# Situation: A 29-year-old woman with relapsing-remitting multiple sclerosis (MS) is admitted to the medical ward with new weakness and numbness of both legs for 3 days. She lives in a hot, humid area and works in an office. Intravenous methylprednisolone 1 g once daily for 5 days is started. Which monitoring should the nurse include during this course?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630417  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 29-year-old woman with relapsing-remitting multiple sclerosis (MS) is admitted to the medical ward with new weakness and numbness of both legs for 3 days. She lives in a hot, humid area and works in an office.

Intravenous methylprednisolone 1 g once daily for 5 days is started. Which monitoring should the nurse include during this course?

## 보기

1. Hourly neurovascular checks of both lower limbs
2. Serum calcium levels drawn twice a day for 5 days
3. Blood glucose checks before meals and at bedtime **✔ 정답**
4. Visual acuity testing with an eye chart each shift

**정답: 3**

## 해설

High-dose corticosteroids commonly cause hyperglycemia, so blood glucose is monitored, along with blood pressure, mood and mental status, and sleep. The course speeds recovery from the relapse but does not change the long-term course of the disease.

## 심화 해설

The monitoring to include
She is receiving IV methylprednisolone 1 g once daily for 5 days for an MS relapse. High-dose corticosteroids commonly cause hyperglycemia, so blood glucose is monitored, along with blood pressure, mood and mental status, and sleep. Blood glucose checks before meals and at bedtime are the monitoring the nurse should include.

Why high-dose steroids raise glucose
Corticosteroids increase glucose production by the liver, reduce glucose uptake by muscle and fat, and induce insulin resistance. With pulse doses as large as 1 g of methylprednisolone, hyperglycemia is common even in clients without diabetes, and it can be marked in those who have it. Glucose often peaks in the afternoon and evening after a morning dose, which is why checks before meals and at bedtime are useful. Elevated glucose can cause dehydration, impaired healing, and infection risk, so it is detected and treated.

Other effects to watch during the course
Short courses of high-dose steroids may also cause fluid retention and elevated blood pressure, mood changes ranging from euphoria to irritability or depression, insomnia, a metallic taste, gastric irritation, and increased susceptibility to infection. The course speeds recovery from the relapse but does not change the long-term course of the disease. The nurse teaches the client to report new symptoms and monitors for infection.

| Monitoring | Relevance to a 5-day steroid pulse |
| --- | --- |
| Blood glucose before meals and at bedtime | High-dose steroids commonly cause hyperglycemia |
| Blood pressure, mood, sleep | Common short-term effects |
| Hourly neurovascular limb checks | For casts, fractures, or vascular procedures; not steroid effects |
| Serum calcium twice daily | Not a routine check for a short course |
| Visual acuity each shift | Cataracts are a late effect of long-term use |

Why the other options are wrong
Hourly neurovascular checks assess circulation after casts, fractures, or vascular procedures and do not monitor steroid effects. Serum calcium twice a day is not a routine safety check during a short course; bone loss is a concern with long-term use. Visual acuity testing each shift targets cataracts, which are a late effect of long-term corticosteroids, not something that develops during a 5-day course.

Exam takeaway
Key point IV methylprednisolone pulses for MS relapse: monitor glucose, blood pressure, mood, sleep, and infection. Long-term effects such as cataracts and osteoporosis are not daily concerns in a short course.

## 임상 시나리오

High-Dose Methylprednisolone for MS RelapseWhat to monitor during the pulse
IV methylprednisolone 1 g daily for 5 days speeds recovery from an MS relapse but does not alter the long-term course.

High-dose steroids commonly cause hyperglycemia, so blood glucose is checked before meals and at bedtime. Blood pressure, mood, sleep, and signs of infection are also monitored.

CautionCataracts and bone loss are long-term steroid effects and are not a focus of shift monitoring during a short course.

## 핵심 개념

- **Methylprednisolone** — A corticosteroid given in high IV doses to shorten multiple sclerosis relapses.
- **Steroid-induced hyperglycemia** — High blood glucose caused by corticosteroids increasing glucose production and insulin resistance.
- **MS relapse** — A new or worsening episode of neurologic symptoms in multiple sclerosis lasting at least a day.
- **Insulin resistance** — Reduced response of tissues to insulin, leading to higher blood glucose.

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