Psychotic Disorder Practice Exam/Test (13-23)

CHEAP BUY ! ! !        
NCLEX E-Book with FREE Saunders and KAPLAN ($4)

Situation: J., a 32 year old man with a 5 year history of multiple psychiatric admissions, is brought to the emergency department by the police. He was found wondering the streets, disheveled, shoeless, and confused. Based on h is previous medical records and current behavior, he is diagnosed as having chronic undifferentiated schizophrenia.

13. J. is escorted to the psychiatric unit by an aide. The nurse observes him sitting in the hall looking frightened. He is curled ap in a corner of the bench with his arms over his head and covering his face. How should the nurse approach the patient?

a) walk over to the bench, sit beside him quietly, and place an arm around his shoulders; then say, "I'm the nurse," and wait for a response
b) allow him to remain alone on the bench, where he can observe the unit for a half hour or so until he is more comfortable
c) greet him warmly saying, "Hi, I'm the nurse. This is a very nice unit. I think you'll like it here. Let me show you around"
d) sit about 3 or 4 feet from him on the bench and say, "Hello, J. I'm a nurse on this unit. You appear frightened"; then wait for a response

14. J. responds to the nurse by curling up on the bench even tighter. His arms still cover his head, and his hands are clasped tightly over his ears. the nurse should:

a) show acceptance of J.'s behavior by remaining with him and reassuring him, gently stroking his arms and shoulders
b) tell J. that she will leave him for a while and will return later when he feels more relaxed
c) say gently, "J., I'll just sit here quietly with you for a while," then remain seated nearby
d) say "J., most people feel uncomfortable in hospitals. You shouldn't be afraid, I'm here to help you

15. Later that evening, the nurse finds J. crouched in the corner of his room, with a curtain covering him. His roommate is sitting on the bed laughing and saying, "This guy is really a nut. He should be in a padded cell." How should the nurse respond to the roommate?

a) say "I'm sure J.'s behavior is frightening to you. I understand that you are trying to cover up how you really feel by laughing."
b) say "I'd appreciate it if you'd step outside for a while. I'd like to talk with you after I help J"
c) say nothing and attend to J
d) say, in a neutral tone, "I think your laughing is making J. feel worse. How would you feel if you were J.?"

16. What is the least threatening approach to J. while he sits huddled under the curtain?

a) sit next to him on the floor without speaking, and wait for him to acknowledge the nurse
b) gently remove the curtain and say, "J., this is the nurse. What happened?"
c) approach J. slowly and say, "J., this is the nurse. You appear to be very frightened. Can you tell me what you are experiencing?"
d) call for assistance and do not approach J. until at least two other staff members are present

17. Which is the priority nursing diagnostic category based on J.'s current behavior?

a) anxiety
b) impaired verbal communication
c) altered thought processes
d) dressing and grooming self-care deficit

18. Because J. has previously responded well to treatment with haloperidol (Haldod), the physician orders haloperidol 10 mg orally twice a day. Which adverse effects is most common with this medication?

a) extrapyramidal symptoms
b) hypotension
c) drowsiness
d) tardive dyskinesia

19. During the next several days, J. is observed laughing, yelling, and talking to himself. His behavior is characteristic of:

a) delusion
b) looseness of association
c) illusion
d) hallucination

20. J. tells the nurse, "The earth is doomed, you know. The ozone layer is being destroyed by hair spray. You should get away before you die." J. appears frightened as he says this. The most helpful response is to:

a) says, "J., I think you are overreacting. I know there is some concern about the earth's ozone later, but there is no immediate danger to anyone
b) say, "I've heard about the destruction of the ozone layer and its effect on the earth. Why don't you tell me more about it?"
c) ignore J.'s statement and redirect his attention to some activity or the unit
d) say, "J., are you saying you feel as though something bad will happen to you?"

