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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: This statement is false. Nephropathy is a term that refers to any disease or damage of the kidneys. Acetaminophen overdose can cause nephropathy, but it is not the most serious toxic effect. Nephropathy can manifest as reduced urine output, increased blood urea nitrogen and creatinine levels, and electrolyte imbalance.
Choice B reason: This statement is false. Tachycardia is a term that refers to a fast heart rate, usually more than 100 beats per minute. Acetaminophen overdose can cause tachycardia, but it is not the most serious toxic effect. Tachycardia can be a sign of dehydration, fever, pain, or anxiety.
Choice C reason: This statement is true. Liver dysfunction is the most serious toxic effect of acute acetaminophen overdose. Acetaminophen is metabolized by the liver and can produce a toxic byproduct that damages the liver cells. Liver dysfunction can manifest as jaundice, abdominal pain, nausea, vomiting, and elevated liver enzymes.
Choice D reason: This statement is false. Central nervous system depression is a term that refers to a reduced level of consciousness, alertness, and responsiveness. Acetaminophen overdose can cause central nervous system depression, but it is not the most serious toxic effect. Central nervous system depression can be a sign of hypoxia, hypoglycemia, or drug intoxication.
Correct Answer is C
Explanation
Choice A reason: This statement is false. 3% Sodium Chloride is a hypertonic solution that can cause fluid overload, hypernatremia, and cellular dehydration. It is not indicated for a patient with nausea, vomiting, and Salmonella infection, who is likely to have fluid and electrolyte losses.
Choice B reason: This statement is false. Dextrose 10% in water is a hypotonic solution that can cause fluid shifts, hyponatremia, and cellular edema. It is not indicated for a patient with nausea, vomiting, and Salmonella infection, who is likely to have fluid and electrolyte losses.
Choice C reason: This statement is true. 0.9% Sodium Chloride with 40 mEq Potassium (KCl) is an isotonic solution that can maintain fluid and electrolyte balance. It is indicated for a patient with nausea, vomiting, and Salmonella infection, who is likely to have fluid and electrolyte losses, especially sodium and potassium.
Choice D reason: This statement is false. Lactated Ringers is an isotonic solution that can maintain fluid and electrolyte balance, but it also contains lactate, which can be converted to bicarbonate in the liver. It is not indicated for a patient with nausea, vomiting, and Salmonella infection, who may have metabolic acidosis due to diarrhea and lactate accumulation.
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