Which information obtained by the nurse in the clinic about a patient who has been taking prednisone 40 mg daily for 3 weeks is most important to report to the health care provider?
Patient's blood pressure is 148/84 mm Hg.
Patient has not been taking the prescribed vitamin D.
Patient stopped taking the prednisone abruptly 2 days ago.
Patient has bilateral 2+ pitting ankle edema.
The Correct Answer is C
Choice A reason: An elevated blood pressure of 148/84 mm Hg is significant and could be related to prednisone use, as corticosteroids can increase blood pressure. However, this finding alone is not as urgent as the abrupt cessation of prednisone, which can lead to adrenal insufficiency and other serious complications.
Choice B reason: Not taking prescribed vitamin D is important, especially in long-term corticosteroid therapy, as vitamin D helps mitigate the risk of bone density loss. However, this issue is not as immediately critical as abruptly stopping prednisone.
Choice C reason: Stopping prednisone abruptly after taking it for 3 weeks is critical information that must be reported to the healthcare provider immediately. Prednisone is a corticosteroid that suppresses the adrenal glands' ability to produce natural steroids. Abrupt discontinuation can lead to adrenal insufficiency, which can be life-threatening. Symptoms of adrenal insufficiency include severe fatigue, weakness, body aches, low blood pressure, and potential shock. Gradual tapering is required to allow the adrenal glands to recover and resume natural steroid production.
Choice D reason: Bilateral 2+ pitting ankle edema is a notable finding and may indicate fluid retention, which can be a side effect of prednisone. While it is important and requires monitoring, it does not carry the same immediate risk as the abrupt cessation of the medication.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Asking the patient why the wandering episodes have occurred might not be effective because patients with Alzheimer's disease often have memory and cognitive impairments that make it difficult for them to understand or articulate the reasons for their behavior. Additionally, it may not address the immediate safety concerns associated with wandering.
Choice B reason: Placing the patient in a room close to the nurse's station is a practical and effective measure to enhance patient safety. Proximity to the nurse's station allows for closer supervision and quicker response if the patient attempts to wander. This action helps prevent potential accidents and ensures that the patient receives timely interventions if needed. It is a proactive approach to managing the wandering behavior commonly seen in patients with Alzheimer's disease.
Choice C reason: Reorienting the patient several times daily is an important aspect of care for individuals with Alzheimer's disease, as it can help reduce confusion and anxiety. However, this alone may not be sufficient to prevent wandering. While reorientation is beneficial, the immediate safety of the patient requires additional measures, such as close supervision.
Choice D reason: Having the family bring in familiar items can provide comfort and a sense of security for the patient, which is important in managing Alzheimer's disease. Familiar objects may help reduce anxiety and agitation, but they do not directly address the safety concerns associated with wandering. This action should be part of a comprehensive care plan that includes measures to prevent wandering and ensure patient safety.
Correct Answer is B
Explanation
Choice A reason: While CT or MRI scans can be helpful in identifying structural changes in the brain associated with dementia, such as atrophy or the presence of strokes, they are not sufficient on their own to diagnose dementia. These imaging techniques are often used to rule out other causes of cognitive impairment and to support a clinical diagnosis, but they do not provide a complete picture of a patient's cognitive function.
Choice B reason: Patient history and cognitive assessment are the primary methods for diagnosing dementia. The clinical diagnosis is based on a thorough evaluation of the patient's medical history, including any changes in cognitive function, behavior, and daily living activities. Cognitive assessments, such as the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA), are used to evaluate memory, attention, language, and other cognitive abilities. These assessments help to determine the presence and severity of cognitive impairment and differentiate dementia from other conditions that may cause similar symptoms.
Choice C reason: A brain biopsy is not a standard procedure for diagnosing dementia. It is an invasive procedure that involves taking a small sample of brain tissue for examination under a microscope. While it can provide definitive information about certain types of dementia, such as Creutzfeldt-Jakob disease, it is rarely used due to its invasiveness and associated risks.
Choice D reason: An electroencephalogram (EEG) is a test that measures electrical activity in the brain. It can be useful in diagnosing certain neurological conditions, such as epilepsy, but it is not typically used to diagnose dementia. EEGs do not provide detailed information about cognitive function or the structural changes in the brain associated with dementia.
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