A nurse is caring for a client in a clinic.

Vital Signs 0915:

Temperature 36.7° C (98° F)

BP 122/80 mm Hg Respiratory rate 20/min Heart rate 99/min

Nurses' Notes 0900:

A 16-year-old client reports to the clinic with their caregiver. The client's caregiver informs the nurse that the client has "not been themselves lately." The client's parents and a sibling passed away from injuries sustained when a tornado moved through their town 1 month ago. They were the only survivors and witnessed their family's deaths.

0910:

The client appears anxious but answers appropriately for age. They report experiencing nightmares that awaken them at night and startle easily during thunderstorms, but the client admits that they have always been afraid of thunderstorms. The client admits to smoking marijuana for about 1 month because it helps clear their mind. They also admit that they have no desire to leave the house. They attend school regularly and are on the honor roll.

Based on the information in the client's medical record, which of the following findings requires immediate follow-up?

Select the 4 findings that require follow-up.

A. Prednisone should generally be taken with food or after a meal to reduce the risk of gastric irritation or ulcer formation. Taking it on an empty stomach can irritate the stomach lining and increase the risk of gastrointestinal side effects, such as gastritis or peptic ulcers.

B. While some medications are best taken at bedtime (such as those with sedative effects), prednisone is a corticosteroid that can affect the body's circadian rhythm and may interfere with sleep. It typically causes insomnia or restlessness, so it’s usually advised to take it in the morning.

C. Prednisone and other corticosteroids can lead to bone loss (osteoporosis) over time, especially with long-term use. One of the side effects of corticosteroid therapy is decreased calcium absorption and bone density loss, making individuals at higher risk for fractures.

D. Prednisone more commonly causes weight gain rather than weight loss. Corticosteroids increase appetite and can lead to fluid retention, both of which can result in weight gain. Additionally, prednisone can cause redistribution of fat, often leading to characteristic side effects like "moon face" or increased abdominal fat.

B. Incorrect. Prednisone is often prescribed as a single daily dose in the morning to coincide with the body's natural cortisol release.

C. Incorrect. While calcium supplementation might be necessary for some individuals on long-term prednisone therapy, it is not a primary instruction related to taking prednisone.

D. Correct. Monitoring for weight loss is important due to the potential for weight changes (both weight gain and weight loss) as a result of prednisone's effects on metabolism and appetite.

Choice C rationale:

Recommending scrambled eggs is appropriate for a client with dysphagia caused by a stroke. Scrambled eggs have a soft and moist texture, making them easier to swallow for individuals with difficulty swallowing. It is crucial to choose foods that are easy to chew and swallow, as well as foods that can be easily moistened with sauces or gravies to aid in swallowing.

Choice A rationale:

Crispy rice bars are dry and hard, posing a significant risk for individuals with dysphagia. Foods that are dry, crunchy, or crumbly can be difficult to swallow and may lead to choking, especially for individuals with impaired swallowing abilities. Therefore, crispy rice bars are not a suitable choice for a client with dysphagia.

Choice B rationale:

Peanut butter, especially when consumed without added moisture or in large amounts, can be thick and sticky, making it challenging to swallow, especially for individuals with dysphagia. It can adhere to the walls of the throat, causing discomfort and difficulty in swallowing. While peanut butter can be a good source of protein, it is not an ideal choice for someone with swallowing difficulties.

Choice D rationale:

Soda crackers are dry and can be crumbly, making them a poor