Practice Question
A nurse is caring for a client who is taking prednisone for long-term treatment of rheumatoid arthritis. The nurse should monitor the client for which of the following adverse effects of this medication?
Answer Choices:
Correct Answer:
Bone loss
Rationale:
🦴 Prednisone, a glucocorticoid, is well known to cause decreased bone formation and increased bone resorption, leading to osteoporosis and bone loss with long-term use.
🦴 This places clients at increased risk for pathologic fractures, vertebral compression fractures, and height loss.
🦴 The nurse should monitor for bone pain, changes in posture, and should anticipate that the provider might order bone density testing.
🦴 Preventive measures may include calcium, vitamin D, weight-bearing exercise, and sometimes additional medications to protect bone.
🦴 Therefore, bone loss is a key adverse effect to monitor in clients receiving long-term prednisone therapy.
Liver toxicity
🦴 While some medications are strongly associated with hepatotoxicity (like certain anticonvulsants or acetaminophen in large doses), prednisone is more prominently associated with metabolic, endocrine, and musculoskeletal effects.
🦴 Long-term glucocorticoid use is more likely to cause hyperglycemia, infection risk, Cushingoid features, and osteoporosis than direct liver toxicity.
🦴 Routine monitoring for liver damage is not the primary focus in a client on chronic prednisone.
🦴 If the client is on other hepatotoxic drugs, liver monitoring may be needed, but that is not specific to prednisone alone.
🦴 Thus, liver toxicity is not the main adverse effect the nurse is expected to watch for with prednisone.
Hypoglycemia
🦴 Glucocorticoids like prednisone tend to cause hyperglycemia, not hypoglycemia, because they increase gluconeogenesis and decrease peripheral glucose utilization.
🦴 Clients with diabetes may require increased doses of insulin or oral hypoglycemics when on chronic steroids.
🦴 The nurse should monitor for signs of elevated blood glucose, such as polyuria, polydipsia, and elevated serum glucose levels.
🦴 Hypoglycemia would not be an expected direct effect of prednisone unless the client is on other strong glucose-lowering therapies out of balance.
🦴 Therefore, hypoglycemia is not the expected adverse effect of long-term prednisone therapy.
Hemolytic anemia
🦴 Hemolytic anemia involves destruction of red blood cells and is associated with specific conditions or certain drugs, but it is not commonly linked to prednisone.
🦴 In some autoimmune hemolytic anemias, prednisone is actually used as a treatment, not a cause.
🦴 The major hematologic concern with glucocorticoids is more about immunosuppression and infection risk, not red cell destruction.
🦴 Therefore, monitoring for hemolytic anemia is not the key concern in a client taking long-term prednisone.
🦴 Bone and metabolic effects are more prominent.
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This question is from RN PHARMACOLOGY 2023 ✅ which contains 65 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN ATI Pharmacology
- Answer Choices: 4