21. After a half hour, J. continues to ramble about the ozone layer and being doomed to die. He paces in an increasingly agitated manner, and he begins to speak more loudly. At this time, the nurse should:

a) check to see whether the physician ordered haloperidol on an as-needed basis
b) allow J. to continue pacing but observe him closely
c) try to involve J. in a current events discussion group that is about to start
d) tell J. to go to his room for a while

22. The treatment team reviews J.'s behavior and decides to continue increasing his haloperidol dosage for the next few weeks. The nurse must closely observe the patient fro:

a) signs of haloperidol toxicity
b) evidence of the therapeutic window effect
c) increased incidence of orthostatic hypotension
d) indications of tardive dyskinesia

23. After several months, J. improves, and the physician decides to change the medication to haloperidol decanoate (haldol decanoate). Why is this change made?

a) haloperidol decanoate is more effective
b) haloperidol decanoate has fewer side effects
c) a change in medication produces a better response
d) haloperidol decanoate can be given monthly instead of daily


13) d
- Rationale: In approaching J. for the first time, the nurse should keep in mind that schizophrenic patients fear closeness. Moving too close to the patient at first may be seen as invasion of his personal space, which could frighten him and cause him to strike out at the nurse. To avoid overwhelming J., the nurse should limit her introduction to who she is and acknowledge that the patient appears frightened. Touch can have unpredictable meanings to a frightened psychiatric patient, so it is best to avoid it, especially with someone new. Because J. is obviously in distress, the nurse should gently intervene rather than leave him alone or ignore his distress with false reassurance about how nice the unit is.

14) c
- Rationale: The nurse should attempt to establish trust by demonstrating acceptance of J.'s behavior and offering to remain with him. This lets J. know that he does not have to talk to get her attention. Touching or stroking the patient ignores the indications that he is trying to distance himself as a protective measure and would be viewed as intrusive and threatening. Because the patient's behavior results from his resistance to closeness, leaving him alone would reinforce this conduct and would add to his anxiety. Attempts to offer verbal reassurance are likely to be ineffective for a withdrawn and frightened patient such as J.

15) b
- Rationale: Because the nurse's first priority is to attend to J., the most appropriate action is to ask the roommate to step outside. The nurse should recognize the roommate's behavior as a probable sign of increased anxiety and should ask the roommate to leave without engaging him in a prolonged discussion. However, she should confront the roommate as soon as possible to discuss his reaction to J.'s behavior and to explore more appropriate responses. Any attempt to interpret the roommate's behavior at this time could escalate his anxiety about the situation and cause additional outbursts that could further increase J.'s anxiety.

16) c
- Rationale: J.'s behavior indicates that he is experiencing severe anxiety and panic. The nurse can avoid startling him by approaching him slowly while talking to him, yet maintaining a safe distance of 3' to 4' (about 1 to 1.5 m). Although sitting at the same level as the patient can facilitate communication, failing to maintain a safe distance may place the nurse at considerable risk should the patient suddenly become violent. The nurse should encourage J. to discuss his present experience by reflecting her observations of his behavior. She should not attempt to remove the curtain, which is being used to protect against intrusion. As j.'s anxiety decreases, he can be asked to remove it himself. Additional staff members should be called if the patient does not tolerate the nurse's approach and becomes agitated; however, initially, their presence would probably frighten him more.

17) a
- Rationale: The priority nursing diagnostic category is Anxiety, severe to panic-level, as evidenced by J.'s extreme withdrawal and attempt to protect himself from the environment. The nurse must act immediately to reduce his anxiety and to protect the patient and others from possible injury. Impaired verbal communication, as evidenced by noncommunicativeness. Altered thought processes, as evidenced by an inability to understand the situation, and Dressing and grooming self-care deficit, as evidenced by a disheveled appearance, are all appropriate nursing diagnostic categories but are not the priority in this situation.

18) c
- Rationale: Extrapyramidal effects, including dystonia, akathisia, pseudoparkinsonism, and tremors, are the most common adverse reactions associated with haloperidol (Haldol), a high-potency antipsychotic drug. Haloperidol rarely causes tardive dyskinesia, a severe, irreversible extrapyramidal reaction. Hypotension and drowsiness are common side effects of low-potency antipsychotic agents, such as chlorpromazine and thioridazine.

19) d
- Rationale: Auditory hallucination, hearing voices when there are no external stimuli, is common in schizophrenic patients. The nurse can indirectly determine that J. is hallucinating by observing such behaviors as laughing, yelling, and talking to himself. Delusions, false beliefs or ideas that arise without external stimuli, also are common in patients with schizophrenia. For example, a delusional patient may believe that he is being controlled by the television in his room. Schizophrenic patients may exhibit looseness of association, a pattern of thinking and communicating in which ideas are not clearly linked to one another. For example, the patient may make statements that are disconnected and unclear to the listener. A less severe perceptual disturbance is illusion, wherein in the patient misinterprets actual external stimuli. For example, the patient may see a red exit sign and think that the wall is on fire. Illusions are not commonly associated with schizophrenia.

