A nurse is teaching a patient who is to begin long-term therapy with prednisone to treat rheumatoid arthritis.
The nurse should instruct the patient to take which of the following supplements while taking this medication?

Choice A rationale

Formation of fistulas (abnormal connections between organs) and abscesses (collections of pus) are characteristic complications of Crohn's disease. The transmural inflammation in Crohn's disease can penetrate through the bowel wall, leading to these developments.

Choice B rationale

Crohn's disease can affect any part of the gastrointestinal tract from the mouth to the anus, although it most commonly involves the ileum and colon. Symptoms are not confined to the large intestine. Ulcerative colitis, another inflammatory bowel disease, primarily affects the colon.

Choice C rationale

While antibiotics may be used to treat secondary infections or complications of Crohn's disease, they are not a primary treatment for the underlying inflammatory process and do not typically lead to improvement of the disease itself. Crohn's disease is a chronic inflammatory condition that requires immunomodulatory or anti-inflammatory medications.

Choice D rationale

Rectal bleeding is more commonly associated with ulcerative colitis, where the inflammation is typically limited to the mucosal layer of the colon and rectum, leading to ulceration and bleeding. While some bleeding can occur in Crohn's disease, it is generally less prominent than in ulcerative colitis.

Choice A rationale

Checking blood glucose levels for hypoglycemia once yearly is insufficient for a patient taking high doses of oral glucocorticoids for an extended period. Glucocorticoids can cause hyperglycemia by increasing gluconeogenesis and insulin resistance. Therefore, blood glucose monitoring should be more frequent, especially when initiating or adjusting the dosage. Normal fasting blood glucose levels are typically 70-99 mg/dL.

Choice B rationale

Limiting the intake of calcium-rich foods is incorrect advice for a patient on long-term glucocorticoid therapy. Glucocorticoids can decrease calcium absorption from the gut and increase bone resorption, leading to osteoporosis. Therefore, patients on these medications should be encouraged to maintain an adequate intake of calcium and vitamin D to help preserve bone density. Normal total serum calcium levels range from 8.6 to 10.2 mg/dL.

Choice C rationale

Monitoring for fractures over the next several months is an important instruction for a patient taking high doses of oral glucocorticoids long-term. Glucocorticoids increase the risk of osteoporosis and subsequent fractures, particularly vertebral compression fractures and hip fractures, due to their effects on bone metabolism. Regular monitoring and preventive measures are crucial.

Choice D rationale

Glucocorticoids do not boost immunity; instead, they suppress the immune system by inhibiting the production and function of various immune cells and inflammatory mediators. This immunosuppressive effect is why they are used to treat autoimmune diseases like rheumatoid arthritis, but it also increases the risk of infections.