A nurse is reinforcing teaching with a client who has COPD and has been taking long-term high doses of prednisone. Which of the following instructions should the nurse include in the teaching?

Choice A rationale Limiting potassium-containing foods is not typically indicated for patients on long-term prednisone. Prednisone, a corticosteroid, can cause hypokalemia by increasing renal potassium excretion, leading to a need for potassium supplementation or increased intake, not restriction, to maintain normal serum potassium levels (3.5-5.0 mEq/L) and prevent cardiac dysrhythmias. Choice B rationale Withholding prednisone for 48 hours prior to receiving contrast dye is unnecessary. This instruction is more pertinent to medications like metformin, which can interact with contrast dye and lead to lactic acidosis, particularly in clients with renal impairment, but it does not apply to prednisone. Choice C rationale Taking prednisone on an empty stomach is generally not recommended. Prednisone can cause gastric irritation, including dyspepsia and peptic ulcer disease, due to its prostaglandin inhibitory effects. Therefore, it is typically advised to take it with food or milk to minimize gastrointestinal upset and protect the gastric mucosa. Choice D rationale Prednisone, a glucocorticoid, elevates blood glucose levels by promoting gluconeogenesis and reducing peripheral glucose utilization, mimicking the effects of stress hormones. Long-term use can lead to steroid-induced hyperglycemia or even diabetes mellitus. Therefore, periodic monitoring of blood glucose is crucial to detect and manage this metabolic side effect, with normal fasting glucose being less than 100 mg/dL.