Which information obtained by the nurse in the clinic about a patient who has been taking prednisone 40 mg daily for 3 weeks is most important to report to the health care provider?
Patient's blood pressure is 148/84 mm Hg.
Patient has not been taking the prescribed vitamin D.
Patient stopped taking the prednisone abruptly 2 days ago.
Patient has bilateral 2+ pitting ankle edema.
The Correct Answer is C
Choice A reason: An elevated blood pressure of 148/84 mm Hg is significant and could be related to prednisone use, as corticosteroids can increase blood pressure. However, this finding alone is not as urgent as the abrupt cessation of prednisone, which can lead to adrenal insufficiency and other serious complications.
Choice B reason: Not taking prescribed vitamin D is important, especially in long-term corticosteroid therapy, as vitamin D helps mitigate the risk of bone density loss. However, this issue is not as immediately critical as abruptly stopping prednisone.
Choice C reason: Stopping prednisone abruptly after taking it for 3 weeks is critical information that must be reported to the healthcare provider immediately. Prednisone is a corticosteroid that suppresses the adrenal glands' ability to produce natural steroids. Abrupt discontinuation can lead to adrenal insufficiency, which can be life-threatening. Symptoms of adrenal insufficiency include severe fatigue, weakness, body aches, low blood pressure, and potential shock. Gradual tapering is required to allow the adrenal glands to recover and resume natural steroid production.
Choice D reason: Bilateral 2+ pitting ankle edema is a notable finding and may indicate fluid retention, which can be a side effect of prednisone. While it is important and requires monitoring, it does not carry the same immediate risk as the abrupt cessation of the medication.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Increased serum chloride is not a typical finding associated with syndrome of inappropriate antidiuretic hormone (SIADH). In SIADH, the body's regulation of water is impaired, leading to water retention and dilutional hyponatremia. Serum chloride levels might not be significantly affected and are not the primary laboratory indicator for this condition.
Choice B reason: Elevated hematocrit is not directly related to SIADH. Hematocrit levels reflect the proportion of red blood cells in the blood. In SIADH, the main issue is water retention leading to dilutional hyponatremia, rather than changes in red blood cell concentration. Therefore, hematocrit levels are not a key laboratory finding in this disorder.
Choice C reason: Decreased serum sodium, or hyponatremia, is a hallmark finding in SIADH. The excessive release of antidiuretic hormone (ADH) leads to water retention, diluting the sodium in the blood and resulting in low serum sodium levels. This hyponatremia can cause symptoms such as disorientation, headache, and muscle cramps, as seen in the patient. Monitoring and correcting serum sodium levels is crucial in the management of SIADH.
Choice D reason: Low urine specific gravity is not expected in SIADH. In fact, patients with SIADH typically have a high urine specific gravity due to the excessive release of ADH, which causes the kidneys to reabsorb water and concentrate the urine. This concentrated urine reflects the body's attempt to reduce water excretion in response to elevated ADH levels. Therefore, low urine specific gravity would not be an initial laboratory finding in this condition.
Correct Answer is D
Explanation
Choice A reason: "It must have been from sharing needles with my roommate." This statement is incorrect because hepatitis A is not typically transmitted through sharing needles. Hepatitis A is primarily spread through the fecal-oral route, which involves ingestion of contaminated food or water.
Choice B reason: "It is likely transmitted through kissing or sexual activity." This statement is also incorrect. Hepatitis A is not commonly spread through kissing or sexual activity. It is mainly transmitted through consuming contaminated food or water or close contact with an infected person.
Choice C reason: "I think I caught it because I have a family history of liver problems." This statement reflects a misunderstanding of how hepatitis A is transmitted. Hepatitis A is not linked to genetic predisposition or family history of liver problems. It is an infectious disease spread through the fecal-oral route.
Choice D reason: "I probably got it from drinking contaminated water or eating food handled by someone who didn't wash their hands properly." This statement is correct and indicates an accurate understanding of how hepatitis A is transmitted. The virus is often spread through consumption of contaminated food or water, particularly in areas with poor sanitation.
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