10/25/23 Passpoint Practice #1 (Quiz 6)

6. A medical-surgical nurse is caring for a client with end-stage kidney disease. The client asks the nurse, "Will I die soon?" What would be the most appropriate response(s) by the nurse? Select all that apply. "I can't discuss that, but the health care provider will come by later and can discuss the prognosis with you." "Do you want me to call the local clergy for you to obtain last rites?" "We are doing everything medically possible, and you will be fine." "You're in the final stage of illness, so you may have little time remaining." "Do you want to talk about how you are feeling about your prognosis?"

"You're in the final stage of illness, so you may have little time remaining." "Do you want to talk about how you are feeling about your prognosis?" Explanation: It is essential that nurses engage in honest dialogue concerning moral situations such as dying, even though such conversations can be difficult for everyone involved. When the client asks a question about end of life, there is an opportunity for teaching. Since the client asked the nurse the question, the nurse should not deflect the question to the health care provider. Nurses should never give false reassurance to a client. Nothing in the scenario indicates that the client is religious or, specifically, has asked for last rites.

8. A nurse is working on a medical unit at a unionized hospital that has insufficient nurses and staff to provide competent care to the clients. What should the nurse do? Select all that apply. Explain the situation to the clients and try to provide good care. Notify the supervisor verbally that this is unsafe and hope for no errors. Refuse the assignment and walk off the unit. Accept the assignment and make a written protest to the administration. Complete an unsafe staffing form and provide care as safely as possible.

- Accept the assignment and make a written protest to the administration. - Complete an unsafe staffing form and provide care as safely as possible. Explanation: The nurse must accept the assignment or be liable for negligence and abandonment. The nurse should fill out an unsafe staffing form as soon as possible as this may be evidence to provide protection in the case of a medical error during the shift. Refusing the assignment is illegal and abandonment. Verbal notification can be provided but is not the best action as there is not a record of the conversation if a problem occurs. Clients should never know that staffing is unsafe as this will create unnecessary anxiety or stress for the client.

25. An adolescent client diagnosed with posttraumatic stress disorder (PTSD) is admitted to the unit after slicing both arms with a razor blade. He says, "Maybe my mother will listen to me now. She tells me I am just crazy when I say I am screwed up because my stepdad had sex with me for years." What should the nurse do in order of priority from first to last? All options must be used. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1Ask the client to talk about appropriate ways to express anger toward his mother. 2Ask the client to be specific about what he means by "screwed up." 3Ask the client to state what he will do if he feels urge to hurt himself. 4Ask the client about the stepdad possibly abusing younger children in the family

- Ask the client to state what he will do if he feels urge to hurt himself. - Ask the client about the stepdad possibly abusing younger children in the family. - Ask the client to be specific about what he means by "screwed up." - Ask the client to talk about appropriate ways to express anger toward his mother. Explanation: The nurse should first assure the client's safety after the client's self-mutilation. Another safety issue is whether the stepdad possibly may be abusing younger children; if so, a police report may need to be filed. Then, it is important to know what the client means exactly by "screwed up" to identify other emotions and behaviors that need attention. It is very common for survivors of childhood sexual abuse to have intense anger at those who did not stop or prevent the abuse, and once the other steps have been taken, the nurse can begin to help the client manage his anger.

18. A nursing student asks a nurse how to manage the morning assignment prior to breakfast. The nurse responds with prioritizing the needs of the clients and time management for safe care delivery. What should be the nurse's priority action(s) at the start of the shift? Select all that apply. obtaining the client's vital signs prior to breakfast assessing a client prior to scheduled physical therapy appointment applying a new ostomy appliance administering all medications prior to breakfast following the room order to assess clients

- Assessing a client prior to scheduled physical therapy appointment - Obtaining the client's vital signs prior to breakfast Explanation: The nurse will assess a client prior to a physical therapy appointment to be sure that the client is able to participate in the therapy session. The nurse will also need to obtain vital signs to begin assessments at the beginning of the shift. If the nurse administers all medications prior to breakfast, there may be food interactions with some medications. If the nurse follows the room order to assess clients the nurse may not be safe and client care is not prioritized. The nurse may not have time to change the ostomy appliance as well as complete a five-client assessment prior to breakfast.

