A nurse is providing teaching for a patient who has gastroesophageal reflux disease (GERD) about ways to manage their condition.
Which of the following instructions should the nurse include?

Choice A rationale

Checking blood glucose levels for hypoglycemia once yearly is insufficient for a patient taking high doses of oral glucocorticoids for an extended period. Glucocorticoids can cause hyperglycemia by increasing gluconeogenesis and insulin resistance. Therefore, blood glucose monitoring should be more frequent, especially when initiating or adjusting the dosage. Normal fasting blood glucose levels are typically 70-99 mg/dL.

Choice B rationale

Limiting the intake of calcium-rich foods is incorrect advice for a patient on long-term glucocorticoid therapy. Glucocorticoids can decrease calcium absorption from the gut and increase bone resorption, leading to osteoporosis. Therefore, patients on these medications should be encouraged to maintain an adequate intake of calcium and vitamin D to help preserve bone density. Normal total serum calcium levels range from 8.6 to 10.2 mg/dL.

Choice C rationale

Monitoring for fractures over the next several months is an important instruction for a patient taking high doses of oral glucocorticoids long-term. Glucocorticoids increase the risk of osteoporosis and subsequent fractures, particularly vertebral compression fractures and hip fractures, due to their effects on bone metabolism. Regular monitoring and preventive measures are crucial.

Choice D rationale

Glucocorticoids do not boost immunity; instead, they suppress the immune system by inhibiting the production and function of various immune cells and inflammatory mediators. This immunosuppressive effect is why they are used to treat autoimmune diseases like rheumatoid arthritis, but it also increases the risk of infections.

Choice A rationale

A pyloric obstruction is a blockage at the outlet of the stomach, preventing gastric contents from emptying into the duodenum. A nasogastric tube is inserted to decompress the stomach by removing accumulated fluids and gases, relieving pressure and distension.

Choice B rationale

While a nasogastric tube can be used for enteral feeding in some situations, it is not the primary rationale for its use in a pyloric obstruction. The obstruction would prevent the delivery of nutrients into the small intestine for absorption.

Choice C rationale

Medications can be administered through a nasogastric tube, but this is a secondary use in the context of a pyloric obstruction. The primary goal is to relieve the obstruction's effects by decompression.

Choice D rationale

Determining the pH of gastric secretions can be done via a nasogastric tube, but this is a diagnostic measure and not the primary therapeutic rationale for its use in treating a pyloric obstruction. Decompression is the priority.