A client with COPD exacerbation has been ordered oral prednisone to be tapered over two weeks. Which of the following side effects does the nurse recognize could occur during prednisone therapy? [Select all that apply.]

Hyperglycemia

Hyperkalemia

Fluid retention

Gl distress

Hypotension

Answer and Explanation

Correct Answer : A,C,D

A) Hyperglycemia:
Prednisone, a glucocorticoid, can increase blood glucose levels by stimulating the liver to produce more glucose and decreasing the effectiveness of insulin. This can lead to hyperglycemia, particularly in individuals who are predisposed to diabetes or glucose intolerance. Therefore, monitoring blood glucose levels is important during prednisone therapy, especially in clients with a history of diabetes or those at risk for developing it.

B) Hyperkalemia:
Prednisone and other corticosteroids typically decrease potassium levels rather than increase them. This occurs because corticosteroids can promote the excretion of potassium in the kidneys. Hyperkalemia is not a common side effect of prednisone therapy. In fact, hypokalemia (low potassium) is more likely to occur, so this is not a concern for clients receiving prednisone.

C) Fluid retention:
One of the common side effects of prednisone is fluid retention due to its effect on the kidneys and the way it can increase sodium reabsorption. This can lead to edema (swelling), especially in the lower extremities, and could also contribute to an increase in blood pressure. Clients taking prednisone, particularly in higher doses or for extended periods, should be monitored for signs of fluid retention and hypertension.

D) GI distress:
Gastrointestinal distress, including gastritis, ulcers, or nausea, is a common side effect of prednisone and other corticosteroids. The risk is higher if the medication is taken on an empty stomach or at high doses. To minimize this, prednisone is typically taken with food or milk, and clients are monitored for signs of GI irritation.

E) Hypotension:
Prednisone can cause increased blood pressure due to fluid retention and the resulting increased blood volume. It can also affect the balance of sodium and potassium, contributing to hypertension rather than hypotension. Hypotension is not a typical side effect of prednisone therapy, and the nurse should be vigilant for signs of high blood pressure rather than low.

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Correct Answer is D

Explanation

A) Assess the client's potassium level:
While electrolyte imbalances, including low potassium, can contribute to symptoms like restlessness or muscle weakness, it is not the first priority in a client with COPD who suddenly becomes restless and anxious. Restlessness and anxiety in this context are more likely to be due to hypoxia (low oxygen levels), hypercapnia (high carbon dioxide levels), or respiratory distress.

B) Check the client's temperature:
An elevated temperature may indicate an infection, such as pneumonia or a respiratory tract infection, which can exacerbate COPD symptoms. However, in the context of sudden restlessness and anxiety, this is less likely to be the most immediate cause. The primary concern should be addressing the potential respiratory issues, such as hypoxia or acute exacerbation, rather than focusing on fever, unless other signs of infection are present.

C) Increase the client's oxygen flow rate to 15 L/min:
While it is important to ensure adequate oxygenation in a client with COPD, increasing the oxygen flow rate to 15 L/min may not be appropriate, as COPD patients are typically at risk for oxygen-induced hypercapnia. These patients often rely on low levels of oxygen to stimulate breathing, and administering high-flow oxygen can suppress their respiratory drive, potentially worsening carbon dioxide retention.

D) Encourage the client to perform pursed-lip breathing:
Pursed-lip breathing is a highly effective technique for COPD patients to help increase oxygenation and decrease the work of breathing. This technique involves the client breathing in through the nose and exhaling slowly through pursed lips, which helps to keep the airways open longer and facilitates the removal of trapped air in the lungs.

A. Administering oxygen via nasal cannula at 2 U/min B. Helping the client select a low-salt diet C. Maintaining a semi-Fowler's position as often as possible D. Encouraging the client to drink 2 to 3 L of water daily

Correct Answer is D

Explanation

A) Administering oxygen via nasal cannula at 2 L/min:
Oxygen therapy may be necessary for clients with COPD, but in this case, the primary concern is thick, tenacious bronchial secretions that the client cannot clear. Administering oxygen may be appropriate if the client has low oxygen saturation, but it does not directly address the difficulty in expectorating sputum. The focus should be on hydration and mobilization of secretions, rather than oxygen administration alone.

B) Helping the client select a low-salt diet:
While a low-salt diet is important for clients with conditions like hypertension or heart failure, it is not directly relevant to the issue of tenacious bronchial secretions in COPD. The priority in this scenario is to improve the client’s ability to clear the thick mucus, which is more effectively addressed by hydration rather than dietary changes.

C) Maintaining a semi-Fowler's position as often as possible:
Positioning the client in a semi-Fowler's position can help improve lung expansion and facilitate breathing. It can also reduce the work of breathing and increase comfort. However, while this is a helpful positioning strategy, it is not the most direct intervention to address the client’s difficulty with expectoration. The client’s difficulty with mucus clearance is best addressed with hydration to thin the secretions.

D) Encouraging the client to drink 2 to 3 L of water daily:
Hydration is one of the most important interventions for clients with COPD who have tenacious bronchial secretions. Adequate fluid intake helps to thin mucus, making it easier to cough up and clear from the airways. This intervention directly addresses the client’s complaint of not being able to bring up mucus, making it the most appropriate action to take.

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A client with COPD exacerbation has been ordered oral prednisone to be tapered over two weeks. Which of the following side effects does the nurse recognize could occur during prednisone therapy? [Select all that apply.]

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Correct Answer is D

Explanation

Correct Answer is D

Explanation

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