condition or the adverse effects.

DIF: Cognitive Level: Application REF: p. 608 OBJ: 5

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

3. What is the rationale for administering glucocorticoid therapy as an adjunct to chemotherapeutic agents?

a.

Assists with pain control

b.

Raises blood sugar to meet the increased metabolic needs

c.

Produces immunosuppression effects

d.

Reduces mucositis

ANS: C

Glucocorticoids have an anti inflammatory and antiallergenic action. Suppression of inflammation resulting from cancer enhances the effectiveness of the chemotherapeutic agents. Glucocorticoids do not have an analgesic effect. Glucocorticoids increase blood glucose, but it is an adverse effect, not a primary effect. Glucocorticoids do not reduce mucositis.

DIF: Cognitive Level: Comprehension REF: p. 608 OBJ: 2 | 5

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

4. A patient with type 1 diabetes was prescribed a glucocorticoid for chronic obstructive pulmonary disease. Which will the nurse expect in the treatment plan?

a.

A decrease in the amount of insulin needed

b.

No change in the amount of insulin needed

c.

An increase in the need for carbohydrates

d.

An increase in the insulin needed

ANS: D

Glucocorticoids may elevate blood glucose levels and induce hyperglycemia, particularly in prediabetic or diabetic patients. Insulin needs increase with an increase in blood glucose levels. Carbohydrate needs will not increase.

DIF: Cognitive Level: Application REF: p. 610 OBJ: 4

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

5. Which condition would require mineralocorticoid replacement?

a.

Addisons disease

b.

Diabetes insipidus

c.

Myxedema

d.

Glomerulonephritis

ANS: A

Addisons disease is a result of failure of the adrenal cortex to produce mineralocorticoids, glucocorticoids, and sex hormones. Replacement therapy of all hormones is essential for the patient to lead a healthy life. Diabetes insipidus is treated with vasopressin. Myxedema is treated with thyroid hormone. Glomerulonephritis is treated with antibiotics.

DIF: Cognitive Level: Comprehension REF: p. 607 OBJ: 5

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

6. Which fluid replacement method will the nurse identify for a patient on a fluid restriction?

a.

Freely throughout the day and evening shift

b.

One third of the allowed volume on each shift

c.

Half the volume with meals and the remainder divided among shifts

d.

As the patient desires

ANS: C

When fluid restrictions are prescribed, one half of fluid volume is generally given with meals. The other half is given on a per shift basis. When allowed the opportunity to take fluids freely, most patients will use all of their allotment early in the day and not have enough left for meals and medications later. Because most patients are asleep on the night shift, the fluid requirement is less.

DIF: Cognitive Level: Application REF: p. 606 OBJ: 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

7. Which will the nurse include in the teaching plan for a patient asking about the use of salt substitutes while on a sodium restricted diet?

a.

Salt substitutes may be high in potassium and should be used sparingly.

b.

Salt substitutes are safe for unlimited use.

c.

The salty flavor is reduced, so additional amounts are needed for desired flavor.

d.

Salt substitutes may interact with the patients medications.

ANS: A

Potassium restrictions may be indicated if the patient is taking a potassium sparing diuretic. Salt substitutes may be high in potassium; therefore, their use must be limited. Salt substitutes tend to have a more salty taste than sodium chloride, so reduced amounts are needed to provide desired flavor. It is unlikely that salt substitute will interact with patients medications.

DIF: Cognitive Level: Comprehension REF: p. 606 OBJ: 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

8. A patient on a high dosage of corticosteroids over a period of time may develop which type of psychiatric complication?

a.

Lethargy

b.

Psychotic behaviors

c.

Manic phases

d.

Anxiety attacks

ANS: B

A patient receiving a higher dosage of corticosteroids is susceptible to psychotic behavioral changes. The most susceptible patient is one with previous histories of mental dysfunction. Perform a baseline assessment of the patients ability to respond rationally to the environment and the diagnosis of the underlying disease. Lethargy, mania, and anxiety are not common complications of treatment with corticosteroids.

DIF: Cognitive Level: Comprehension REF: p. 610 OBJ: 5

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

9. What is the rationale for monitoring vital signs of patients receiving corticosteroids?

a.

