Which medical condition would warrant a prescription for high-dose corticosteroids?
Uncontrolled diabetes mellitus
A recent diagnosis of lung cancer
Acute exacerbation of COPD
Chronic asthma
The Correct Answer is C
Choice A rationale:
Uncontrolled diabetes mellitus: Corticosteroids can have a hyperglycemic effect, meaning they can raise blood sugar levels. This makes them generally unsuitable for use in patients with uncontrolled diabetes mellitus. In fact, corticosteroids might even worsen glycemic control in these patients. While corticosteroids might be used in some cases of diabetes mellitus, such as to treat diabetic retinopathy or nephropathy, they would be used cautiously and with close monitoring of blood sugar levels.
Choice B rationale:
A recent diagnosis of lung cancer: Corticosteroids are not a primary treatment for lung cancer. They might be used in some cases to help manage symptoms or side effects of other treatments, such as chemotherapy or radiation therapy. However, they would not typically be used as a first-line treatment for lung cancer itself.
Choice C rationale:
Acute exacerbation of COPD: Corticosteroids are a mainstay of treatment for acute exacerbations of COPD. They work by reducing inflammation in the airways, which helps to improve airflow and relieve symptoms such as wheezing, shortness of breath, and chest tightness. Corticosteroids can be given orally, intravenously, or by inhalation. The dose and duration of treatment will depend on the severity of the exacerbation.
Choice D rationale:
Chronic asthma: Corticosteroids are often used as a long-term control medication for chronic asthma. However, they are typically used at lower doses than those used for acute exacerbations of COPD. Inhaled corticosteroids are the preferred form of treatment for chronic asthma, as they deliver the medication directly to the airways and have fewer systemic side effects.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Propylthiouracil (PTU) is a thionamide medication that inhibits the synthesis of thyroid hormones. It is the preferred drug for presurgical treatment of Graves' disease because it effectively lowers thyroid hormone levels and reduces the risk of thyroid storm, a life-threatening complication that can occur during or after surgery.
PTU acts by blocking the enzyme thyroid peroxidase, which is essential for the production of thyroid hormones. It also inhibits the conversion of thyroxine (T4) to triiodothyronine (T3), the more active form of thyroid hormone. This results in a decrease in circulating levels of both T4 and T3, leading to a reduction in the symptoms of hyperthyroidism.
PTU is typically started at a dose of 100-300 mg daily, divided into two or three doses. The dose is then adjusted based on the patient's response and thyroid hormone levels. The goal of treatment is to achieve a euthyroid state, which means that the thyroid hormone levels are within the normal range.
PTU is generally well-tolerated, but it can cause some side effects, including skin rash, itching, nausea, vomiting, abdominal pain, joint pain, and hair loss. In rare cases, it can also cause serious side effects, such as liver damage and agranulocytosis (a decrease in white blood cells).
Choice B rationale:
Liotrix (Thyrolar) is a combination of synthetic T4 and T3 hormones. It is not used for presurgical treatment of Graves' disease because it can worsen the symptoms of hyperthyroidism.
Choice C rationale:
Propranolol (Inderal) is a beta-blocker medication that can be used to control the symptoms of hyperthyroidism, such as tachycardia, tremor, and anxiety. However, it does not lower thyroid hormone levels and is not used for presurgical treatment of Graves' disease.
Choice D rationale:
Levothyroxine sodium (Synthroid) is a synthetic T4 hormone. It is used to treat hypothyroidism, but it is not used for presurgical treatment of Graves' disease.
Correct Answer is B
Explanation
Rationale for Choice A:
Repeating the dose of nitroglycerin SL is not recommended at this time due to the patient's hypotension (blood pressure of 88/68 mmHg).
Administering additional nitroglycerin could further lower the blood pressure, potentially leading to adverse consequences such as dizziness, lightheadedness, or even fainting.
It's crucial to prioritize patient safety and avoid actions that could exacerbate their condition. Rationale for Choice B:
Notifying the provider is the most appropriate action in this situation for several reasons:
The patient's chest pain has not been relieved by the initial dose of nitroglycerin, indicating a need for further evaluation and potential adjustments to the treatment plan.
The patient's blood pressure is low, which warrants close monitoring and possible intervention to prevent complications.
The provider can assess the patient's overall clinical picture, including other symptoms and medical history, to determine the best course of action.
Early notification allows for timely interventions and potential prevention of further complications. Rationale for Choice C:
While nitroglycerin by translingual spray may be considered in some cases of persistent angina, it's not the most appropriate choice in this situation due to the patient's hypotension.
The translingual spray can also have a rapid onset of action, which might further lower the blood pressure if not carefully monitored.
It's essential to consider the patient's overall hemodynamic status before administering any medication that could potentially affect blood pressure.
Rationale for Choice D:
Administering NPH insulin is not relevant to the management of angina or chest pain.
Insulin is used to treat hyperglycemia in patients with diabetes, and its administration would not address the underlying issue of the patient's chest pain.
It's important to select interventions that are directly targeted at the patient's presenting symptoms and condition.
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