A nurse is providing instruction to a client who has chronic asthma and a new prescription for prednisone. For which of the following adverse effects should the nurse instruct the client to monitor?

Prednisone is a synthetic glucocorticoid used to suppress airway inflammation in chronic asthma. It inhibits the migration of polymorphonuclear leukocytes and reverses increased capillary permeability. Significant side effects arise from its immunosuppressive properties and its impact on glucose metabolism and bone density during prolonged therapy. Rationale: A. Signs of infection are a primary concern for patients on prednisone because glucocorticoids suppress the immune system and mask early inflammatory symptoms. The drug inhibits the activity of white blood cells, making it difficult for the body to fight pathogens. The nurse must instruct the client to report even low-grade fevers or sore throats immediately to prevent systemic spread. B. Urinary frequency is not a direct adverse effect of prednisone, although the drug can cause secondary hyperglycemia. While excessive glucose in the urine might eventually cause polyuria, it is not the hallmark side effect a patient should prioritize. The instruction should focus more on the direct risks of corticosteroid therapy, such as fluid retention and electrolyte imbalances like hypokalemia. C. Low blood pressure is not expected with prednisone therapy; instead, glucocorticoids often cause sodium and water retention, leading to hypertension. Prednisone increases the sensitivity of vascular smooth muscle to catecholamines, which can elevate systemic vascular resistance. Monitoring for weight gain and peripheral edema is more relevant than watching for hypotension in this clinical context. D. Skin inflammation is actually treated by prednisone rather than caused by it, as the medication is a potent anti-inflammatory. However, long-term use can lead to skin thinning, ecchymosis, and delayed wound healing. The nurse should clarify that while the drug reduces inflammation, it weakens the integrity of the dermal layers, making the skin more fragile and prone to injury.