A nurse is teaching a patient about taking high doses of oral glucocorticoids for an extended period to treat rheumatoid arthritis.
Which of the following instructions should the nurse include in the teaching?
"Plan to check blood glucose levels for hypoglycemia once yearly.”.
"Limit the intake of calcium-rich foods while taking the medication.”.
"Monitor for fractures over the next several months.”.
"Glucocorticoids will boost immunity.”.
The Correct Answer is C
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Pruritus following scabies treatment is often due to residual irritation from the mites and the inflammatory response. Mittens can prevent scratching, which can exacerbate the itching, lead to skin breakdown, and increase the risk of secondary infections.
Choice B rationale
Rubbing the affected area, even gently, can further irritate the skin and intensify the itching sensation. This can prolong discomfort and potentially cause skin damage.
Choice C rationale
Applying additional scabicide after the prescribed treatment is completed is generally not recommended and can cause skin irritation or even systemic toxicity if overused. Pruritus after treatment is usually due to the body's reaction to dead mites and their products, not ongoing infestation.
Choice D rationale
Hot showers can dry out the skin and worsen pruritus. Warm or cool showers are generally recommended for individuals experiencing itching, as they are less likely to cause further irritation.
Correct Answer is A
Explanation
Choice A rationale
Formation of fistulas (abnormal connections between organs) and abscesses (collections of pus) are characteristic complications of Crohn's disease. The transmural inflammation in Crohn's disease can penetrate through the bowel wall, leading to these developments.
Choice B rationale
Crohn's disease can affect any part of the gastrointestinal tract from the mouth to the anus, although it most commonly involves the ileum and colon. Symptoms are not confined to the large intestine. Ulcerative colitis, another inflammatory bowel disease, primarily affects the colon.
Choice C rationale
While antibiotics may be used to treat secondary infections or complications of Crohn's disease, they are not a primary treatment for the underlying inflammatory process and do not typically lead to improvement of the disease itself. Crohn's disease is a chronic inflammatory condition that requires immunomodulatory or anti-inflammatory medications.
Choice D rationale
Rectal bleeding is more commonly associated with ulcerative colitis, where the inflammation is typically limited to the mucosal layer of the colon and rectum, leading to ulceration and bleeding. While some bleeding can occur in Crohn's disease, it is generally less prominent than in ulcerative colitis.
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