A patient with a history of chronic obstructive pulmonary disease (COPD) and type 2 diabetes has been treated for pneumonia for the past week. The patient has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, the pneumonia has resolved, but when monitoring the blood glucose levels, the nurse notices that the level is still elevated. What is the best explanation for this elevation?

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.

Choice A reason: Antibiotics are not likely to interact with corticosteroids, unless they are aminoglycosides, which can increase the risk of hypokalemia. However, most antibiotics do not affect the metabolism or efficacy of corticosteroids.

Choice B reason: Nonsteroidal anti-inflammatory drugs (NSAIDs) can interact with corticosteroids, as they both have anti-inflammatory and immunosuppressive effects. This can increase the risk of gastrointestinal bleeding, ulceration, and perforation. Therefore, the nurse should monitor the patient for signs of bleeding and advise the patient to avoid taking NSAIDs with corticosteroids.

Choice C reason: Opioid analgesics are not likely to interact with corticosteroids, unless they are codeine, which can decrease the clearance of corticosteroids. However, most opioid analgesics do not affect the metabolism or efficacy of corticosteroids.

Choice D reason: Antidepressants are not likely to interact with corticosteroids, unless they are monoamine oxidase inhibitors (MAOIs), which can increase the risk of hypertension and hypertensive crisis. However, most antidepressants do not affect the metabolism or efficacy of corticosteroids.