A nurse is teaching a client prescribed methotrexate about potential dietary restrictions. Which statement indicates the correct understanding of the teaching?

Rationale:

A. Glucocorticoids do not improve muscle strength. In fact, long-term corticosteroid use can cause steroid-induced myopathy, which leads to muscle weakness, particularly in the proximal muscles of the thighs and shoulders. This side effect can reduce the patient’s overall physical function and mobility rather than enhancing it. Therefore, this is not an expected or beneficial effect of corticosteroid therapy.

B. Glucocorticoids are immunosuppressive, meaning they reduce the body’s ability to mount an immune response. This places the patient at increased risk of infections, including opportunistic infections. Patients should be educated to monitor for signs of infection such as fever, cough, sore throat, or unusual fatigue, and seek medical attention promptly if symptoms occur.

C. Corticosteroids affect carbohydrate, protein, and fat metabolism, which can lead to elevated blood glucose levels, particularly in patients with pre-existing diabetes or impaired glucose tolerance. They also cause fluid retention and increased vascular sensitivity to catecholamines, which can elevate blood pressure. Patients should monitor for symptoms such as increased thirst, frequent urination, fatigue, headaches, or swelling, and regularly check their blood pressure and glucose levels as recommended by their healthcare provider. This monitoring is essential to detect and manage complications early.

D. While glucocorticoids can reduce inflammation and alleviate pain during a flare-up, they do not directly improve joint mobility. Improvements in mobility are usually achieved through physical therapy, exercise, and long-term disease-modifying antirheumatic drugs (DMARDs) rather than corticosteroid therapy alone

Rationale:

A. A normal or shortened prothrombin time (PT) indicates that the extrinsic coagulation pathway is functioning properly. In DIC, PT is usually prolonged due to depletion of clotting factors. A PT of 10 seconds is within or slightly below normal, so it does not indicate factor depletion.

B. D-dimer is a fibrin degradation product that increases when there is active clot breakdown. In DIC, D-dimer is usually elevated, often several times higher than normal. A value of 0.5 mcg/mL is normal or low, suggesting minimal fibrinolytic activity, not depletion of clotting factors.

C. DIC is characterized by widespread clot formation and consumption of clotting factors and platelets, leading to thrombocytopenia. A platelet count of 100,000/mm³ (below the normal range of 150,000–400,000/mm³) indicates depletion of platelets, reflecting consumption coagulopathy. This is a hallmark of DIC and a critical indicator that coagulation factors are being used up faster than they can be replenished.

D. Normal fibrinogen levels range from approximately 200–400 mg/dL. In DIC, fibrinogen levels are often decreased due to consumption in widespread clotting. A level of 400 mg/dL is normal or high, and does not suggest depletion of coagulation factors.