20) d
- Rationale: J.'s statement combines truth (the ozone layer is being destroyed), some exaggeration that may be delusional (the earth is doomed), and some projection of his own fears (the nurse should get away). By choosing to respond to the underlying message about J.'s fear of being destroyed, the nurse attempts to help him identify and express his feelings in a more direct and appropriate manner. Reflecting doubt about delusional statements can help the patient see that the nurse does not share his belief. However, such reflection should not be stated judgmentally ("You are Overacting"). Pursuing a discussion about the ozone layer or ignoring his comments completely are nontherapeutic approaches because they do not acknowledge his fear.

21) a
- Rationale: Because interpersonal interventions have failed to decrease J.'s anxiety level, medication is needed. If an as-needed order is unavailable, the nurse should ask the physician to write one. If the nurse does not intervene and allows J. to continue pacing, his anxiety and agitation may escalate, which may be dangerous to the patient and others. Involving J. in a discussion group would probably increase his anxiety level and cause him act out aggressively. Telling J. to go to his room after he receives his medication would be helpful; the combination of an antipsychotic agent and reduced stimuli will help to decrease his agitation.

22) b
- Rationale: The therapeutic window effect is the point at which an increase in dosage decreases a drug's therapeutic effect. Therefore, the nurse must closely observe the patient as the haloperidol dosage is increased. The toxic level of haloperidol has not been clearly established. Orthostatic hypotension is not common with this drug; tardive dyskinesia are rare. A patient receiving haloperidol is typically observed for therapeutic effects rather than intolerable side effects.

23) d
- Rationale:
Haloperidol decanoate (Haldol Decanoate), given by depot injection, has a 4 week duration of action, which makes it appropriate for patients who require long-term drug therapy. Haloperidol decanoate is not more effective; nor is it useful for treating patients with acute psychotic episodes because a therapeutic level is not achieved for up to 3 months. Although this form of haloperidol rarely causes sedation or postural hypotension, it often produces extrapyramidal symptoms. Switching antipsychotic agents does not achieve a better response; high-potency antipsychotic drugs are equivalent in clinical effectiveness.

Related Topics:

NCLEX Preparation Course - Critical Thinking Exercises VI (Questions 61-70)

Here are the Answers to NCLEX Preparation Course - Critical Thinking VI (61-70) -->

Situation: Baby Nicole is born with myelomeningocele.

61. Antibiotic therapy is started, but Baby Nicole's condition worsens. Which is a later sign of meningitis that the nurse should report?

a) hypothermia
b) opisthotonus
c) sunset the sign of the eyes
d) depressed fontanels

62. Six months after surgery, baby Nicole develops fever and convulsion. Which observation by the nurse would help confirm a diagnosis of meningitis?

a) rigidity of the lower extremities
b) increased pulse rate
c) high pitch cry
d) severe constipation

63. The nurse explains to the parents of Baby Nicole that even if the surgery was successful. Nicole need a continued health supervision of a:

a) cardiologist
b) dental hygienist
c) urologist
d) speech therapist

64. When Baby Nicole was 1 day old she has surgery for reduction of myelomeningocele. Which nursing intervention is critical during the postoperative period?

a) passive range-of-motion exercises of the lower extremities
b) suprapubic manual expression of urine
c) observation of the frequency and character of the stools
d) daily measurement of the head circumference

65. Which is the best position of Nicole before surgery?

a) trendelenburg's in the prone position
b) flat, on her side
c) semi fowler's on her side
d) prone position on her side

66. An internal fire drill is scheduled to be done in the hospital. To make beds available for the fire drill, who among these clients may be discharged?

a) the client with oral simplex virus whose culture is negative, temperature is 37.4C
b) the client with pneumonia, WBC is level 12,000/
c) the client with anemia whose hemoglobin level is 7.5g/dL
d) the client with renal failure with serum potassium level of 3 mEq/L

67. A nurse is caring for a client with a burn injury to the lower legs. Nitrofurazone (furacin) is prescribed to be applied to the site of injury. The nurse documents which of the following in the plan of care as the appropriate method to apply this medication?

a) apply dressings soaked with saline solution over the medication
b) apply 1-inch film directly to the burn sites
c) apply 1/16-inch film directly to the burn sites
d) apply 1/2-inch film directly to the burn sites

68. The nurse would expect to find which of the following:

a) abdominal rigidity
b) distended abdominal and umbilical veins
c) visible waves of peristalsis
d) rectal prolapse

69. Following surgery for Pyloric Stenosis, Hannah is started on glucose water. Infant formula is held until:

a) bowel sounds are detected
b) vital signs are stable
c) the infants is able to retain clear liquids
d) diarrhea is absent

PREVIOUS [---------------------]

Related Topics:

    NCLEX Secrets - Neurology Board Review (1-5)

    NCLEX Secrets - Neurology Board Review

    Situation: Warren was admitted to the hospital with a diagnosis of hypertension.

