# A 55-year-old client with rheumatoid arthritis is being discharged on prednisone 20 mg PO every morning long term. Which discharge instruction is most important?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375100&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 55-year-old client with rheumatoid arthritis is being discharged on prednisone 20 mg PO every morning long term. Which discharge instruction is most important?

## Option

1. Take it on an empty stomach in the morning, double the dose if you miss one, and discontinue when symptoms abate.
2. Take it at bedtime to reduce morning stiffness, stop it slowly over one week, and avoid wearing a medical alert bracelet.
3. Take it with food in the morning, do not stop abruptly, and follow the prescribed taper schedule. **✔ Correct answer**
4. Stop the medication when pain improves, take at bedtime to reduce nausea, and avoid calcium supplements.

**Correct answer: 3**

## Explanation

Long-term oral corticosteroids suppress the hypothalamic-pituitary-adrenal axis. Abrupt discontinuation causes adrenal insufficiency that can progress to adrenal crisis (hypotension, hypoglycemia, hyperkalemia, fatigue, vomiting, shock). Key teaching for chronic prednisone: (1) take with food in the morning to mimic the natural cortisol peak and reduce GI upset, (2) never stop abruptly; follow the prescribed taper, (3) report signs of infection (fever, sore throat, dysuria) because steroids mask classic signs and impair healing, (4) self-monitor for hyperglycemia, weight gain or edema, mood and sleep changes, easy bruising, and cataracts and glaucoma, (5) calcium 1000 to 1200 mg and vitamin D 800 to 1000 units daily, weight-bearing exercise, and bone-density monitoring for osteoporosis prevention, (6) wear a medical alert bracelet that identifies steroid dependency, (7) carry a sick day plan and obtain a stress dose during major illness, surgery, or trauma, (8) do not double a missed dose; take the next scheduled dose. Stopping early or doubling doses are direct contraindications.

## In-depth explanation

The single most life-threatening teaching point is the no-abrupt-stop rule because of HPA suppression. Pair it with the with-food-in-morning rule for absorption and circadian alignment.

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