7. A nurse is working on a medical unit at a hospital with an ethics review board. Which situation(s) would be appropriate for the nurse to forward for ethics committee review? Select all that apply. The child of Jehovah Witness parents being refused lifesaving blood transfusions. An adult in ICU being restrained to maintain an endotracheal tube placement. The comatose client with a feeding tube and no advanced directive whose children want it removed and spouse does not. A client whose last drink was 4 months ago placed on the liver transplant list. A lesbian couple actively seeking fertilization injections.

- The child of Jehovah Witness parents being refused lifesaving blood transfusions. - A client whose last drink was 4 months ago placed on the liver transplant list. - The comatose client with a feeding tube and no advanced directive whose children want it removed and spouse does not. Explanation: Dilemmas centering on religious beliefs, removal of feeding tubes, and prevention of death and dying are prevalent in medical practice and appropriate for ethics committee review. Administration of fertilization injections to any infertile couples is an accepted medical practice. Restraints are acceptable to prevent pulling of necessary lifesaving tubes in critical care settings. Allocation of organs to a patient who has not met the set parameters is an appropriate ethical issue for review.

5. A nurse is assigned a client with an acute exacerbation of rheumatoid arthritis (RA). Which medical facts about RA are essential in developing a plan of care? Select all that apply. The client may not exercise once the disease is diagnosed. Onset is acute and usually occurs between ages 20 and 40. The first-line treatment is gold salts and methotrexate. Erythrocyte sedimentation rate (ESR) is elevated, and x-rays show erosions and decalcification of involved joints. Inflamed cartilage triggers complement activation, which stimulates the release of additional inflammatory mediators. The client experiences stiff, swollen joints bilaterally.

- The client experiences stiff, swollen joints bilaterally. - Erythrocyte sedimentation rate (ESR) is elevated, and x-rays show erosions and decalcification of involved joints. - Inflamed cartilage triggers complement activation, which stimulates the release of additional inflammatory mediators. Explanation: RA is a chronic disorder where individuals experience stiff, swollen joints due to a severe inflammatory reaction. Elevated ESR and x-ray evidence of bony destruction are indicative of severe involvement. RA starts insidiously, with fatigue, persistent low-grade fever, anorexia, and vague skeletal symptoms, usually in middle age between the ages 35 and 50 years. Maintaining the ROM by a prescribed exercise program is essential, but clients must rest between activities. Salicylates and nonsteroidal anti-inflammatory drugs are considered the first-line treatments.

16. A nurse is assigned five clients on the medical-surgical floor. Place in order which client the nurse will assess during the first assessment round starting with who the nurse should see first. All options must be used. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1a client with a recorded episode of hypoxia earlier in the day 2a client admitted with leg cellulitis needing an initial intravenous antibiotic 3a client requesting medication teaching with an insulin dose in one hour 4a client awaiting transport to another hospital in two hours 5a client with dementia requiring wrist restraints to secure medical equipment

- a client with a recorded episode of hypoxia earlier in the day - a client with dementia requiring wrist restraints to secure medical equipment - a client admitted with leg cellulitis needing an initial intravenous antibiotic - a client requesting medication teaching with an insulin dose in one hour - a client awaiting transport to another hospital in two hours Explanation: The nurse will first assess the client with a recorded episode of hypoxia earlier in the day because of the respiratory compromise concern. Then the client with dementia requiring wrist restraints to secure medical equipment to be sure the client is safe. The client admitted with leg cellulitis needing an initial intravenous antibiotic will be assessed next to begin the antibiotic therapy. The client requesting medication teaching with insulin dose in one hour and lastly the client awaiting transport to another hospital in two hours can be seen at the end of the initial round.

3. The nurse should assess which clients for risk for falling? Select all that apply. client who is 45 years of age, in hospice with terminal cancer, and receiving morphine every 2 hours client who is 80 years of age and in a locked facility for clients with cognitive impairment client who is 62 years of age, recovering from breast biopsy in outpatient surgery, and has a fear of falling client who is 75 years of age and recovering at home from hip replacement surgery on the left hip client who is 70 years of age, hospitalized for lung biopsy, and receiving no medications

- client who is 45 years of age, in hospice with terminal cancer, and receiving morphine every 2 hours - client who is 62 years of age, recovering from breast biopsy in outpatient surgery, and has a fear of falling - client who is 80 years of age and in a locked facility for clients with cognitive impairment - client who is 75 years of age and recovering at home from hip replacement surgery on the left hip Explanation: Clients who are at risk for falling include the client taking narcotics, the client with a known fear of falling, the client with cognitive impairment, and the client with gait problems. Age and setting are not necessarily risks for fallings.