Orthostatic hypotension

b.

Malignant hyperthermia

c.

Infection

d.

Hyperglycemia

ANS: C

Patients receiving corticosteroids are more susceptible to infection, and fever is often an early indicator of infection. Glucocorticoids, however, sometimes suppress a febrile response to infection. Orthostatic hypotension is not a common adverse effect of treatment with corticosteroids. Malignant hyperthermia is an anesthetic related complication. Hyperglycemia is a common adverse effect of treatment with corticosteroids, but it is not assessed by vital signs

DIF: Cognitive Level: Comprehension REF: p. 604 | p. 610

OBJ: 4 TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

10. The nurse is assessing a patient for adverse effects of long term glucocorticoid therapy. Which condition would most likely be present?

a.

Dehydration

b.

Hypotension

c.

Osteoporosis

d.

Thrombocytopenia

ANS: C

Long term glucocorticoid therapy may produce osteoporosis. Dehydration, hypotension, and thrombocytopenia are not adverse effects of long term glucocorticoid therapy.

DIF: Cognitive Level: Comprehension REF: p. 610 OBJ: 5

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

11. The nurse transcribes a new order for a patient for a fludrocortisone. When planning the time of administration, the nurse will schedule this medication to be given:

a.

with breakfast and dinner.

b.

once daily in the evening.

c.

before meals.

d.

with lunch.

ANS: B

Mineralocorticoids are usually given once daily in the evening. Glucocorticoids are usually ordered twice daily with breakfast and with dinner.

DIF: Cognitive Level: Analysis REF: p. 606 OBJ: 4

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

12. Which statement(s) made by a patient on a corticosteroid medication show(s) a need for further education?

a.

I should increase my potassium intake.

b.

I may have to decrease my fluid intake.

c.

I will avoid weight bearing measures.

d.

I will change position frequently.

ANS: C

Weight bearing measures should be encouraged for the patient taking corticosteroids to prevent calcium loss. An increase in potassium is often necessary when on corticosteroids. Fluid restrictions may be imposed when taking corticosteroids. Position should be changed at least every 2 hours for the patient taking corticosteroids.

DIF: Cognitive Level: Analysis REF: p. 607 OBJ: 4

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance; Physiological Integrity

MULTIPLE RESPONSE

13. The nurse is instructing a patient about adverse effects associated with corticosteroid therapy. What information would be important to include? (Select all that apply.)

a.

Avoid crowds or people with an infection.

b.

Monitor and care for your skin daily; change positions frequently.

c.

Take medication on an empty stomach.

d.

During periods of physical or psychological stress, higher doses of corticosteroids are necessary. Contact your health care provider.

e.

Follow a diet low in sodium.

ANS: A, B, D, E

Corticosteroid therapy patients should avoid large crowds or people with an infection.

Patients taking corticosteroid drugs should monitor for signs of edema, skin breakdown, and weight daily. During periods of physical or psychological stress, increased dosing may be necessary. Patients taking corticosteroid drugs should follow a low sodium diet that is also high in potassium, if not contraindicated. Corticosteroids should be taken with food to avoid gastrointestinal upset.

DIF: Cognitive Level: Application REF: pp. 606-607 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

14. What are functions of glucocorticoids? (Select all that apply.)

a.

Maintain fluid and electrolyte balance

b.

Have anti inflammatory activities

c.

Regulate protein, carbohydrate, and fat metabolism

d.

Provide relief of rheumatoid arthritis

e.

Include aldosterone

ANS: B, C, D

Glucocorticoids have anti inflammatory and antiallergenic activities. Glucocorticoids (cortisone, hydrocortisone, prednisone, and others) regulate carbohydrate, protein, and fat metabolism. Glucocorticoids are effective for immunosuppression in the treatment of certain cancers, organ transplantation, autoimmune diseases (e.g., lupus erythematosus, dermatomyositis, rheumatoid arthritis), relief of allergic manifestations (e.g., serum sickness, severe hay fever, status asthmaticus), and treatment of shock. In addition, they may be used to treat nausea and vomiting resulting from chemotherapy. Glucocorticoids do not maintain fluid and electrolyte imbalance. Glucocorticoids do not include aldosterone.

