Chapter 26 Adrenal Hormones
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
Fludrocortisones 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?
, 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 infants 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 nurses best response?
, 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 drugdrug interaction.
6. A patient who is steroid dependent due to adrenocortical insufficiency calls the clinic and
is very upset, telling the nurse of the extreme stress he or she is experiencing right now.
What does the nurse expect the health care provider will order concerning his or her
medication?
A) The dosage may continue as ordered.
B) The medication may be discontinued until stress declines.
C) The dosage of the medication may be increased.
D) The dosage of the medication may be decreased.
Ans C
Feedback
The patients body will initiate a stress reaction. Normally, activation of the stress
reaction can cause release of adrenocorticotropic hormone (ACTH) and secretion of the
adrenocortical hormones. A patient with adrenocortical insufficiency may not be able to
supplement the increased need for ACTH. The stress reaction may block the immune and
inflammatory systems, making the body more susceptible to pathogens. Therefore, an
increase in medication may be necessary to prevent further adrenal insufficiency and to
meet the increased demands for corticosteroids in the body under stress.
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
Fludrocortisones 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?
, 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 infants 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 nurses best response?
, 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 drugdrug interaction.
6. A patient who is steroid dependent due to adrenocortical insufficiency calls the clinic and
is very upset, telling the nurse of the extreme stress he or she is experiencing right now.
What does the nurse expect the health care provider will order concerning his or her
medication?
A) The dosage may continue as ordered.
B) The medication may be discontinued until stress declines.
C) The dosage of the medication may be increased.
D) The dosage of the medication may be decreased.
Ans C
Feedback
The patients body will initiate a stress reaction. Normally, activation of the stress
reaction can cause release of adrenocorticotropic hormone (ACTH) and secretion of the
adrenocortical hormones. A patient with adrenocortical insufficiency may not be able to
supplement the increased need for ACTH. The stress reaction may block the immune and
inflammatory systems, making the body more susceptible to pathogens. Therefore, an
increase in medication may be necessary to prevent further adrenal insufficiency and to
meet the increased demands for corticosteroids in the body under stress.