19. The postpartum nurse is about to perform the initial assessment of four clients. Which client should the nurse see first? 20-year-old primipara who is 6 hours postpartum after delivery of a 40-week infant weighing 7 pounds 5 ounces 15-year-old primipara who is 3 hours postpartum after delivery of a 38-week infant weighing 6 pounds 2 ounces 29-year-old multipara who is 4 hours postpartum after delivery of a 39-week infant weighing 10 pounds 2 ounces 35-year-old multipara who is 3 hours postpartum after delivery of a 36-week infant weighing 5 pounds 6 ounces

29-year-old multipara who is 4 hours postpartum after delivery of a 39-week infant weighing 10 pounds 2 ounces Explanation: The 29-year-old multiparous mother who recently delivered a large infant is at risk for postpartum hemorrhage. The other multiparous mother has less of a risk for postpartum hemorrhage since her infant was small. The two primiparous mothers are not at risk for postpartum hemorrhage.

24. The nurse is completing a health history review of a client who has received long term medical steroid therapy for lupus. Which client data does the nurse recognize as potentially linked to the steroid use? Select all that apply. an increase in blood pressure three infections over the course of the year acne noted on the forehead, cheeks, and back routine symptoms of nausea a 16 pound (7.3 kilogram) weight loss

3 infections over the course of the year Acne noted on the forehead, cheeks, and back Explanation: Suppression of the immune system occurs when a client receives long term steroid therapy, making the client more susceptible to infections. Acne is present related to oily skin and also the overproduction of the acne bacterium, Propionibacterium acnes. Also, changes in metabolism occur leading to weight gain, not weight loss. Nausea and hypertension are not commonly seen with steroid use.

17. An unlicensed assistive personnel (UAP) reports to the nurse that the client had a large amount of blood on the adult brief in a skilled nursing home. Place the steps the nurse will take to assess and care for the client in order. All options must be used. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1Assess the client's perineal area for any further drainage. 2Obtain the client's vital signs. 3Report the event to the family with any change in treatment. 4Examine the adult brief. 5Report the findings to the healthcare provider. 6Ask the unlicensed assistive personal to recover the adult brief.

Ask the unlicensed assistive personal to recover the adult brief. Examine the adult brief. Assess the client's perineal area for any further drainage. Obtain the client's vital signs. Report the findings to the healthcare provider. Report the event to the family with any change in treatment. Explanation: In this situation, the nurse will have the UAP recover the adult brief, and then the nurse will examine the brief to assess the drainage. The nurse will then assess the client's perineal area for any further drainage. The nurse will obtain the client's vital signs to assess for hypotension related to blood loss and will report the findings, including the drainage and vital signs, to the healthcare provider. Finally, the nurse will report the event to the family with any change in treatment.

26. The parents of a 14-year-old child voice their concern to the clinic nurse about their child showing signs of depression. The parents have reported that the client has difficulty in school and that they have brought the child to the community mental health center for further assessment and treatment. What would be the priority assessments for the nurse to preform? Select all that apply. Irritability Behavioral difficulties Labile moods Cognitive impairment Anxiety disorder

Behavioral difficulties Irritability Explanation: Adolescents with depression typically demonstrate irritability and behavioral problems. Anxiety would not be a priority assessment because anxiety disorders are most commonly associated with younger children. Cognitive impairments are typically comorbid with delirium, dementia, and learning difficulties, and not a priority assessment with adolescent depression. Labile mood would be more characteristic of a client with bipolar disorder.

10. The nurse enters the client's room to perform a postpartum assessment 1 hour after vaginal birth. The client's sheets are saturated in frank blood, and the client appears pale. Place the interventions in the order the nurse will perform them. All options must be used. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1. Delegate assessment of vital signs. 2. Ensure patent intravenous access. 3. Perform fundal massage. 4. Lower the head of bed, and reassure the client. 5. Insert an indwelling urinary catheter. 6. Call for help.

Call for help. Lower the head of bed, and reassure the client. Perform fundal massage. Delegate assessment of vital signs. Ensure patent intravenous access. Insert an indwelling urinary catheter. Explanation: As the first person on the scene of a postpartum hemorrhage, the nurse needs to immediately call for assistance and have the team activated. The nurse should lay the client flat to facilitate effective fundal massage and to help with cerebral perfusion. At this time, it is important to briefly inform the client of the nurse's concern and explain what to expect with the interventions. (The nurse provides this reassurance while performing the interventions). Because fundal massage is essential, the nurse should continue this while delegating the assessment of vital signs to another team member. Intravenous access must be established quickly for fluid administration, blood sampling, and possible transfusion. Finally, once IV access is established, a urinary catheter is placed, if possible. The team will also perform other interventions, such as applying oxygen.

11. Which of the following interventions will help prevent a pulmonary embolus (PE) in a postpartum woman? Select all that apply. Encourage the client to increase fluid intake. Teach the client leg exercises she can do in bed. Encourage the client to ambulate in the room. Give the client an anticoagulant prophylaxis. Elevate the client's legs on a soft pillow.

Encourage the client to increase fluid intake. Teach the client leg exercises she can do in bed. Encourage the client to ambulate in the room. Explanation: Pulmonary embolus (PE) is primarily caused by a clot in the veins of the leg or pelvis. Having the three elements of Virchow's triad increases the client's risk of postpartum DVT. Those elements include hypercoagulation, venous stasis, and vessel wall injury. To prevent hypercoagulation, the nurse should encourage fluid intake to prevent dehydration. Venous stasis and vessel wall injury can be prevented by early ambulation. Anticoagulation would be contraindicated in postpartum women. Elevating their legs on pillows could cause vessel wall damage.

27. A client is hearing voices that are telling the client to commit suicide. The client demands a knife to use on their wrists. The nurse calls for another team member to come to the room and provide assistance. Which is the most appropriate intervention for the nurse to implement? Search the client's room for potential weapons while the client goes to the group meeting. Put the client in restraints after giving an intramuscular dose of medication. Give oral doses of haloperidol and lorazepam as needed and prescribed. Ask the client to talk about their anger and what is causing it.

Give oral doses of haloperidol and lorazepam as needed and prescribed. Explanation: Haloperidol and lorazepam together decrease hallucinations and agitation, thus decreasing the risk for self-harm, so this is the most appropriate intervention. Putting the client in restraints is premature because danger is not imminent. Asking the client to talk about their anger is inappropriate because the client is beyond rational conversation. The nurse should not send the client to the group meeting without addressing the hallucinations. A room search is appropriate only after the crisis with the client is handled and ethically should be done with the client present.

1. The nurse is planning care for a client with a spinal injury who is to remain on complete bedrest. What should the nurse do to prevent the development of pressure ulcers? Select all that apply. Monitor the white blood cell count. Turn the client every 2 hours. Monitor the serum albumin. Inspect the skin for redness. Request a prescription for a pressure mattress. Insert an indwelling urinary catheter.

Monitor the serum albumin. Request a prescription for a pressure mattress. Inspect the skin for redness. Explanation: The nurse should establish a schedule to turn the client every 2 hours. The nurse should also monitor the client's serum albumin; a decreased serum albumin indicates malnutrition and is considered a risk factor in the development of pressure ulcers. An alternating air pressure mattress prevents pressure on the skin, which is a risk factor for pressure ulcers. The nurse should assess the client's skin for redness, an early sign of pressure. Inserting an indwelling catheter requires a health care provider's (HCP's) prescription and is not necessary at this time. The nurse monitors the white blood cell count only if an infection is present.

14. The nurse is administering furosemide to a client. What will the nurse include in the client's plan of care? Select all that apply. Monitor for signs of hyperkalemia daily. Assess blood pressure prior to administration. Monitor urinary output hourly. Assess peripheral pulses prior to administration. Administer medication with food.

Monitor urinary output hourly. Assess blood pressure prior to administration. Explanation: Furosemide can be given with or without food. Assessment of peripheral pulses is not required as furosemide should not affect peripheral pulses. Monitoring of urinary output is essential to determine the therapeutic effect of the medication. Assessment of blood pressure is necessary as the decrease in fluid volume caused by the medication should decrease the client's blood pressure. Furosemide causes excretion of potassium and the nurse should monitor for signs of hypokalemia.

21. The nurse finds a client in a long term care facility, after the evening meal, to be unresponsive with cold, clammy skin to touch. A finger stick blood glucose level reveals 21 mg/dL. What are the nurse's immediate priority actions? Select all that apply. Administer as needed glucagon 1 mg intramuscularly now. Alert the family to the change in condition after the client is stable. Notify the healthcare provider of hypoglycemic event. Identify if the client has clear breath sounds. Encourage the client to drink orange juice

Notify the healthcare provider of hypoglycemic event. Administer as needed glucagon 1 mg intramuscularly now. Explanation: The nurse will need to notify the healthcare provider of the hypoglycemia. The nurse will also need to treat the hypoglycemia with glucagon 1mg IM now. The client is unresponsive and will not be able to drink orange juice. Breath sounds are not a priority during hypoglycemia. The family will be notified of change of condition when the client is stable, but this is not the priority action.

23. The nurse is caring for a 74-year-old female client who has been admitted to the medical-surgical unit with bacterial pneumonia. The client is restless and diaphoretic. The client's respirations are labored. The nurse reviews the vital signs (see chart). Which action(s) should the nurse take? Select all that apply. Initiate oxygen per nasal cannula at 2 L per minute as prescribed. Notify the health care provider (HCP). Use a cool, moist cloth to wipe areas of diaphoresis. Obtain an accurate measure of urine output. Increase oral fluids to 1200 mL every 8 hours. Ensure the client stays in bed with one pillow under their head. Administer acetaminophen as prescribed.

Obtain an accurate measure of urine output. Increase oral fluids to 1200 mL every 8 hours. Notify the health care provider (HCP). Administer acetaminophen as prescribed. Use a cool, moist cloth to wipe areas of diaphoresis. Explanation: The client's condition is worsening as evidenced by the diaphoresis that puts the client at risk for dehydration, and as evidenced by the increase in heart rate, respiration rate, and blood pressure due to the increase in temperature and the infection in the lungs. The nurse should initiate accurate intake and output records to monitor fluid deficit and ensure the client obtains at least 1200 mL of fluids in 8 hours. The nurse can make the client comfortable using a cool, moist cloth in areas of diaphoresis. The nurse should administer acetaminophen to reduce the temperature and notify the health care provider of the changes in vital signs. The client should not remain in bed and can ambulate with assistance or sit in a chair; the head of the bed can be elevated; these actions will encourage deep breathing and support lung expansion. The client's oxygen saturation, while slightly declining, is still within normal limits.

9. A nurse is caring for a client who is 3 days postpartum and breastfeeding their baby. The nurse assesses that the episiotomy area is red and edematous; the breasts are firm and tender on palpation; and the fundus is firm and 2 fingerbreadths below the umbilicus. Which nursing action(s) would be indicated? Select all that apply. Encourage the client to sit on a supportive device. Suggest the client take cool sitz baths twice a day. Ask the client how often the baby feeds. Suggest that the client apply cool compresses to the breasts. Obtain a specimen for culture and sensitivity from the episiotomy site.

Suggest that the client apply cool compresses to the breasts. Ask the client how often the baby feeds Explanation: The client is experiencing symptoms of engorgement. Cool compresses between feedings can help decrease swelling. Determining when the baby last fed is critical because frequent feedings can help relieve symptoms. The nurse must also assess how long the baby feeds, if the baby has a correct latch, and if the baby empties the breast during feeds. Sitting on supportive devices is not necessary as the episiotomy is healing. Cool sitz baths do not promote circulation to the area; instead, they cause vasoconstriction and decrease blood flow to the area, therefore prolonging healing and increasing discomfort. Obtaining a specimen for culture and sensitivity from the episiotomy site is not warranted at this time. If edema and redness continue for more than 2 days, further assessment is required to rule out infection.

12. Parents are asking about the signs and symptoms of a urinary tract infection (UTI). What possible manifestation(s) should the nurse include in the response? Select all that apply. fever diarrhea dysuria vomiting abdominal pain

abdominal pain vomiting diarrhea fever dysuria Explanation: The classic signs of a urinary tract infection include enuresis, abdominal pain, vomiting, diarrhea, strong-smelling urine, dysuria, and urgency. Fever is common in younger children.

20. A three-year-old child brought to the emergency department is not breathing and is cyanotic. The parent states that the child has likely swallowed a penny. What is the nurse's first intervention? attempt a blind finger sweep give 100% oxygen administer five back blows administer abdominal thrusts

administer abdominal thrusts Explanation: A child between the ages of 1-8 should receive abdominal thrusts to help dislodge the object first. Administering 100% oxygen will not help if the airway is occluded. Infants younger than age 1 should receive back blows before chest thrusts. Blind finger sweeps should never be performed because this could push the object further back into the airway.

4. A client is being admitted with a spinal cord transection at C7. Which assessment(s) would take priority upon the client's arrival? Select all that apply. bladder function respirations reflexes blood pressure temperature

blood pressure temperature respirations Explanation: The nurse should assess the client for spinal shock, which is the immediate response to spinal cord transection. Hypotension occurs, and the body loses core temperature to environmental temperature. The nurse must treat the client immediately to manage hypotension and hypothermia. The nurse should also ensure that there is an adequate airway and respirations; there may be respiratory compromise due to intercostal muscle involvement. Once the client is stable, the nurse should conduct a complete neurologic check. The nurse should take all precautions to keep the client's head, neck, and spine position in straight alignment. If the client is conscious, the nurse should briefly assess major reflexes, such as the Achilles, patellar, biceps, and triceps tendons, and sensation of the perineum for bladder function.

28. The nurse is with the parents of an adolescent client who recently attempted suicide. The nurse cautions the parents to be especially alert for which changes in their child? desire to spend more time with friends engaging in more risk-taking or reckless behaviors giving away valued personal items expressing a desire to date deciding to try out for an extracurricular activity

giving away valued personal items Explanation: Giving away personal items has consistently been shown to be an indicator of suicide plans in a depressed and suicidal individual. Increased risk-taking or reckless behavior is associated with increased thoughts of suicide, especially when the risk-taking behaviors include illicit drug use. Expression of a desire to date, trying out for an extracurricular activity, or the desire to spend more time with friends indicates a return of interest in normal adolescent activities.

13. A child with nephrosis is taking prednisone. The nurse should teach the caregivers to report which adverse effects? Select all that apply. bleeding gums increased urinary output respiratory infection hematemesis vision problems

hematemesis respiratory infection Explanation: Adverse effects of steroid therapy include edema of the face and trunk, increased susceptibility to infection, gastric and intestinal mucosal bleeding, sodium and water retention, and hypertension. Steroid therapy can also cause vision problems. Urinary output is decreased due to the retention of sodium. Bleeding gums do not result from steroids.

15. The nurse creates a diet plan with the family of a child with acute renal failure. Which diet plan would be most appropriate for the child? high carbohydrate and protein high fat and carbohydrate low fat and protein low carbohydrate and fat

high fat and carbohydrate Explanation: The child with acute renal failure needs extra calories to reduce tissue catabolism, metabolic acidosis, and uremia. Using a high-fat and high-carbohydrate diet helps supply the necessary extra calories. If the child is able to tolerate oral foods, concentrated food sources that are high in carbohydrates and fat but low in protein, potassium, and sodium may be provided.

2. The nurse is providing discharge instructions about dietary limitations to a client with gout. Which foods should the client avoid? Select all that apply. sardines beer hard cheeses red wine orange juice

sardines red wine beer Explanation: The client with gout must limit intake of purines in the diet. Sardines, red wine, and beer contain purines and would increase the client's uric acid, which is what form the tophi is in in the joint leading to exacerbation of the gout. Orange juice does not substantially change uric acid level, and hard cheeses are avoided in clients who must avoid tyramine, not uric acid.

22. A client with Addison disease is taking corticosteroid replacement therapy. The nurse should instruct the client about which side effect(s) of corticosteroids? Select all that apply. increased susceptibility to infection hypotension hypocalcemia skeletal muscle weakness hyperkalemia mood changes

skeletal muscle weakness mood changes hypocalcemia increased susceptibility to infection Explanation: The long-term administration of corticosteroids in therapeutic doses often leads to serious complications or side effects. Corticosteroid therapy is not recommended for minor chronic conditions; the potential benefits of treatment must always be weighed against the risks. Hypokalemia may develop; corticosteroids act on the renal tubules to increase sodium reabsorption and enhance potassium and hydrogen excretion. Corticosteroids stimulate the breakdown of protein for gluconeogenesis, which can lead to skeletal muscle wasting. Central nervous system adverse effects are euphoria, headache, insomnia, confusion, and psychosis. The nurse watches for changes in mood and behavior, emotional stability, sleep pattern, and psychomotor activity, especially with long-term therapy. Hypocalcemia related to anti-vitamin D effect may occur. Corticosteroids cause atrophy of the lymphoid tissue, suppress cell-mediated immune responses, and decrease the production of antibodies. The nurse must be alert to the possibility of masked infection and delayed healing (anti-inflammatory and immunosuppressive actions). Retention of sodium (and subsequently water) increases blood volume and, therefore, blood pressure.