Which question by the nurse is a priority when a patient on long-term corticosteroid treatment reports fatigue, nausea, and salt cravings?

Which question by the nurse is a priority when a patient on long-term corticosteroid treatment reports fatigue, nausea, and salt cravings?

• A. Have you stopped taking your corticosteroid?
• B. Do you exercise vigorously every day?
• C. Do you drink caffeine?
• D. Have you recently started a new vitamin?

Answer: (A)

When someone has been on long-term corticosteroid therapy, the body’s own cortisol production can be suppressed. If the patient suddenly stops taking the steroid, the adrenal glands can’t quickly resume cortisol production, leading to adrenal insufficiency or an adrenal crisis. This is a medical emergency because inadequate cortisol (and often aldosterone) causes fatigue, nausea, vomiting, abdominal pain, and salt cravings due to disturbed sodium and fluid balance. Asking if the patient has stopped taking the corticosteroid is the most important question because it directly explains the mechanism behind these symptoms and guides immediate management. If the patient has indeed stopped or missed doses, the nurse should alert the clinician promptly, as restarting the steroid and planning a careful taper are often needed to prevent or treat adrenal crisis. Questions about exercise, caffeine, or a new vitamin don’t address the potentially life-threatening cause of these symptoms in someone on long-term steroids, so they’re not the priority in this situation.

When someone has been on long-term corticosteroid therapy, the body’s own cortisol production can be suppressed. If the patient suddenly stops taking the steroid, the adrenal glands can’t quickly resume cortisol production, leading to adrenal insufficiency or an adrenal crisis. This is a medical emergency because inadequate cortisol (and often aldosterone) causes fatigue, nausea, vomiting, abdominal pain, and salt cravings due to disturbed sodium and fluid balance.

Asking if the patient has stopped taking the corticosteroid is the most important question because it directly explains the mechanism behind these symptoms and guides immediate management. If the patient has indeed stopped or missed doses, the nurse should alert the clinician promptly, as restarting the steroid and planning a careful taper are often needed to prevent or treat adrenal crisis.

Questions about exercise, caffeine, or a new vitamin don’t address the potentially life-threatening cause of these symptoms in someone on long-term steroids, so they’re not the priority in this situation.