Which information obtained by the nurse in the endocrine 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 stopped taking the medication 2 days ago

Patient has not been taking the prescribed vitamin D

Patient has bilateral 2+ pitting ankle edema

Patient's blood pressure is 148/94 mm Hg

Answer and Explanation

The Correct Answer is A

Choice A reason: Patient stopped taking the medication 2 days ago is the most important information to report to the health care provider. Prednisone is a corticosteroid medication that suppresses the immune system and reduces inflammation. Prednisone also affects the production of cortisol, a hormone that regulates the stress response, blood pressure, blood sugar, and metabolism. Prednisone should not be stopped abruptly, as this can cause adrenal insufficiency, a condition where the adrenal glands cannot produce enough cortisol. Adrenal insufficiency can cause symptoms such as fatigue, weakness, nausea, vomiting, low blood pressure, and hypoglycemia. The patient should be instructed to resume taking the prednisone and taper the dose gradually under the supervision of the health care provider.

Choice B reason: Patient has not been taking the prescribed vitamin D is not as important as choice A, but still requires further education by the nurse. Vitamin D is a fat-soluble vitamin that helps the body absorb calcium and phosphorus, and maintain bone health. Prednisone can interfere with the metabolism of vitamin D and cause bone loss, osteoporosis, and fractures. The patient should be advised to take the prescribed vitamin D supplement and eat foods rich in vitamin D, such as fatty fish, egg yolks, cheese, and fortified milk.

Choice C reason: Patient has bilateral 2+ pitting ankle edema is not as critical as choice A, but still needs to be monitored by the nurse. Ankle edema is swelling of the ankles due to fluid accumulation in the tissues. Prednisone can cause ankle edema by increasing the sodium and water retention in the body, and reducing the potassium excretion by the kidneys. The patient should be assessed for signs of fluid overload, such as weight gain, shortness of breath, and crackles in the lungs. The patient should also be encouraged to limit the intake of salt and fluids, and elevate the legs when sitting or lying down.

Choice D reason: Patient's blood pressure is 148/94 mm Hg is not as urgent as choice A, but still needs to be addressed by the nurse. Blood pressure is the force of blood against the walls of the arteries. Prednisone can increase the blood pressure by stimulating the renin-angiotensin-aldosterone system, a hormonal system that regulates the blood volume and pressure. The patient should be advised to check the blood pressure regularly, and report any readings above 140/90 mm Hg to the health care provider. The patient should also be counseled to follow a healthy lifestyle, such as exercising, quitting smoking, reducing stress, and eating a balanced diet low in sodium, fat, and cholesterol.

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Correct Answer is B

Explanation

Choice A reason: This statement is false. Drinking more fluids in the late evening can cause nocturia, which is the need to urinate frequently at night. This can disrupt the sleep cycle and increase the risk of falls.

Choice B reason: This statement is true. Dry mouth is a sign of dehydration and indicates the need for more fluid intake. Older adults may have reduced thirst sensation and may not drink enough fluids throughout the day.

Choice C reason: This statement is false. Caffeine is a diuretic, which means it increases urine output and can worsen dehydration. Confusion is a symptom of dehydration and requires immediate medical attention.

Choice D reason: This statement is false. Feeling full is not a reliable indicator of hydration status. Older adults may have decreased appetite and gastric motility, which can make them feel full even when they are dehydrated.

A. This client may have a high tolerance to opioids and require a higher dose for pain control B. Clients with a history of opioid abuse should not be given an opioid analgesic C. This client should wait until their pain is severe, 10/10 before taking a high dose opioid D. The client's self-report of pain may not be trusted if they have a history of opioid abuse

Correct Answer is A

Explanation

Choice A reason: This statement is true. This client may have a high tolerance to opioids and require a higher dose for pain control, as tolerance is a condition where the body becomes less responsive to the effects of a drug over time, and needs more of the drug to achieve the same effect. Tolerance can develop from chronic or repeated use of opioids, and can vary from person to person. The nurse should assess the client's pain level, history of opioid use, and response to the medication, and adjust the dose accordingly.

Choice B reason: This statement is false. Clients with a history of opioid abuse should not be denied an opioid analgesic, as opioids are effective and appropriate medications for acute pain management, especially after surgery. The nurse should not discriminate or stigmatize the client based on their history of opioid abuse, but rather provide compassionate and evidence-based care. The nurse should also use a multimodal approach to pain management, which involves using non-opioid analgesics, adjuvant medications, and non-pharmacological interventions, such as ice, heat, massage, or relaxation techniques.

Choice C reason: This statement is false. This client should not wait until their pain is severe, 10/10 before taking a high dose opioid, as this can result in poor pain control, increased stress, and delayed recovery. The nurse should encourage the client to take the medication as prescribed, and to report their pain level regularly. The nurse should also educate the client about the benefits of preventive analgesia, which involves taking the medication before the pain becomes severe, and maintaining a steady blood level of the drug.

Choice D reason: This statement is false. The client's self-report of pain may not be disregarded if they have a history of opioid abuse, as pain is a subjective and personal experience, and the client is the best judge of their own pain. The nurse should not assume that the client is exaggerating, lying, or drug-seeking, but rather respect and validate the client's pain report. The nurse should also use objective indicators of pain, such as vital signs, facial expressions, body movements, and behavioral changes, to support the client's pain assessment.

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Which information obtained by the nurse in the endocrine 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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is A

Explanation

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