Chapter 71: Glucocorticoids in Nonendocrine Diseases

Chapter 71: Glucocorticoids in Nonendocrine Diseases

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. A patient who has taken glucocorticoids for 3 years tells a nurse, “I’ve lost my job. I don’t know how I’m going to support my family and pay all the bills.” Which glucocorticoid dosage adjustment would the nurse expect?

a.	Decreased dosage
b.	Increased dosage
c.	Alternate-day dosing
d.	Double the dose

 

 

ANS:   B

At times of physiologic stress, the adrenals secrete large amounts of glucocorticoids and epinephrine (which maintain blood pressure and plasma levels of glucose). If glucocorticoid levels are insufficient, hypotension and hypoglycemia occur. The dose should be increased to compensate for the increased levels of stress.

Reducing the dosage would put the patient at risk for glucocorticoid insufficiency.

Alternate-day dosing results in decreased dosing, which would put the patient at risk for glucocorticoid insufficiency.

The dosage needs to be increased, but doubling the dose is too large of an increase.

 

DIF:    Cognitive Level: Application             REF:    p. 846

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

2. The nurse is teaching a group of nursing students about the use of glucocorticoids and the resultant physiologic effects. Which statement by one of the students best demonstrates understanding of these effects?

a.	“Glucocorticoids inhibit the metabolism of fatty acids for fuel.”
b.	“Glucocorticoids block the synthesis of glucose from amino acids.”
c.	“Glucocorticoids promote the storage of glucose in the form of glycogen.”
d.	“Glucocorticoids increase cellular sensitivity to insulin.”

 

 

ANS:   C

Glucocorticoids promote the storage of glucose in the form of glycogen.

The most consistent effect of glucocorticoids on fat metabolism is not inhibition but stimulation of lipolysis (fat breakdown).

Glucocorticoids promote rather than block the synthesis of glucose from amino acids.

Glucocorticoids do not increase cellular sensitivity to insulin. Other drugs, such as the sulfonylureas, increase cellular sensitivity to insulin.

 

DIF:    Cognitive Level: Application             REF:    p. 846

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Health Promotion and Maintenance

 

3. The nurse is caring for a patient taking high-dose glucocorticoids and is creating a plan of care for the patient. Which nursing diagnosis is the priority for the plan of care?

a.	Risk for disturbed sensory perception, auditory
b.	Risk for infection
c.	Risk for fluid volume deficit
d.	Risk for ineffective airway clearance

 

 

ANS:   B

Patients taking glucocorticoids are at risk for infection, because glucocorticoids increase the susceptibility to infection by suppressing host defenses.

Glucocorticoids do not disturb sensory perception.

Glucocorticoids do not put the patient at risk for fluid volume deficit, but rather for fluid volume excess.

Glucocorticoids do not promote a risk of ineffective airway clearance.

 

DIF:    Cognitive Level: Application             REF:    p. 850

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

4. The nurse would question an order for the administration of a glucocorticoid in a patient with

a.	systemic lupus erythematosus.
b.	rheumatoid arthritis.
c.	systemic fungal infections.
d.	asthma.

 

 

ANS:   C

The nurse should question administration of a glucocorticoid to a patient with a fungal infection, because the drug could mask the symptoms of a systemic-wide infection.

The use of glucocorticoids in a patient with systemic lupus erythematosus is expected, because it is an autoimmune disorder that would respond to glucocorticoid intervention.

The use of glucocorticoids in a patient with rheumatoid arthritis is expected, because it is an autoimmune disorder that would respond to glucocorticoid intervention.

The use of glucocorticoids in a patient with asthma is expected, because it is an inflammatory disorder that would respond to glucocorticoid intervention.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 850

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies