A client who has been taking prednisone to treat asthma is advised to discontinue the medication. The client should be instructed to reduce the dose gradually to prevent which of the following adverse effects?

Correct Answer: B

Rationale: In pharmacology, it is crucial to understand the principles of corticosteroid therapy to provide safe and effective care to clients. In this scenario, the correct answer is B) Adrenocortical insufficiency. When a client abruptly stops taking prednisone, a corticosteroid, after prolonged use, it can suppress the body's natural production of cortisol. Cortisol is essential for various physiological functions, including maintaining blood pressure, regulating metabolism, and responding to stress. Abrupt discontinuation can lead to adrenocortical insufficiency, as the adrenal glands may not be able to produce enough cortisol to meet the body's needs, resulting in potentially life-threatening complications. The incorrect options can be explained as follows: A) Hyperglycemia: While corticosteroids like prednisone can indeed increase blood sugar levels, abrupt discontinuation is more likely to lead to adrenocortical insufficiency rather than hyperglycemia. C) Severe dehydration: Discontinuing prednisone gradually helps prevent adrenal suppression, not dehydration. D) Rebound pulmonary congestion: This is not a common adverse effect associated with corticosteroid discontinuation but rather may occur with the use of certain medications for asthma. Educationally, it is important to teach students and healthcare professionals about the significance of tapering corticosteroid doses gradually to allow the body's adrenal glands to resume cortisol production safely. Understanding the mechanism of action and potential adverse effects of corticosteroids is essential in managing patients effectively and ensuring optimal outcomes in clinical practice.

Correct Answer: B

Rationale: Limiting intake of caffeine-containing beverages is important for managing peptic ulcer disease as caffeine can stimulate gastric acid secretion, which may worsen the condition. It is advisable to choose decaffeinated beverages and avoid caffeinated drinks to help reduce the risk of aggravating the ulcer.

Correct Answer: C

Rationale: In the context of a client receiving chemotherapy and being prescribed ondansetron IV for nausea and vomiting, the nurse should monitor for tremors as an adverse effect. Ondansetron is a serotonin 5-HT3 receptor antagonist commonly used to prevent nausea and vomiting associated with chemotherapy. Tremors can be a potential side effect due to its action on neurotransmitter pathways in the brain. Option A, hypotension, is less likely with ondansetron as it is not known to significantly affect blood pressure. Option B, bradycardia, is also less common with ondansetron compared to other antiemetic medications. Option D, urinary retention, is not typically associated with ondansetron use. Educationally, understanding the potential adverse effects of medications used in specific clinical situations is crucial for nurses to provide safe and effective care. Monitoring for and recognizing these adverse effects promptly can help prevent complications and improve patient outcomes. In the case of chemotherapy patients, managing nausea and vomiting effectively can significantly impact their quality of life during treatment.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Prothrombin time (PT). Warfarin is an anticoagulant medication that works by inhibiting the synthesis of vitamin K-dependent clotting factors in the liver, specifically factors II, VII, IX, and X. Prothrombin time (PT) measures the extrinsic pathway of the coagulation cascade, primarily assessing the functionality of factors II, VII, and X. Monitoring PT levels is crucial when a patient is on warfarin therapy to ensure the proper anticoagulant effect without increasing the risk of bleeding. Option A) Hemoglobin is not directly related to the therapeutic effect of warfarin. Hemoglobin levels are monitored to assess for anemia or other blood disorders. Option C) Bleeding time assesses the time it takes for blood to clot, but it is not a specific indicator of warfarin's therapeutic effect. Prolonged bleeding time may indicate a platelet disorder. Option D) Activated partial thromboplastin time (aPTT) primarily measures the intrinsic pathway of the coagulation cascade and is more commonly used to monitor heparin therapy, not warfarin. Monitoring aPTT is essential for assessing the effectiveness of heparin in preventing thrombus formation. Educationally, understanding the rationale behind selecting PT for monitoring warfarin therapy is crucial for nursing practice. It highlights the importance of selecting appropriate laboratory tests to assess the therapeutic effects of medications accurately. This knowledge enhances patient care by ensuring the safe and effective use of anticoagulants in clinical practice.

Correct Answer: A

Rationale: In pharmacology, monitoring for signs of digoxin toxicity is crucial for client safety. The correct answer is A) Visual disturbances. Digoxin toxicity often presents with visual disturbances such as yellow-green halos around objects due to its effect on the optic nerve. This is a classic indicator of digoxin toxicity. Option B) Tachycardia is incorrect because digoxin toxicity typically presents with bradycardia, not tachycardia. Digoxin slows the heart rate, so an increase in heart rate would be an atypical finding. Option C) Increased appetite is incorrect because it is not a typical symptom of digoxin toxicity. In fact, anorexia or decreased appetite is more common with digoxin toxicity due to its effects on the gastrointestinal system. Option D) Constipation is incorrect as well. Digoxin toxicity is more likely to cause gastrointestinal disturbances such as nausea, vomiting, or diarrhea rather than constipation. Educationally, understanding the manifestations of digoxin toxicity is essential for nurses and healthcare providers to ensure early detection and intervention. This knowledge helps in preventing serious complications and providing safe and effective care to clients receiving digoxin therapy.