A patient on steroid therapy should be taught to -

Appeared in: UPPSC 2023

Explanation

Patients on long-term steroid therapy must be taught not to stop the medication abruptly to prevent a life-threatening condition.
Prolonged use suppresses the hypothalamic-pituitary-adrenal (HPA) axis, causing the adrenal glands to stop producing the body's natural cortisol.
Abrupt cessation can trigger acute adrenal insufficiency (Addisonian crisis), a medical emergency characterized by severe hypotension, weakness, and shock.
The dose must be tapered (reduced gradually) under a prescriber's supervision to allow the adrenal glands time to resume their normal function.

Option A: Patients should never self-adjust steroid doses. Unprescribed increases can lead to toxicity and severe side effects like Cushing's syndrome.
Option B: Steroids commonly cause increased appetite, fluid retention, and weight gain. Encouraging more food would worsen these side effects.
Option D: Steroids are known to raise blood glucose levels (hyperglycemia) by promoting glucose production and causing insulin resistance. Increasing sugar intake is dangerous.

Clinical Relevance

Nursing practice connection: Use the key finding related to Patient education for corticosteroid therapy to guide bedside assessment, documentation, and the next nursing action.
A primary nursing responsibility is educating patients on the critical importance of medication adherence and the dangers of abrupt withdrawal to prevent a life-threatening adrenal crisis.
Nurses must diligently monitor patients on steroids for a wide range of side effects, including hyperglycemia, hypertension, weight gain, signs of infection (which may be masked), and mood changes.
What if? If the patient were on a very short course of steroids (e.g., a 5-day 'steroid burst' for an allergic reaction), tapering might not be required as significant HPA axis suppression is less likely. However, this decision always rests with the prescriber.

How to Approach the Question

First, identify the core of the question: It's asking for the most important patient safety instruction related to steroid therapy.
Recall the major risks and side effects of corticosteroids. Key points include effects on blood sugar, weight, immunity, and, most critically, the adrenal glands.
Evaluate each option against this knowledge.
Option A (self-dosing) is unsafe for any potent medication. Option B (increasing food) contradicts the known side effect of weight gain. Option D (increasing sugar) contradicts the known side effect of hyperglycemia.
Recognize that Option C (not stopping abruptly) addresses the most severe, acute, and life-threatening risk associated with long-term steroid use—adrenal crisis due to HPA axis suppression. This makes it the highest priority teaching point.

Concept Tested & Keywords

QRsFcn8QRnI8Rjus3jiAon

E6 Pharmacology Nursing Lilley 11e Part 2 pp. 226-228, 225-227

Practise the full UPPSC 2023

Attempt every question from this paper in a timed mock, then review the full solution for each one.