Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A client with diabetes mellitus is being admitted to the hospital for surgery. The client has been taking Glucocorticoids (Prednisone) long-term for uncontrolled COPD. Which of the following must the nurse consider when she is obtaining a health history? (Select All that Apply.)
A. Due to the use of long-term glucocorticoids her medication must not be abruptly discontinued to avoid adrenal suppression
B. The client may develop low blood pressure
C. The use of long-term glucocorticoids places the client at risk for increased susceptibility to infection
D. The use of long-term glucocorticoids may have contributed to a spike in blood glucose levels
E. The client will most likely experience more pain
This question is an excerpt from Nurse Dive's nursing test bank - ATI NUR 229 Pharmacology Test #1 OEK Proctored Exam. Take the full exam now
Full Explanation
The nurse must consider the following when obtaining a health history for a client with diabetes mellitus who has been taking glucocorticoids (prednisone) long-term for uncontrolled COPD:
- Due to the use of long-term glucocorticoids, the medication must not be abruptly discontinued to avoid adrenal suppression. Abruptly stopping glucocorticoids can lead to adrenal insufficiency and a potentially life-threatening condition. Gradual tapering of the medication is necessary under medical supervision.
- The use of long-term glucocorticoids may contribute to a spike in blood glucose levels. Glucocorticoids can cause insulin resistance and increase blood sugar levels, which can be problematic for individuals with diabetes mellitus.
- The use of long-term glucocorticoids places the client at risk for increased susceptibility to infection. Glucocorticoids can suppress the immune system, making the client more susceptible to infections. This is important to consider, especially in a hospital setting where the risk of acquiring infections may be higher.
Regarding the other options:
The client may develop low blood pressure: While glucocorticoids can cause fluid retention and increased blood pressure, they are not typically associated with low blood pressure.
The client will most likely experience more pain: The use of glucocorticoids is not directly related to increased pain perception. Pain management may be influenced by various factors, but it is not specifically attributed to long-term glucocorticoid use.
Similar Questions
A nurse is teaching a client about taking an expectorant to treat a cough. The nurse should explain that this type of medication has which of the following actions?
A. Reduces inflammation
B. Dries mucous membranes
C. Stimulates secretions
Expectorants are medications that help to loosen and thin mucus in the respiratory tract, making it easier to cough up and expel. They work by increasing the production of respiratory tract secretions, which helps to hydrate and thin the mucus, making it less sticky and easier to clear from the airways. By stimulating the production and secretion of mucus, expectorants promote coughing and facilitate the removal of excess mucus and phlegm from the respiratory system. It's important to note that expectorants are primarily used for productive coughs (coughs that produce phlegm or mucus). If the cough is dry and non-productive, other types of cough suppressants or remedies may be more appropriate.
D. Suppresses the urge to cough
Full Explanation
Expectorants are medications that help to loosen and thin mucus in the respiratory tract, making it easier to cough up and expel. They work by increasing the production of respiratory tract secretions, which helps to hydrate and thin the mucus, making it less sticky and easier to clear from the airways. By stimulating the production and secretion of mucus, expectorants promote coughing and facilitate the removal of excess mucus and phlegm from the respiratory system.
It's important to note that expectorants are primarily used for productive coughs (coughs that produce phlegm or mucus). If the cough is dry and non-productive, other types of cough suppressants or remedies may be more appropriate.
Regarding the other options:
Reduces inflammation: Expectorants do not have a direct effect on reducing inflammation in the respiratory tract. Anti-inflammatory medications such as glucocorticoids are typically used for reducing inflammation in conditions like asthma or chronic obstructive pulmonary disease (COPD).
Dries mucous membranes: Expectorants do not have a drying effect on mucous membranes. In fact, they work to increase the hydration and fluidity of respiratory secretions.
Suppresses the urge to cough: Expectorants do not suppress the urge to cough. They promote coughing by facilitating the clearance of mucus and phlegm from the airways. Cough suppressants, on the other hand, are medications used to relieve a dry, non-productive cough by suppressing the cough reflex.
Fluticasone (Flonase) a nasal glucocorticoid has been prescribed for a client with allergic rhinitis. The nurse teaches the client which is the most common side effect of continuous use.
A. Dry nasal mucosa and nosebleeds
Nasal glucocorticoids are commonly used to treat allergic rhinitis and work by reducing inflammation in the nasal passages. However, one of the potential side effects of using these medications is the drying of the nasal mucosa, which can lead to discomfort and occasional nosebleeds. It is important for clients to be aware of this side effect and to take appropriate measures to mitigate it, such as using a humidifier, staying hydrated, and gently applying a saline nasal spray if needed. Rhinorrhea refers to a runny nose and is not a common side effect of fluticasone or other nasal glucocorticoids. Dizziness and hallucinations are also not typical side effects associated with the use of fluticasone. However, it is important to note that individual responses to medications can vary, and if a client experiences any unusual or concerning side effects while taking fluticasone, they should consult their healthcare provider for further evaluation.
B. Rhinorrhea
C. Dizziness
D. Hallucinations
Full Explanation
Nasal glucocorticoids are commonly used to treat allergic rhinitis and work by reducing inflammation in the nasal passages. However, one of the potential side effects of using these medications is the drying of the nasal mucosa, which can lead to discomfort and occasional nosebleeds. It is important for clients to be aware of this side effect and to take appropriate measures to mitigate it, such as using a humidifier, staying hydrated, and gently applying a saline nasal spray if needed.
Rhinorrhea refers to a runny nose and is not a common side effect of fluticasone or other nasal glucocorticoids. Dizziness and hallucinations are also not typical side effects associated with the use of fluticasone. However, it is important to note that individual responses to medications can vary, and if a client experiences any unusual or concerning side effects while taking fluticasone, they should consult their healthcare provider for further evaluation.
Client teaching regarding the use of leukotriene receptor antagonist (LTRAS) drug such as Montelukast (Singulair) would include which statement by the nurse?
A. Take the medication when you are short of breath and begin wheezing.
B. It will take about 3 or 4 weeks before you notice a therapeutic effect.
C. Increase fiber and fluid in your diet to prevent the common adverse effect of constipation
D. This medication works by preventing the inflammation that causes your asthma attacks.
Leukotriene receptor antagonists (LTRAs) like Montelukast are commonly used in the treatment of asthma. They work by blocking the action of leukotrienes, which are inflammatory substances that can cause narrowing and inflammation of the airways in individuals with asthma. By preventing this inflammation, LTRAs help to reduce asthma symptoms and prevent asthma attacks.
Full Explanation
Leukotriene receptor antagonists (LTRAs) like Montelukast are commonly used in the treatment of asthma. They work by blocking the action of leukotrienes, which are inflammatory substances that can cause narrowing and inflammation of the airways in individuals with asthma. By preventing this inflammation, LTRAs help to reduce asthma symptoms and prevent asthma attacks.
The other options mentioned in the statements are not accurate or appropriate for teaching about Montelukast. Taking the medication only when experiencing symptoms is not the recommended approach, as LTRAs are typically taken regularly as part of ongoing asthma management. The statement about the therapeutic effect taking several weeks to notice is not accurate, as Montelukast can start to provide symptom relief within a shorter timeframe.
Additionally, the statement about increasing fiber and fluid intake to prevent constipation is unrelated to the use of Montelukast and may not apply to this medication specifically.