They raise blood glucose (hyperglycemia), so diabetics need closer glucose monitoring.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client on long-term oral corticosteroids asks about stopping them. The nurse teaches to:
Answer: B. Never stop corticosteroids abruptly — taper to avoid adrenal crisis. Also take with food, monitor glucose, and watch for infection (immunosuppression).
Question 2 of 5
A nurse is assessing a client who has been receiving high-dose IV corticosteroids. Which finding requires immediate intervention?
Answer: B. Corticosteroids cause sodium and water retention and can precipitate or worsen heart failure and hyperglycemia. New crackles in the lungs with shortness of breath and weight gain suggest fluid overload and require immediate intervention. Mild mood elevation, increased appetite, and a slightly rounded face are expected effects that are not emergencies.
Question 3 of 5
A client with ITP is prescribed corticosteroids. The nurse explains that this medication is used to achieve what effect?
Answer: A. In ITP, the immune system destroys platelets. Corticosteroids suppress this immune response, reducing platelet destruction and raising the platelet count. They do not directly stimulate platelet production in the marrow.
Question 4 of 5
A client in preterm labor at 30 weeks gestation is prescribed terbutaline. What is the primary purpose of this medication?
Answer: B. Terbutaline is a beta-adrenergic agonist used as a tocolytic to relax the uterus and suppress preterm contractions, buying time for corticosteroids to mature fetal lungs. It does not induce labor, control bleeding, or treat hypertension. Maternal tachycardia is a key side effect to monitor.
Question 5 of 5
A client at 29 weeks gestation in preterm labor is prescribed betamethasone. The nurse explains the primary purpose of this medication. Which statement is correct?
Answer: B. Antenatal corticosteroids such as betamethasone are given to accelerate fetal lung maturity and reduce the incidence and severity of neonatal respiratory distress syndrome when preterm birth is anticipated. They do not stop contractions; that is the role of tocolytics.
Keep the streak going with more questions like these, each with a full rationale.
What is corticosteroids?
Chronic use causes Cushingoid effects and adrenal suppression, so the drug must never be stopped abruptly. Memory aid: steroids cause a 'moon face' and raise sugar, weight, and infection risk.
Key points to remember
- They raise blood glucose (hyperglycemia), so diabetics need closer glucose monitoring.
- They suppress the immune system, increasing infection risk and masking the signs of infection such as fever.
- Long-term use causes Cushingoid features: moon face, buffalo hump, truncal obesity, thin skin, easy bruising, and striae.
- They cause sodium and water retention with potassium loss, leading to edema, hypertension, and hypokalemia.
- Chronic use causes osteoporosis, muscle wasting, mood changes, cataracts, and GI ulcers.
- Abrupt withdrawal after long-term use can trigger life-threatening adrenal crisis.
Signs & symptoms
- ↑ glucose, ↑ wt, moon face
- ↓ K+, ↑ Na+, fluid retention
- Mood swings, ↑ infection risk
Nursing priorities
- Monitor blood glucose, blood pressure, weight, and signs of infection.
- Administer oral doses with food to reduce GI irritation and ulcer risk.
- Taper the dose gradually rather than stopping abruptly.
- Protect the patient from infection and exposure to ill people.
- Monitor potassium and assess for edema and fluid retention.
Labs & values
Patient teaching
- Never stop the medication suddenly; it must be tapered by your provider.
- Avoid people who are sick and report fever or signs of infection.
- Take the medication with food, and carry medical identification stating you take steroids.
Red flags: report now
- Signs of infection (which may be subtle or fever may be masked) require prompt evaluation.
- Abrupt discontinuation after prolonged use can cause adrenal crisis with hypotension, weakness, and shock.
- Black, tarry stools or signs of GI bleeding.
- Markedly elevated blood glucose or severe hyperglycemia.
References
Clinical references for this topic
