A nurse is teaching a client with rheumatoid arthritis who has a new prescription for oral glucocorticoid therapy. Which client statement indicates understanding of the teaching?

A. Oral glucocorticoid therapy primarily affects metabolic and immune functions rather than causing direct nephrotoxicity that requires bi-weekly renal monitoring. While chronic use can impact systemic health, routine creatinine or BUN checks are not the primary focus of steroid education. Assessment should instead prioritize monitoring for adrenal suppression, osteoporosis, and signs of secondary infection due to the drug's immunosuppressive properties. B. Combining glucocorticoids with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin significantly increases the risk of peptic ulcer disease and gastrointestinal bleeding. Both medications inhibit protective gastric prostaglandins, leading to synergistic mucosal damage that can result in life-threatening hemorrhage. This statement reflects a dangerous misunderstanding of medication safety that requires immediate correction and reinforcement of gastrointestinal precautions. C. Glucocorticoids facilitate gluconeogenesis and decrease peripheral glucose utilization, typically resulting in hyperglycemia rather than hypoglycemia. Eating frequently to prevent a blood sugar drop is unnecessary and may contribute to the weight gain and truncal obesity associated with Cushingoid side effects. Clients should instead be taught to monitor for signs of elevated blood glucose and maintain a balanced, low-calorie diet. D. Long-term glucocorticoid use inhibits osteoblast activity and reduces intestinal calcium absorption, which significantly increases the risk of bone mineral density loss and osteoporosis. Engaging in weight-bearing exercise and taking daily calcium and vitamin D supplements are vital interventions to preserve skeletal integrity and prevent fractures. This statement confirms the client understands how to mitigate the musculoskeletal complications of chronic steroid therapy.