NurseDive Free Nursing Practice Question

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:

1. 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.
2. 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.
3. 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.

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.

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.