A corticosteroid, prednisone, is prescribed for a client with diabetes mellitus who is using Humulin 70÷30 daily.
Which of the following prescription changes does the nurse expect during the therapy with the prednisone?
Decreased dosage of Humulin 70÷30.
Add an oral hypoglycemic medication.
Increased dosage of prednisone.
Increased dosage of Humulin 70÷30.
The Correct Answer is D
This question focuses on the interaction between corticosteroids and insulin therapy in diabetic patients. It requires understanding that prednisone induces hyperglycemia through gluconeogenesis, which necessitates an upward adjustment of the insulin dose to maintain euglycemia throughout the duration of the glucocorticoid therapy.
Choice A rationale
Decreasing the dosage of insulin would be contraindicated, as prednisone causes significant hyperglycemia. Reducing insulin while the patient is on corticosteroids would precipitate severe, life-threatening diabetic ketoacidosis, which is a major complication of uncontrolled blood glucose levels during therapy.
Choice B rationale
Adding an oral hypoglycemic agent is generally ineffective for Type 1 diabetic patients, who are insulin-dependent. These medications act primarily by increasing endogenous insulin production or enhancing sensitivity in Type 2 diabetes, which is not applicable to the pathophysiology of Type 1.
Choice C rationale
Increasing the dosage of prednisone would further exacerbate the patient's hyperglycemia. Corticosteroids are prescribed for their anti-inflammatory or immunosuppressive effects; increasing them unnecessarily exposes the patient to greater risk of side effects and metabolic disturbance without therapeutic benefit for diabetes.
Choice D rationale
Prednisone increases blood glucose levels by promoting gluconeogenesis in the liver and reducing cellular glucose uptake. The nurse must expect an increase in the Humulin 70÷30 dosage to counteract this effect and prevent the development of sustained, harmful hyperglycemia during treatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
This question addresses the emergency management of opioid-induced respiratory depression. The nurse must recognize signs of overdose, specifically bradypnea (normal rate 12 to 20 breaths/minute), and act immediately to administer a specific pharmacological antagonist to reverse opioid receptor binding and restore stable respiratory function.
Choice A rationale
Oxygen administration provides supportive care but does not address the underlying cause of respiratory depression. Opioids must be reversed at the receptor level to restore the brain's drive to breathe, making oxygen a secondary intervention in an acute opioid toxicity crisis.
Choice B rationale
Naloxone is a competitive opioid antagonist that rapidly displaces opioids from receptors. It is the specific antidote for morphine-induced respiratory depression and will restore the patient's normal respiratory rate and prevent further hypoxemia and the risk of cardiac arrest.
Choice C rationale
Flumazenil is the specific antidote for benzodiazepine overdose. It has no pharmacological effect on opioid receptors and would be completely ineffective in reversing the respiratory depression caused by morphine, leaving the patient at high risk for ongoing respiratory failure.
Choice D rationale
Intubation is reserved for cases where pharmacological reversal fails or the airway cannot be protected. In this acute opioid overdose, administration of naloxone is the first-line intervention that can quickly reverse the respiratory depression without the risks associated with invasive intubation.
Correct Answer is A
Explanation
This question tests understanding of the pharmacological interactions of HMG-CoA reductase inhibitors. It requires identifying the effect of grapefruit juice on drug metabolism, which is critical for preventing increased systemic drug concentrations and the subsequent risk of significant muscle-related adverse effects or liver toxicity.
Choice A rationale
Grapefruit juice inhibits the cytochrome P450 3A4 enzyme system in the intestinal wall. Since atorvastatin is metabolized by this enzyme, avoiding grapefruit juice is essential to prevent increased serum drug levels, which significantly raises the risk of myopathy.
Choice B rationale
Atorvastatin is typically well-absorbed and can be taken with or without food. Taking it with food can sometimes reduce minor gastrointestinal discomfort, but it is not a requirement for absorption or the efficacy of the medication.
Choice C rationale
Clay-colored stools are a sign of hepatotoxicity or biliary obstruction. This is a severe adverse reaction that requires immediate medical evaluation and cessation of the medication, rather than an expected finding during the course of standard statin therapy.
Choice D rationale
Routine lab tests, specifically liver function tests (LFTs) and occasionally creatine kinase levels, are required for patients on statins. Monitoring LFTs is essential to detect early drug-induced liver injury, which may occur even in asymptomatic patients taking this medication.
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