DIF: Cognitive Level: Comprehension REF: p. 608 OBJ: 2

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

15. A patient has been diagnosed with rheumatoid arthritis and will begin daily oral corticosteroid treatment. Which baseline assessment(s) would be important for a patient receiving corticosteroids? (Select all that apply.)

a.

Baseline weight

b.

Blood pressure

c.

Complete blood cell count (CBC)

d.

Electrolyte studies

e.

Hydration status

ANS: A, B, D, E

Baseline assessments for patients receiving corticosteroid therapy include weight, blood pressure, electrolyte studies, intake and output, and diet and hydration status. A baseline CBC is not needed for patients taking corticosteroids.

DIF: Cognitive Level: Application REF: pp. 604-605 OBJ: 4

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

16. Which measure(s) for monitoring hydration and fluid balance would be inappropriate for the patient on steroid therapy? (Select all that apply.)

a.

Daily weights

b.

Abdominal girth measurements

c.

Reports of thirst

d.

Neurologic assessment

e.

Assessment for alteration in skin integrity

ANS: A, B

Perform daily weights using the same scale, in clothing of approximately the same weight, at the same time, usually before breakfast. Record and report significant weight changes. (Weight gains and losses are the best indicators of fluid gain or loss.) As appropriate to the patients condition, obtain and record abdominal girth measurements. Thirst, altered mental status, and alteration of skin integrity are late signs of dehydration and therefore not a good way to monitor fluid balance.

DIF: Cognitive Level: Application REF: p. 605 OBJ: 4

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

17. What would be primary therapeutic outcome(s) expected from fludrocortisone (Florinef) therapy? (Select all that apply.)

a.

Reduced inflammation

b.

Pain relief

c.

Blood pressure control

d.

Restored fluid and electrolyte balance

ANS: C, D

Fludrocortisone is used in combination with glucocorticoids to treat salt losing adrenogenital syndrome for blood pressure control and to restore fluid and electrolyte balance. Because fludrocortisone has mineralocorticoid and glucocorticoid effects, it has an anti inflammatory action. However, this is not one of the primary therapeutic outcomes expected from fludrocortisone therapy. Fludrocortisone does not relieve pain.

DIF: Cognitive Level: Comprehension REF: pp. 607-608 OBJ: 2 | 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

18. A patient with type 2 diabetes is being discharged on glucocorticoid (prednisone) therapy for rheumatoid arthritis. Which information will the nurse include in discharge teaching? (Select all that apply.)

a.

Daily, single dose therapy should be taken in the morning.

b.

The metabolic needs of your body will be increased.

c.

Steroids should never be discontinued abruptly.

d.

Signs and symptoms of infections may not be evident.

e.

Blood glucose levels will be elevated on corticosteroid therapy.

ANS: A, C, D, E

During steroid replacement therapy, the drugs should mimic the bodys circadian rhythm. Steroids ordered once a day are given early in the morning. Steroid replacement therapy is gradually tapered in small increments before discontinuation to ensure that the patients adrenal glands are able to start secreting steroids to compensate for the reduced drug dosage. Glucocorticoids have an anti inflammatory action and therefore suppress the signs and symptoms of an infection. An adverse effect of glucocorticoid therapy is increased blood sugar levels. Glucocorticoids do not increase the bodys metabolic needs.

DIF: Cognitive Level: Application REF: pp. 608-610 OBJ: 2 | 4 | 5

TOP: Nursing Process Step: Planning

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

19. A patient has just received a new prescription for a corticosteroid medication. The nurse is educating a patient on symptoms to report to the health care provider. When providing this education, the nurse will inform the patient to report: (Select all that apply.)

a.

productive cough.

b.

dyspnea.

c.

confusion.

d.

chest pain.

e.

weight gain.

ANS: A, B, C, D, E

Symptoms to be reported when on a corticosteroid include productive cough, dyspnea, confusion, chest pain, and weight gain.

DIF: Cognitive Level: Application REF: p. 606 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance; Physiological Integrity

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