Pharm CH 36 Complete Guide 2024 Questions And Verified Answers (A+)

Pharm CH 36 Complete Guide 2024 Questions And Verified Answers (A+) A 45-year-old woman has been taking a corticosteroid and calls the clinic reporting the development of acne-like lesion on her face as well as facial hair. What is the nurse's best response? "Stop taking the drug immediately." "If you shave it regularly, no one will notice." "Sadly, this is an adverse effect seen in women. It should improve when you finish the medication." "This is a permanent problem. You will need to schedule electrolysis treatments." - Sadly, this is an adverse effect seen in women. It should improve when you finish the medication." Explanation: An adverse effect in women who take corticosteroids is acne and hair on the face. This side effect usually resolves after the medication is discontinued. The drug should never be stopped abruptly but weaned gradually. A 54-year-old woman with a history of asthma is prescribed prednisone to treat an exacerbation of her condition. The nurse is explaining to the client how this medication decreases the immune response. What mechanism of action of the drug causes this? Increase in phagocytosis Decrease in the number of eosinophils Increased antigen-antibody reaction Increase in immunoglobulins - Decrease in the number of eosinophils Explanation: Its immunosuppressant effects are attributable to suppression of phagocytosis, a decrease in the number of circulating eosinophils and lymphocytes, suppression of delayed hypersensitivity reactions, a decrease in antigen-antibody tissue reactions, and a decrease in plasma immunoglobulins. This action of the hormone can leave clients susceptible to infection due to the suppressed immune response. A 72-year-old woman is on long-term glucocorticoid therapy. It will be most important for the nurse to instruct the client to: avoid direct sunlight. take measures to minimize the risk of falls. avoid eating excess red meat. avoid dairy products. - take measures to minimize the risk of falls. Explanation: Long-term glucocorticoid therapy can cause muscle weakness and fatigue, especially in the elderly, and can predispose them to falls. Long-term or high-dose glucocorticoid therapy also places the client at increased risk for osteoporosis, making fractures more likely. Hence, the client should be advised to take measures to minimize the risk of falls. There are no specific precautions related to avoiding direct sunlight during glucocorticoid therapy. A diet that controls carbohydrate and calorie intake is always important, but the client would not need to avoid red meat or dairy products while on glucocorticoid therapy. A child diagnosed with adrenal insufficiency takes PO hydrocortisone daily. The client is followed regularly by a nurse, who assesses the child every 3 months. What assessment data should the nurse prioritize during these assessments? Height and weight Signs of early onset of puberty Gait and range of motion Orientation and level of consciousness - Height and weight Explanation: Long-term hydrocortisone use can significantly impair growth and development in pediatric clients, so the nurse must monitor for this closely. Hydrocortisone does not normally affect level of consciousness or range of motion, and it does not hasten the onset of puberty. A client diagnosed with Cushing's disease is not a surgical candidate and is consequently being treated with ketoconazole. The nurse should be aware that ketoconazole achieves a therapeutic effect by what means? suppressing pituitary secretion of adrenocorticotropic hormone (ACTH) inhibiting the enzymes that contribute to cortisol synthesis antagonizing the cortisol receptors on body cells causing the adrenal cortex to atrophy - inhibiting the enzymes that contribute to cortisol synthesis Explanation: Health care providers use ketoconazole to control cortisol secretion in Cushing's disease. Ketoconazole acts by inhibiting the first step in cortisol biosynthesis and the conversion of deoxycortisol to cortisol. It does not antagonize cortisol receptors, affect the pituitary gland, or induce atrophy of the adrenal cortex. A client diagnosed with Cushing's disease will soon begin treatment with ketoconazole. The nurse should be cognizant of the black box warning for this drug and consequently monitor what laboratory values? White blood cell differential Blood urea nitrogen and creatinine AST, ALT, and GGT Hemoglobin, hematocrit, and red blood cell count - AST, ALT, and GGT Explanation: The FDA has issued a black box warning stating that ketoconazole can cause hepatotoxicity. As a result, monitoring of liver function with AST, ALT, and GGT testing may be a priority over assessment of white cells, red cells, and renal function. A client has been admitted to the emergency department with a diverse constellation of signs and symptoms. What diagnostic finding is most consistent with a diagnosis of Addison disease? serum sodium 128 mEq/L (128 mmol/L) serum potassium 3.9 mEq/L (3.90 mmol/L) serum albumin 4.0 g/dL (40 g/L) blood glucose 75 mg/dL (4.16 mmol/L) - serum sodium 128 mEq/L (128 mmol/L) Explanation: Hyponatremia, a decrease in serum sodium concentration less than 136 mEq/L (136 mmol/L), is characteristic of adrenal insufficiency. Potassium levels are typically elevated greater than approximately 5.0 to 5.5 mEq/L (5.0 to 5.5 mmol/L) in adults. Hypoglycemia is also common, but a blood glucose level of 75 mg/dL (4.16 mmol/L) is within reference ranges. Albumin levels are not usually affected A client is being treated with corticosteroids for chronic adrenocortical insufficiency. Unless otherwise directed, the client should be instructed to take the medication at what time? between 0600 and 0900 any time of day provided it is accompanied by food at bedtime 2100 - between 0600 and 0900 Explanation: Daily administration is required in cases of chronic adrenocortical insufficiency. The entire daily dose can be taken each morning, between 0600 and 0900. This schedule stimulates normal endogenous corticosteroid secretion. Later times would not produce the needed stimulation and desired endogenous corticosteroid secretion. A client is prescribed a corticosteroid to reduce inflammation caused by an autoimmune disorder. Which information would the nurse include when teaching the client about this medication? Stop the medication if weight gain occurs. Take the medication until symptoms subside. There are minimal adverse effects of this medication. The medication is prescribed in gradually decreasing doses. - the medication is prescribed in gradually decreasing doses. Explanation: A common cause of adrenal insufficiency is prolonged use of corticosteroid hormones. When exogenous corticosteroids are used, they interfere with the feedback system and the adrenal glands begin to atrophy because the glands are no longer stimulated to produce or secrete the hormone. It takes several weeks to recover from atrophy caused by lack of stimulation. To prevent adrenal insufficiency in the client taking steroid therapy, doses will be prescribed to gradually taper the client from the hormones. This gives the adrenal glands time to recover and start producing hormones again. The medication should not be abruptly stopped. Weight gain is a common side effect of corticosteroids. The medication should be taken as prescribed and not just until the symptoms subside. Corticosteroids can cause hyperglycemia, edema, and other adverse effects. A client prescribed alternate-day administration of corticosteroids asks the nurse why the drug isn't administered every day. How would the nurse describe the benefit of alternate-day therapy (ADT)? "It increases the production of endogenous corticosteroids." "It allows for faster initial treatment of symptoms." "It minimizes suppression of adrenal function." "It improves adherence to the administration schedule." - "It minimizes suppression of adrenal function." Explanation: High doses of corticosteroids can suppress the hypothalamic-pituitary-adrenal, or HPA, axis, resulting in decreased production of endogenous corticosteroids. Alternate-day therapy (ADT), in which a double dose is taken every other morning, allows rest periods so that adverse effects are decreased while anti-inflammatory effects continue. ADT is used only for maintenance therapy after signs and symptoms have been controlled by more frequent dosing.