A patient is started on intravenous hydrocortisone. Which nursing action should be performed after administra… - NORCET 9 Prelims-2025

NORCET 9 Prelims-2025

Pharmacology

Medium

Appeared in: NORCET 9 Prelims-2025

Explanation

Hydrocortisone, a corticosteroid, increases blood glucose levels by promoting gluconeogenesis in the liver and increasing insulin resistance in peripheral tissues.
This effect, known as steroid-induced hyperglycemia, can occur in patients with or without a prior diagnosis of diabetes.
Therefore, monitoring blood glucose levels is a critical nursing action to detect and manage potential hyperglycemia after administration.
Early detection allows for timely intervention, such as adjusting diet or administering insulin, to prevent complications associated with high blood sugar.

Option B: Corticosteroids promote sodium and water retention, which can lead to hypertension and fluid overload. Encouraging a high-sodium diet would exacerbate this effect.
Option C: Withholding fluid intake is not a standard or routine nursing action for patients on hydrocortisone. While fluid retention is a potential side effect, the primary nursing action is to monitor intake, output, and daily weight.
Option D: The word "only" makes this option incorrect. While corticosteroids can cause hypokalemia (low potassium) and it should be monitored, nurses must assess for a wide range of potential side effects, including hyperglycemia, hypertension, and signs of infection.

Visual 1: Flowchart: Illustrating the pathway of how corticosteroids lead to hyperglycemia (gluconeogenesis and insulin resistance).
Visual 2: Infographic: Summarizing the systemic side effects of long-term corticosteroid use, often remembered by the mnemonic CUSHINGOID.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Nursing interventions and side effect monitoring for corticosteroid therapy in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Patient safety is paramount. Undetected steroid-induced hyperglycemia can lead to severe complications, including diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS).
Nurses must educate patients on long-term corticosteroid therapy about the signs of hyperglycemia (e.g., increased thirst, frequent urination, blurred vision) and the importance of regular follow-ups.
What if? If the patient was a known diabetic on insulin, the nurse's priority would be even higher. They would need to monitor blood glucose more frequently and anticipate the need for an increased insulin dose as per a sliding scale or provider's order.

How to Approach the Question

First, identify the drug mentioned: Hydrocortisone is a corticosteroid.
Next, recall the main physiological effects and common side effects of the corticosteroid drug class. Think about their impact on metabolism, electrolytes, and the immune system.
Evaluate each option based on this knowledge. Ask yourself, 'Is this action appropriate given the known effects of hydrocortisone?'
Option A: Does hydrocortisone affect glucose? Yes, it raises it. So, assessing blood glucose is logical.
Option B: Does it affect sodium? Yes, it causes retention. Encouraging more sodium is contraindicated.
Option C: Does it affect fluid balance? Yes, it causes retention. Withholding fluids isn't the standard first step; monitoring is.

Concept Tested & Keywords

Concept Tested: Nursing interventions and side effect monitoring for corticosteroid therapy.
Stem keywords: intravenous hydrocortisone, nursing action, administration
Lead-in keywords: Which
Negative lead-in flag: false

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