A client has been placed on corticosteroid therapy for Addison's disease. The nurse should be aware of which of the following side effects associated with this type of therapy? (Select all that apply)
Weight loss
Poor wound healing
Hypertension
Hypotension
Alterations in glucose metabolism
Correct Answer : B,C,E
Reasoning:
Choice A reason: Weight loss is not a typical side effect of corticosteroid therapy for Addison’s disease. Corticosteroids mimic cortisol, promoting weight gain through increased appetite and fat redistribution. Weight loss is more common in untreated Addison’s disease due to cortisol deficiency and reduced appetite.
Choice B reason: Poor wound healing is a side effect of corticosteroids, as they suppress immune responses and inhibit collagen synthesis. This impairs fibroblast activity and tissue repair, increasing infection risk and delaying wound closure, a significant concern for patients on long-term therapy for Addison’s disease.
Choice C reason: Hypertension is a common side effect of corticosteroids due to their mineralocorticoid effects, which increase sodium and water retention, elevating blood volume and pressure. This is particularly relevant in Addison’s disease treatment, where corticosteroids restore deficient aldosterone and cortisol, potentially causing fluid overload.
Choice D reason: Hypotension is not a side effect of corticosteroid therapy but a symptom of untreated Addison’s disease due to aldosterone deficiency, causing sodium loss and hypovolemia. Corticosteroid therapy corrects this, so hypotension is unlikely unless under-dosed or during acute crisis.
Choice E reason: Alterations in glucose metabolism are a side effect of corticosteroids, which induce insulin resistance and increase gluconeogenesis, leading to hyperglycemia. In Addison’s disease, corticosteroids replace deficient cortisol, but excess dosing can mimic Cushing’s syndrome, causing elevated blood glucose and requiring careful monitoring.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Reasoning:
Choice A reason: Consuming adequate fluids is essential in diabetes insipidus to replace the large volumes of water lost through polyuria due to ADH deficiency. Adequate hydration prevents dehydration, maintains electrolyte balance, and alleviates excessive thirst, supporting the body’s compensatory mechanisms to manage the high urine output characteristic of this condition.
Choice B reason: Daily IV fluid therapy is not a practical or necessary intervention for diabetes insipidus. While severe dehydration may require IV fluids, oral hydration is sufficient for most patients to manage polyuria. Regular clinic visits for IV therapy are invasive, costly, and not standard for controlling thirst or fluid loss.
Choice C reason: Limiting fluid intake at night is counterproductive in diabetes insipidus, as it exacerbates dehydration caused by excessive urine output. Patients need to maintain hydration to compensate for water loss and reduce thirst. Restricting fluids could worsen symptoms and lead to complications like hypernatremia or hypovolemia.
Choice D reason: Daily weighing monitors fluid status but does not directly control thirst or compensate for urine loss in diabetes insipidus. While useful for assessing treatment response, it is a passive measure and does not address the active need to replace fluid losses through adequate oral intake to manage symptoms.
Correct Answer is C
Explanation
Reasoning:
Choice A reason: A blood pressure of 150/90 mm Hg is not an absolute contraindication for thrombolytic therapy. While hypertension must be controlled (below 185/110 mm Hg) before thrombolytics, it is manageable with medication, unlike hemorrhagic stroke, which poses an immediate and absolute risk of worsening bleeding.
Choice B reason: Previous thrombolytic therapy within 12 months is not an absolute contraindication. Guidelines restrict thrombolytics within a shorter timeframe (e.g., recent major surgery), but prior therapy alone does not preclude use. Hemorrhagic stroke is a definitive contraindication due to the risk of catastrophic bleeding.
Choice C reason: Evidence of hemorrhagic stroke is an absolute contraindication for thrombolytic therapy, as thrombolytics like tPA dissolve clots, increasing bleeding in an already hemorrhagic brain. This risks worsening intracranial hemorrhage, leading to neurological deterioration or death, making it a critical exclusion criterion.
Choice D reason: Evidence of stroke evolution, such as progressing symptoms, is not an absolute contraindication. It may influence timing or eligibility, but thrombolytics can still be used within the time window if ischemic. Hemorrhagic stroke is a definitive barrier due to bleeding risk.
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