A client with type 2 diabetes mellitus managed on insulin is admitted for an acute Asthma exacerbation. The healthcare provider prescribes oral prednisone. What is the priority nursing intervention?

Rationale: A. Monitor for signs of hypoglycemia is incorrect because prednisone, a corticosteroid, typically causes hyperglycemia, not hypoglycemia. Corticosteroids increase blood glucose levels by stimulating gluconeogenesis, reducing peripheral glucose uptake, and promoting insulin resistance. Therefore, the client is at increased risk of high blood sugar, not low blood sugar. B. Prednisone commonly causes significant hyperglycemia, especially in clients with type 2 diabetes mellitus. Because this client is already insulin-dependent, the priority intervention is to anticipate the need for increased insulin dosing and adjust the regimen accordingly. This prevents severe hyperglycemia, diabetic ketoacidosis (DKA), or hyperosmolar hyperglycemic state (HHS). Close monitoring of blood glucose levels and titration of insulin is essential. C. The dose of prednisone is determined by the provider for asthma management. Increasing the dose without provider direction is unsafe and would worsen hyperglycemia and potential steroid-related complications. D. Although corticosteroids can cause fluid retention, fluid restriction is not appropriate or safe unless the client has another condition requiring restriction (e.g., heart failure). Managing glucose levels is a much higher priority, and fluid restriction does not prevent steroid-induced hyperglycemia.