A 38-year-old female has been on corticosteroids for several months to manage severe asthma exacerbations. The patient reports weight gain, feeling anxious, experiencing insomnia, and noticing increased facial hair growth. Which of the following is the most likely explanation for these symptoms?

Cushing's syndrome

Adrenal insufficiency

Diabetes mellitus

Dystonia

Answer and Explanation

The Correct Answer is A

A. Cushing's syndrome: Prolonged use of corticosteroids can lead to iatrogenic Cushing's syndrome. Common features include weight gain (especially central), mood changes such as anxiety or irritability, insomnia, and physical changes like hirsutism (increased facial hair), moon face, and truncal obesity due to chronic hypercortisolism.
B. Adrenal insufficiency: This condition typically results from abrupt withdrawal of corticosteroids, leading to fatigue, hypotension, and electrolyte imbalances. It does not cause the excess cortisol-related symptoms described in this patient’s presentation.
C. Diabetes mellitus: While corticosteroids can raise blood glucose levels and increase the risk for diabetes, the described symptoms—particularly the weight distribution and hirsutism—are more indicative of Cushing’s syndrome than diabetes.
D. Dystonia: Dystonia involves involuntary muscle contractions causing repetitive movements or abnormal postures. It is not associated with the metabolic and hormonal effects caused by long-term corticosteroid use.

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Correct Answer is A

Explanation

A. "The risk of suicidal thoughts is highest during the first few weeks of treatment.": This is the most accurate statement. During the initial weeks of antidepressant therapy, especially in adolescents and young adults, the risk of suicidal ideation may increase as energy levels improve before mood stabilizes. Close monitoring during this period is critical.
B. "Antidepressants eliminate the risk of suicidal thoughts in all patients.": While antidepressants help many patients, they do not eliminate the risk of suicidal thoughts. Some individuals may continue to experience or even develop new suicidal ideation, particularly early in treatment.
C. "Suicidal thoughts are a common side effect experienced by most patients.": Suicidal ideation is a serious but not common side effect. It occurs in a subset of patients, particularly younger individuals, and must be monitored closely, but it is not experienced by the majority.
D. "Suicidal thoughts only occur in patients with a history of suicide attempts.": Suicidal ideation can develop in individuals without a previous history. Risk factors include age, underlying psychiatric conditions, and individual response to medication—not just past behavior.

A. Advise the parent to discontinue the medication immediately. B. Encourage the parent to eliminate all snacks between meals to promote hunger at mealtimes. C. Encourage the parent to increase the child's physical activity to stimulate appetite. D. Encourage the parent to make breakfast the most important meal of the day before administering the medication.

Correct Answer is D

Explanation

A. Advise the parent to discontinue the medication immediately: Discontinuing the medication without consulting the healthcare provider is unsafe. Stimulants are effective in managing ADHD symptoms, and any adjustments should be made under medical supervision. Abrupt cessation may lead to a return or worsening of symptoms.
B. Encourage the parent to eliminate all snacks between meals to promote hunger at mealtimes: While reducing snacks may improve appetite, it can also result in missed opportunities for nutrient intake, especially when the child already has a reduced appetite due to the medication. This intervention is not the most appropriate or immediate.
C. Encourage the parent to increase the child's physical activity to stimulate appetite: Physical activity can naturally increase appetite over time, but it is not the most direct or effective strategy for managing stimulant-induced appetite suppression. This approach is more of a long-term supportive strategy.
D. Encourage the parent to make breakfast the most important meal of the day before administering the medication: Stimulant medications commonly reduce appetite, especially later in the day. Ensuring the child eats a nutritious breakfast before taking the medication helps maximize calorie and nutrient intake when appetite is highest. This is the most appropriate initial nursing intervention.

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A 38-year-old female has been on corticosteroids for several months to manage severe asthma exacerbations. The patient reports weight gain, feeling anxious, experiencing insomnia, and noticing increased facial hair growth. Which of the following is the most likely explanation for these symptoms?

Nursing Test Bank

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Correct Answer is D

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