A patient has been on daily, high-dose glucocorticoid therapy for the treatment of rheumatoid arthritis. His prescription runs out before his next appointment with his physician. Because he is asymptomatic, he thinks it is all right to withhold the medication for 3 days. What is likely to happen to this patient? (Select All that Apply)
Nothing it is appropriate to stop the medication for 3 days
He will go into thyroid storm
Nasojejunal tube
He will go into adrenal crisis
His autoimmune disease will go into remission
The Correct Answer is D
A. Nothing it is appropriate to stop the medication for 3 days: Abrupt discontinuation of long-term, high-dose glucocorticoids suppresses the hypothalamic–pituitary–adrenal (HPA) axis. The body is unable to rapidly resume endogenous cortisol production. Even a short interruption can lead to serious physiological consequences.
B. He will go into thyroid storm: Thyroid storm is associated with uncontrolled hyperthyroidism and is unrelated to glucocorticoid withdrawal. There is no mechanism linking sudden cessation of steroids to acute thyroid hormone excess.
C. Nasojejunal tube: Placement of a nasojejunal tube is a medical intervention, not a physiological consequence of stopping glucocorticoids. It has no relevance to steroid withdrawal or adrenal function.
D. He will go into adrenal crisis: Chronic glucocorticoid therapy suppresses endogenous cortisol production by the adrenal glands. Sudden withdrawal can result in acute adrenal insufficiency, leading to hypotension, hypoglycemia, weakness, and shock. This is a medical emergency requiring prompt treatment.
E. His autoimmune disease will go into remission: Glucocorticoids suppress inflammation and immune activity; stopping them abruptly increases the risk of disease flare rather than remission. Rheumatoid arthritis symptoms often worsen when anti-inflammatory therapy is withdrawn. Remission would not be expected in this context.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Recovery: The recovery phase occurs when kidney function returns toward normal, with stabilization of GFR, BUN, creatinine, and electrolytes. Urine output is normal or near normal, reflecting restoration of renal excretory function. Monitoring continues to ensure full recovery and prevent relapse or complications.
B. Oliguria: The oliguric phase is characterized by urine output less than 400 mL/day and elevated waste products. This patient’s urine output of 1.75 liters/24 hours is well above the oliguria threshold, indicating adequate renal output.
C. Initiation: The initiation phase is the early period after kidney injury, marked by declining GFR and accumulating BUN and creatinine. Normal labs and urine output suggest the patient has progressed beyond this phase.
D. Diuresis: The diuretic phase involves high urine output but typically persistent elevations in BUN and creatinine as the kidneys clear accumulated waste. Because this patient’s labs are already within normal limits, the diuretic phase has resolved, and the patient is in recovery.
Correct Answer is A
Explanation
A. Brainstem injury: Rigid extension of the arms and legs in response to painful stimulation represents decerebrate posturing. This motor response indicates dysfunction at the level of the brainstem, often due to increased intracranial pressure or herniation. It reflects severe neurologic compromise requiring immediate intervention.
B. Cerebral hemispheric injury (decorticate): Decorticate posturing involves flexion of the upper extremities with extension of the lower extremities. This pattern suggests damage above the brainstem, typically involving the cerebral hemispheres or internal capsule. The fully extended posture described does not match this presentation.
C. Meningeal irritation: Meningeal irritation is associated with signs such as neck stiffness, photophobia, and headache. It does not produce abnormal posturing responses to pain. The described motor response reflects deeper neurologic injury rather than meningeal involvement.
D. Alcohol intoxication: Alcohol intoxication may cause altered mental status, impaired coordination, or decreased consciousness. It does not cause abnormal posturing such as rigid extension of all extremities. The neurologic findings described are not explained by alcohol use alone.
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