During a routine checkup, a patient states that she is unable to take the prescribed antihistamine because of one of its most common adverse effects. The nurse suspects that which adverse effect has been bothering this patient?

Choice A reason: Decreases inflammation is a therapeutic effect of prednisone. Prednisone is a corticosteroid that suppresses the immune system and reduces the production of inflammatory mediators. This helps to relieve the pain, swelling, and stiffness of rheumatoid arthritis.

Choice B reason: Increases bone density is not a therapeutic effect of prednisone. Prednisone can cause bone loss and osteoporosis by decreasing calcium absorption and increasing calcium excretion. This increases the risk of fractures and bone damage.

Choice C reason: Reduces risk of infection is not a therapeutic effect of prednisone. Prednisone can increase the risk of infection by weakening the immune system and making it less able to fight off pathogens. This requires close monitoring and prophylactic antibiotics.

Choice D reason: Improves peripheral blood flow is not a therapeutic effect of prednisone. Prednisone can impair peripheral blood flow by causing vasoconstriction and increasing blood pressure. This can worsen the symptoms of peripheral vascular disease and increase the risk of thrombosis.

Choice A reason: A 32-year-old client who has benign breast disease does not have a contraindication for receiving oral contraceptives. Benign breast disease is not associated with an increased risk of breast cancer or thromboembolic events. However, the nurse should advise the client to perform regular breast self-examinations and report any changes.

Choice B reason: A 26-year-old client who has migraine headaches at the start of each menstrual cycle does not have a contraindication for receiving oral contraceptives. Migraine headaches that are related to the menstrual cycle may actually improve with oral contraceptives, as they can regulate the hormonal fluctuations. However, the nurse should monitor the client for any signs of stroke or hypertension, as these are rare but serious complications of oral contraceptives.

Choice C reason: A 28-year-old client who has a history of pelvic inflammatory disease does not have a contraindication for receiving oral contraceptives. Pelvic inflammatory disease is an infection of the reproductive organs that can cause infertility, chronic pain, and ectopic pregnancy. Oral contraceptives can reduce the risk of pelvic inflammatory disease by creating a thick cervical mucus that prevents the entry of bacteria. However, the nurse should remind the client that oral contraceptives do not protect against sexually transmitted infections, and that barrier methods should be used in addition.

Choice D reason: A 38-year-old client who reports smoking one pack of cigarettes every day has a contraindication for receiving oral contraceptives. Smoking increases the risk of cardiovascular diseases, such as myocardial infarction, stroke, and peripheral vascular disease. Oral contraceptives also increase the risk of these diseases, especially in women older than 35 years. Therefore, the combination of smoking and oral contraceptives can have a synergistic effect and cause serious harm. The nurse should recommend other methods of contraception for this client, such as intrauterine devices, implants, or injections.