Chapter 51: Glucocorticoids

Chapter 51: Glucocorticoids

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A patient has been taking oral prednisone 60 mg daily for 3 days for an asthma exacerbation, which has resolved. The patient reports having gastrointestinal (GI) upset. The primary care nurse practitioner (NP) should:

ANS:  A

The patient’s asthma symptoms have resolved, so the prednisone may be discontinued. If the patient has been on the medication for a few days, it is not necessary to taper the dose before the patient stops taking it. If the patient required long-term dosing of the steroid, a PPI could be used. Every-other-day dosing is used. Alternate-day dosing is sometimes used for long-term therapy to minimize suppression of the hypothalamic-pituitary-adrenal (HPA) axis.

DIF:    Cognitive Level: Applying (Application)                           REF:   576

2. A patient will require a long course of steroids to treat a chronic inflammatory condition. The primary care NP expects the specialist to order:

ANS:  C

Hydrocortisone is a short-acting glucocorticoid. The use of a short-acting agent and an alternate-day dosage regimen should be considered for long-term therapy. Prednisone and triamcinolone are medium-acting glucocorticoids. Dexamethasone is a long-acting glucocorticoid.

DIF:    Cognitive Level: Applying (Application)                           REF:   576

3. A 7-year-old patient who has severe asthma takes oral prednisone daily. At a well-child examination, the primary care NP notes a decrease in the child’s linear growth rate. The NP should consult the child’s asthma specialist about:

ANS:  C

Administration of a double dose of a glucocorticoid every other morning has been found to cause less suppression of the HPA axis and less growth suppression in children. Because the child has severe asthma, an oral steroid is necessary. Growth hormone therapy is not indicated. Twice-daily dosing would not change the HPA axis suppression.

DIF:    Cognitive Level: Applying (Application)                           REF:   576

4. A 70-year-old patient with COPD who is new to the clinic reports taking 10 mg of prednisone daily for several years. The primary care NP should:

ANS:  B

Serum glucose and potassium levels are part of monitoring for side effects of steroids. Because elderly patients are more prone to certain potential catabolic adverse effects of steroid therapy, caution is required. Osteoporosis is often seen with elderly patients, so bone density testing should be performed. The medication dosing regimen should not be changed unless there is an indication of adverse effects.

DIF:    Cognitive Level: Applying (Application)                           REF:   577