Test Bank - Focus on Nursing Pharmacology (8th Edition by Karch)
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:
Fludrocortisone’s 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 infant’s 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 nurse’s 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 patient’s 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.
7. A nurse is providing patient education to a patient who has had corticosteroids
prescribed. What drug will the nurse teach the patient to avoid while taking the
corticosteroids?
a. Aspirin
b. Dimenhydrinate (Dramamine)
c. Ibuprofen (Advil)
d. Famotidine (Pepcid)
Ans: A
Feedback:
, Serum levels and effectiveness may decrease if corticosteroids are combined with
salicylates. Dimenhydrinate, ibuprofen, and famotidine have not been found to
produce drugdrug interaction.
8. The nurse is caring for a patient with a heightened stress response following a
fearful experience. When assessing this patient, what findings will the nurse
attribute to this response? (Select all that apply.)
a. Elevated serum blood glucose
b. Reduced inflammatory response
c. Heightened immune response
d. Increased blood volume
e. Extreme hunger
Ans: A, B, D
Feedback:
The stress response causes an increase in blood volume and a release of glucose for
energy. It also slows the rate of protein production and blocks the activities of the
inflammatory and immune systems, which reserves energy. This patient is unlikely to
be hungry.
9. The nurse is providing patient education to a patient taking a glucocorticoid and
advises the patient to take his or her medication at what time of the day?
a. At bedtime
b. With the noon meal
c. At 3:00 PM
d. Immediately on awakening in the morning
Ans: D
Feedback:
Glucocorticoids should be taken immediately on awaking in the morning to mimic the
normal diurnal pattern. The peak levels of cortisol usually come between 6:00 and
8:00 AM. The levels then fall off slowly and reach a low in the late evening with the
lowest levels around midnight. For those patients who work night shifts, the schedule
would be changed to accommodate their sleep pattern. Waiting until later in the day
could result in sleeplessness.
10. An 8-year-old with asthma has been prescribed triamcinolone (Aristocort). What
dosage of medication would the nurse appropriately deliver?
a. One inhalation per day
b. One inhalation b.i.d.
c. Two inhalations every 3 hours
d. Two inhalations t.i.d.
Ans: D
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:
Fludrocortisone’s 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 infant’s 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 nurse’s 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 patient’s 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.
7. A nurse is providing patient education to a patient who has had corticosteroids
prescribed. What drug will the nurse teach the patient to avoid while taking the
corticosteroids?
a. Aspirin
b. Dimenhydrinate (Dramamine)
c. Ibuprofen (Advil)
d. Famotidine (Pepcid)
Ans: A
Feedback:
, Serum levels and effectiveness may decrease if corticosteroids are combined with
salicylates. Dimenhydrinate, ibuprofen, and famotidine have not been found to
produce drugdrug interaction.
8. The nurse is caring for a patient with a heightened stress response following a
fearful experience. When assessing this patient, what findings will the nurse
attribute to this response? (Select all that apply.)
a. Elevated serum blood glucose
b. Reduced inflammatory response
c. Heightened immune response
d. Increased blood volume
e. Extreme hunger
Ans: A, B, D
Feedback:
The stress response causes an increase in blood volume and a release of glucose for
energy. It also slows the rate of protein production and blocks the activities of the
inflammatory and immune systems, which reserves energy. This patient is unlikely to
be hungry.
9. The nurse is providing patient education to a patient taking a glucocorticoid and
advises the patient to take his or her medication at what time of the day?
a. At bedtime
b. With the noon meal
c. At 3:00 PM
d. Immediately on awakening in the morning
Ans: D
Feedback:
Glucocorticoids should be taken immediately on awaking in the morning to mimic the
normal diurnal pattern. The peak levels of cortisol usually come between 6:00 and
8:00 AM. The levels then fall off slowly and reach a low in the late evening with the
lowest levels around midnight. For those patients who work night shifts, the schedule
would be changed to accommodate their sleep pattern. Waiting until later in the day
could result in sleeplessness.
10. An 8-year-old with asthma has been prescribed triamcinolone (Aristocort). What
dosage of medication would the nurse appropriately deliver?
a. One inhalation per day
b. One inhalation b.i.d.
c. Two inhalations every 3 hours
d. Two inhalations t.i.d.
Ans: D