    1. The nurse should carefully evaluate the pulse prior to administering which medication?

    a) clonidine (catapres)
    b) propanolol (inderal)
    c) atorvastitin calcium (lipitor)
    d) lovastatin (mevinolin)

    2. At the time of Warren's physical examination, which finding was indicative of hypertension?

    a) pupil changes an opthalmoscopic exam
    b) presence of the second heart sound
    c) sinus rhythm on auscultation
    d) cardiac electrocardiogram

    3. When teaching Warren on precautions to take while on antihypertensive medication, the nurse should advice him to:

    a) avoid changing position suddenly
    b) observe for black and blue marks
    c) learn to take his blood pressure TID
    d) take the drugs always on empty stomach

    4. Warren has renal damage related to his hypertensive condition. When teaching him about his diet the nurse should advice him to:

    a) replace whole milk with milk products
    b) use salt substitute such as potassium chloride
    c) eliminate protein from his diet
    d) limit processed foods to fruits and juices

    5. Which test should you order for Warren before treatment is indicated?

    a) creatinine clearance
    b) serum uric acid
    c) serum creatinine
    d) resting electrocardiogram

    NCLEX Secrets - Neurology Board Review:

    1) B
    - Propanolol is a drug that is used for angina pectoris, MI, arrythmias, hypertension, migraine, essential tremor, pheochromocytoma. Its main effect is to block catecholamine effect in heart and blood pressure, thereby, lowering BP and heart rate. The main potential adverse effect of the drug is bradycardia, heart failure, and hypotension. Thus it is very important to always check the patient's apical pulse and blood pressure before administering the drug. If the patient has bradycardia (below 60), withhold giving the drug and notify physician.
    • always give with food to increase absorption
    • advise not to discontinue abruptly as it can exacerbate angina and precipitate MI
    • advise to continue taking the drug even he is already feeling well
    • this drug should not be given to patients with asthma
    • do not discontinue before surgery for pheochromocytoma
    Clonidine (Catapres) is an antihypertensive drug. Although it affects both blood pressure and pulse rate so that these vital signs must be checked before administering catapres, its effect on heart rate is not as much as that of propanolol. If the patient has hypotension and bradycardia, the drug should not be given and the doctor notified.
    • clonidene may cause a weakly positive Coomb's test and decreases excretion of vanilymandelic acid
    • avoid giving with propanolol and betablockers as it results in rebound hypertension
    • avoid giving with Verapamil as it may cause AV block and severe hypotension
    • avoid giving with herbal supplement capsicum as it may reduce antihypertensive effect of catapres
    • avoid orthostatic hypotension by rising slowly and changing position slowly
    • side effect drowsiness will diminish after 4 to 6 weeks
    • the last dose should be taken immediately before going to bed
    • advise not to discontinue drug abruptly as it may cause rebound hypertension
    Lipitor and lovastatin are drugs used to lower LDL and total cholesterol and triglyceride levels.

    2) A
    - letters b,c,d are examinations and findings that are more often carried out and associated with disease conditions of the heart.
    Hypertension is a persistent systolic blood pressure greater than 140 mmHg and a diastolic pressure greater than 90 mmHg. It is characterized by elevated peripheral vascular resistance from constriction of arterioles, which may be caused by sympathetic responses and stimulation of the renin angiotensin mechanism.
    It is classified as primary or essential hypertension in which there is no known etiology, and secondary, which develops as a result of some other condition.
    On Physical Examination:
    • opthalmoscopic exam: the eyes will usually reveal narrowed arterioles, hemorrhage, exudates and papilledema or swelling of the optic nerve
    • apical and peripheral pulses
    • vital signs and BP
    • edema of extremities
    Patients may complain of:
    • headache at the back of the head and neck
    • nocturia
    • confusion
    • nausea and vomiting
    • visual disturbances
    3) A
    - the most common side effect of antihypertensive drugs is orthostatic hypotension. To prevent it, instruct the patient to avoid changing position suddenly and standing for prolonged periods of time. Advise patient to sit down if he feels dizzy.

