Never stop abruptly (adrenal crisis: hypotension, weakness, shock).
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client with an acute COPD exacerbation is prescribed oral prednisone. The nurse teaches the client about this corticosteroid. Which instruction is correct?
Answer: A. Systemic corticosteroids like prednisone must be tapered rather than stopped abruptly to prevent adrenal insufficiency, and they should be taken as prescribed. Taking the dose with food reduces gastric irritation. Stopping the drug suddenly or doubling doses without orders is unsafe.
Question 2 of 5
A nurse is preparing to administer an oral corticosteroid (prednisone) burst to a client with an acute asthma exacerbation. Which teaching point about this medication is most important?
Answer: B. Systemic corticosteroids like prednisone reduce airway inflammation in acute exacerbations. Clients should take the medication with food to reduce gastrointestinal irritation, and a tapering schedule prevents adrenal insufficiency when used longer-term. Abrupt discontinuation after prolonged use can precipitate adrenal crisis. It is not a rescue bronchodilator and works over hours.
Question 3 of 5
A client with asthma is prescribed albuterol and an inhaled corticosteroid. Which instruction about using these inhalers is correct?
Answer: B. Albuterol is a short-acting beta-2 agonist (rescue) and should be used first to open the airways, followed by the inhaled corticosteroid (controller). This sequence allows the steroid to reach deeper into the dilated airways. The corticosteroid is a daily maintenance medication, not a rescue drug.
Question 4 of 5
A client is prescribed both an albuterol inhaler and a fluticasone (inhaled corticosteroid) inhaler. The nurse should instruct the client to use them in which order?
Answer: B. When a short-acting bronchodilator and an inhaled corticosteroid are prescribed together, the bronchodilator (albuterol) should be used first. It opens the airways, allowing deeper penetration and better deposition of the corticosteroid that follows. The client should wait a few minutes between the two inhalers.
Question 5 of 5
A client on long-term prednisone asks why they can't just stop it. The nurse's best response is:
Answer: B. Abruptly stopping a corticosteroid risks adrenal crisis because the adrenal glands have suppressed their own output. It must be tapered.
Keep the streak going with more questions like these, each with a full rationale.
What is prednisone (corticosteroid)?
It treats autoimmune disorders, asthma, COPD exacerbations, allergic reactions, and many inflammatory conditions. Memory aid: think Cushingoid effects. Key principle: never stop abruptly because of adrenal suppression, and it masks infection.
Key points to remember
- Long-term use causes Cushingoid effects: moon face, buffalo hump, truncal obesity, and thin skin.
- It raises blood glucose, raises blood pressure, and causes sodium and fluid retention with potassium loss.
- It suppresses the immune system and masks signs of infection such as fever.
- It must be tapered, never stopped abruptly, to avoid adrenal crisis.
- Long-term use causes osteoporosis, hyperglycemia, peptic ulcers, and delayed wound healing.
Nursing priorities
- Monitor blood glucose, blood pressure, weight, and signs of infection.
- Administer with food to reduce GI irritation and ulcer risk.
- Assess for subtle infection because steroids mask fever and inflammation.
- Teach a slow taper and never abrupt discontinuation.
- Monitor potassium and assess for fluid retention and edema.
Labs & values
Patient teaching
- Take with food and do not stop suddenly; taper as directed.
- Avoid crowds and people who are sick; report any signs of infection.
- Carry medical identification and report mood changes, swelling, or vision changes.
Red flags: report now
- Never stop abruptly (adrenal crisis: hypotension, weakness, shock).
- Report signs of infection, black tarry stools, or severe abdominal pain.
- Report hyperglycemia and unexpected weight gain or swelling.
References
Clinical references for this topic
