A community health nurse is developing a brochure about hypertension.

Which of the following actions should the nurse take?

Prednisone can cause blood glucose levels to increase.

The nurse should explain to the client that the reason for checking his blood glucose level is because prednisone, a medication he is receiving, can cause an increase in blood glucose levels. Prednisone is a corticosteroid medication that is commonly used in the treatment of various conditions, including COPD. It has the potential to raise blood glucose levels by promoting gluconeogenesis (the production of glucose from non-carbohydrate sources) and decreasing insulin sensitivity. Monitoring blood glucose levels is important to assess and manage any potential hyperglycaemia or changes in the client's blood sugar levels while on prednisone.

Older adults are not at increased risk for developing type 1 diabetes mellitus in (option A) is incorrect. Type 1 diabetes is an autoimmune condition that typically occurs in childhood or adolescence, and it is characterized by the destruction of insulin-producing cells in the pancreas.

Albuterol treatments, which are used to relieve bronchospasms in clients with COPD, are not known to cause blood glucose levels to decrease in (option C) is incorrect. Albuterol is a beta-2 adrenergic agonist that primarily acts on the respiratory system and does not have a direct effect on blood glucose levels.

Having COPD does not directly cause blood glucose levels to fluctuate in (option D) is incorrect. While there can be various factors that may indirectly affect blood glucose levels in individuals with COPD (e.g., medications, stress, comorbidities), the primary reason for monitoring blood glucose in this case is the use of prednisone.

In summary, the nurse should explain to the client that the blood glucose levels are being checked because prednisone, a medication he is taking for his COPD, can cause an increase in blood glucose levels. This allows for appropriate monitoring and management of any potential hyperglycemia associated with the use of prednisone.

Explanation

D. Maintain the client in high-Flower’s position

Crackles in the bases of the lungs, shortness of breath, and an increased respiratory rate are signs of pulmonary congestion, which is commonly seen in heart failure. Maintaining the client in a high-Fowler's position, with the head of the bed elevated to a 45-60-degree angle, helps reduce venous return to the heart, decreases fluid accumulation in the lungs, and improves breathing comfort for the client.

The other options are not appropriate actions for the client's condition:

Instructing the client to cough every 4 hours in (option A) is not the priority action in this situation. Coughing may not effectively address the underlying cause of pulmonary congestion and may not provide immediate relief for the client.

Encouraging the client to ambulate to loosen secretions in (option B) is not the priority action in this situation. While ambulation can be beneficial for overall health, the client's symptoms of pulmonary congestion require immediate attention to improve respiratory status.

Increasing the client's intake of oral fluids in (option C) is not the priority action in this situation. While maintaining adequate hydration is important, excessive fluid intake can worsen the symptoms of heart failure and contribute to further fluid accumulation in the lungs.

Therefore, the nurse should maintain the client in high-Fowler's position (option D) to promote optimal lung function and improve breathing comfort. It is important to promptly notify the healthcare provider of the client's condition for further assessment and intervention.