A nurse is teaching a client who has COPD about pursed-lipped breathing.
Which of the following statements should the nurse make?

Choice A rationale

Methylprednisolone is a potent glucocorticoid that typically causes an increase in appetite and subsequent weight gain rather than a decrease. The metabolic effects of corticosteroids include the stimulation of hunger centers in the brain and the redistribution of body fat to the trunk and face. Decreased appetite is not a standard side effect, so emphasizing weight loss would be clinically inaccurate and could lead to the patient ignoring actual symptoms.

Choice B rationale

Corticosteroids like Solu-Medrol are known to cause fluid retention and hypertension due to their mineralocorticoid effects, which lead to sodium and water reabsorption in the renal tubules. While fluid retention occurs, hypotension is not a typical side effect; instead, patients are more likely to experience elevated blood pressure. Monitoring for hypertension is necessary, but the pairing with hypotension makes this choice incorrect as a primary teaching point for this specific medication.

Choice C rationale

Long-term use of corticosteroids can lead to muscle wasting and proximal muscle weakness, known as steroid myopathy, due to increased protein catabolism. Skin changes often involve thinning of the dermis, easy bruising, and delayed wound healing rather than a simple rash. While these are valid concerns, they are generally considered less acutely critical than the systemic metabolic and immunological changes that require frequent monitoring during the initial phases of treatment for COPD.

Choice D rationale

Glucocorticoids suppress the immune system by inhibiting the activity of white blood cells and cytokines, significantly increasing the vulnerability to opportunistic infections. Furthermore, they stimulate gluconeogenesis in the liver and reduce peripheral glucose uptake, leading to hyperglycemia or steroid-induced diabetes. In COPD patients, monitoring blood sugar (normal range 70 to 100 mg/dL) and signs of infection is the highest priority to prevent life-threatening complications while the patient is on systemic steroid therapy.

Choice A rationale

Determining the cause of the acute exacerbation is a secondary goal that should be addressed only after the client is stabilized. Status asthmaticus is a medical emergency characterized by severe bronchospasm that does not respond to initial standard treatments. While identifying triggers like allergens or infections is important for long-term management and preventing future episodes, it does nothing to resolve the immediate, life-threatening airway obstruction the child is currently experiencing during this acute respiratory crisis.

Choice B rationale

Obtaining a peak flow reading is often difficult or impossible for a child in status asthmaticus. These children are usually in significant respiratory distress, using accessory muscles, and may be too exhausted to perform the forceful exhalation required for an accurate reading. Attempting this measurement can delay life-saving treatment and further fatigue the child. Clinical assessment of breath sounds, work of breathing, and oxygen saturation is more practical and safer during the initial emergency management phase.

Choice C rationale

Administering a short-acting B2-agonist (SABA), such as albuterol, is the priority intervention. SABAs work by rapidly stimulating beta-2 receptors in the bronchial smooth muscle, leading to immediate bronchodilation. In status asthmaticus, the airway is severely constricted, and opening the bronchioles is essential to restore ventilation and oxygenation. This medication acts within minutes to relieve the acute obstruction, making it the first-line treatment to prevent respiratory failure and move the child out of the danger zone.

Choice D rationale

Administering an inhaled glucocorticoid is an important part of asthma management, but it is not the priority in an emergency. Glucocorticoids are anti-inflammatory agents that take hours to days to reach their peak effect. They do not provide immediate bronchodilation. While systemic corticosteroids (IV or oral) are often started early in status asthmaticus to reduce airway edema, they are always secondary to the rapid-acting bronchodilators that provide the immediate relief necessary to maintain a patent airway and gas exchange.