    4) D
    - hypertensive patients without renal damage are often placed on a fat/cholesterol, low sodium and low calorie diet.
    Processed, preserved and fast foods are often high in sodium and must be avoided in a low sodium diet
    Proteins are not eliminated in the diet but its intake is limited to the recommended daily allowance to prevent overloading the kidney, adding calories and weight gain.
    Using salt substitutes that contain potassium may interact with the antihypertensive drugs being taken by the patient, especially when patient is taking ACE inhibitors as it may result in hyperkalemia.

    5) C
    - the purpose of the diagnostic tests is to identify possible causes of hypertension and to identify the organs already affected by the disorder in order to institute the most effective treatment regimen for the patient. The routine laboratory tests conducted before initiating treatment include CBC, urinalysis and blood chemistry including glucose, electrolytes, cholesterol, serum creatinine and blood urea nitrogen.
    Serum creatinine and blood urea nitrogen reflect renal function. Hypertension can significantly decrease blood supply to the kidney which can damage the renal system and impair kidney function resulting in fluid retention and inability of the kidney to regulate electrolytes balance and excrete metabolic waste products such as urea. Hematocrit and hemoglobin are monitored as they reflect changes in fluid volume.

    Click here to Visit our Study Guide to Master the Fundamentals of Nursing

    Related Topics:

    NCLEX Secrets about Musculoskeletal Injuries (1-8)

    NCLEX Secrets about Musculoskeletal Injuries

    Situation: Mr. Janno Alcasid, overweight, 61 years old, was admitted and diagnosed with osteoarthritis.

    1. Mr. Alcasid asks the nurse, "What is osteoarthritis?" Which response from the nurse is correct?

    a) your bones are inflamed
    b) your weight bearing joints are inflamed
    c) you have inflammation in your joints
    d) there is shortening of your long bones

    2. Which of the following guidelines should a nurse include in the teaching plan for a patient who has osteoarthritis?

    a) achieve ideal body weight
    b) increase daily calcium intake to 1500 mg
    c) maintain a high fiber diet
    d) sleep at least 10 hours each day

    Situation: Maco, a newly registered nurse, works as a private duty nurse of a 55 year old female Canadian national who has gout.

    3. Which of the following nursing diagnoses is a priority for a patient with gout?

    a) pain
    b) fatigue
    c) risk for infection
    d) risk for peripheral neurovascular dysfunction

    4. The nurse would instruct the patient which of the following to minimize complications?

    a) drinking a minimum of 3000 ml of fluid per day
    b) eating a minimum of 2500 calories per day
    c) walking at least three miles per day
    d) resting at least three hours per day

    5. Foods allowed in the diet of gout patient include:

    a) cheese
    b) beef
    c) sardines
    d) liver

    6. The patient is placed on allopurinol (Zyloprim) therapy. To monitor effectiveness of the therapy, the nurse will monitor which the following serum laboratory values?

    a) uric acid
    b) fasting blood glucose
    c) serum calcium
    d) alkaline phosphatase

    7. A patient with rheumatoid arthritis asks the nurse why she is taking Prednisone (Deltasone) the nurse best response would be that it:

    a) enhance the immune system
    b) increase bone density
    c) decrease inflammation
    d) reduce peripheral edema

    8. A patient under steroid therapy should be advised by the nurse to:

    a) limit carbohydrates in the diet
    b) take the medication on an empty stomach
    c) avoid individuals who have infections
    d) stop the medication when symptoms have subsided

    NCLEX Secrets about Musculoskeletal Injuries:

    1) B
    - Osteoarthritis
    , also known as hypertrophic arthritis, osteoarthritis, senescent arthritis and degenerative joint disease is characterized by destruction of the articular cartilage, which becomes opaque, yellow, soft, weak and deteriorated. It is followed by thickening of bone under the cartilage and formation of osteophytes or bone spurs. Unlike RH, osteoarthritis is not a systemic disease and affects only the joint and its surrounding tissue. This disorder commonly occurs in the 50-70 year age group but women are more severely affected.

