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?

A. "Limit potassium-containing foods in your diet." Long-term prednisone use can lead to hypokalemia (low potassium levels) due to its mineralocorticoid effects, which increase potassium excretion. Clients on chronic corticosteroid therapy may actually need to consume potassium-rich foods to help maintain electrolyte balance, rather than restricting them. B. "Withhold prednisone for 48 hours prior to receiving contrast dye." There is no general recommendation to withhold prednisone before contrast dye administration. However, clients on long-term steroid therapy may require stress-dose steroids if undergoing procedures that could trigger an adrenal crisis. Withholding prednisone without provider guidance could increase the risk of adrenal insufficiency. C. "Measure your blood glucose levels periodically." Prednisone can cause hyperglycemia by increasing insulin resistance and promoting gluconeogenesis. Clients, especially those with diabetes or at risk for metabolic syndrome, should monitor blood glucose levels regularly to detect potential steroid-induced diabetes. Adjustments in diet or medication may be needed based on blood glucose trends. D. "Take prednisone on an empty stomach." Taking prednisone on an empty stomach can increase the risk of gastrointestinal irritation, ulcers, and gastritis. It should be taken with food or milk to help reduce stomach irritation and minimize gastrointestinal side effects. Clients should be advised to follow this guideline to prevent discomfort and potential complications.