    The Signs and Symptoms of Osteoarthritis include:
    • pain - worse with weight bearing, improves with rest may occur with paresthesia
    • joint swelling and enlargement - may be from inflammatory exudates entering joint capsule causing an increase in synovial fluid or from fragments of osteophytes entering synovial cavity
    • decreased ROM - depends on the amount of destroyed cartilage
    • muscular atrophy - from disuse, joint instability and deformity
    • crepitus - must be present on movement of the joint
    • joint stiffness - worse in the morning and after a period of rest and disuse
    • heberden's nodes - bony protuberances occurring on the dorsal surface of the distal interphalangeal joints of the fingers
    • bouchard's nodes - bony protruberances occurring on the proximal interphalangeal joints of fingers
    • coxaarthrosis - pain in the hip on weight bearing with pain progressing to include the groin and medial knee pain and limited range of motion
    • varus (bowlegs) or valgus (knock kneed)
    2) A
    - the primary cause of arthritis is not yet known but it is often-associated with obesity, aging, trauma, fractures, and infections. Osteoarthritis is a wear and tear disease of the joints. The more pressure it takes the more severe and the faster is the progression of the disease. Thus, one of the important aspects of management if the patient is obese is to lose weight to lessen the pressure on the joints

    3) A
    - Gouty arthritis
    is a metabolic disorder characterized by accumulation and deposition of uric acid crystals, called tophi, in tissues especially in joints that results in inflammatory response. It is caused by prolonged hyperuricemia due to problems in synthesizing purines or by poor excretion of uric acid by the kidney. This disorder is more common in men, with onset around age 50.

    The immediate problem of patient suffering from gout is the acute pain experienced on affected joints such as the great toe, feet, ankles, or knees.

    Other signs and symptoms include:
    • malaise
    • pruritus
    • headache
    • elevated serum uric acid
    • presence of tophi
    • positive monsodium urate crystals in synovial fluid
    • inflammation of affected joint
    Nursing care during the acute phase when severe joint pain afflicts the patient includes:
    • provide bed rest
    • use bed cradle to support bed sheets and keep pressures of sheets off joint
    • perform range of motion exercise gently
    • carefully align joints so they are slightly flexed
    • administer medications
    4) A
    - renal urate lithiasis (kidney stones) may result from precipitation of uric acid in the presence of low urinary pH. This can be avoided by allowing the patient liberal fluid intake to promote urinary excretion of uric acid.

    5) A
    - preventive measures for gout:
    • uric acid is formed from metabolism of purine. To prevent further formation and accumulation of uric acid, the patient must be advised to stick on a low purine diet. This means that the patient must avoid: sweet breads, yeast, heart, herring, sardines, anchovies, shellfish, heavy alcohol intake
    • avoidance of excessive weight gain
    • alkaline ash diet to increase the pH of urine to discourage precipitation of uric acid and enhance the action of drugs such as probenicid (Benemid)
    6) A
    - preventive therapy - prevention of future gout attacks is by placing the patient on daily medication that either promote uric acid excretion or prevent uric acid formation. To evaluate the effectiveness of the therapy, serum uric acid level of the patient must be monitored. The medication is effective when uric acid goes down to normal level below 6.9 mg/dl.

    7) C
    - the main effect of corticosteroids is to supress inflammation. However, this same effect is also one of the main setback of corticosteroid therapy suppression of the inflammatory response also decreases the immune response making the patient susceptible to infection.

    8) C
    - Long Term Side Effects of Prednisone Therapy
    • causes GI irritation so it must be taken with food. Patient may need antacid (must not contain sodium) to prevent ulcer. Give once-daily dose in the morning to lessen toxicity. Maybe diluted in juice or semi-solid food such as apple sauce
    • causes sodium and water retention that results in cushinghoid appearance: moon face, buffalo hump, thinning of hair, hypertension and edema. Advise patient on low sodium diet that's high in potassium and protein
    • avoid discontinuing abruptly as it can cause adrenal insufficiency and rebound inflammation. Reduce dosage gradually
    • can cause glaucoma and cataract so monitor patient for visual disturbances and advise to have annual eye exam if on long term therapy
    • increases cholesterol and glucose levels so diabetics must increase insulin dosage
    • skin tests will be false-negative because it suppresses immune response
    • avoid active immunization while under therapy because patient is immunosuppressed
    • causes hypocalcemia and hypokalemia and increased urine calcium levels, causes osteoporosis so patient needs Vitamin D and calcium supplement
    • will decrease iodine uptake and protein-bound iodine levels in thyroid function test
    • tell patient to report: slow healing, exposure to infection, depression, insomnia, psychotic symptoms, weakness and fatigue, dizziness, joint pain, fever, anorexia and fainting
    • always give by deep IM in gluteal muscle to prevent sterile abscess if given by subcutaneous and rotate injection sites route to prevent tissue atrophy
    • always give the lowest dose to minimize toxicity

    Click here to Visit our Study Guide to Master the Fundamentals of Nursing 

    Related Topics: