The nurse is caring for a client who reports taking methotrexate, a disease-modifying anti-rheumatic drug (DMARD) for rheumatoid arthritis. What finding, if experienced by the client, would the nurse suspect is a complication of the medication?

Choice A reason: Kidney disease does not directly cause constipation. While it may cause fluid imbalances or medication side effects, it is not a primary factor in assessing constipation. Bowel function is more influenced by diet, activity, and medications, making kidney disease irrelevant as a routine assessment tool for this condition.

Choice B reason: Dietary intake, particularly low fiber or inadequate hydration, is a primary cause of constipation. Assessing fiber, fluid, and food types helps identify contributing factors, as low-fiber diets slow intestinal transit. This tool is essential in evaluating constipation, as diet directly impacts stool consistency and frequency.

Choice C reason: Routine physical activity affects bowel motility, as sedentary lifestyles slow peristalsis, contributing to constipation. Assessing activity levels identifies whether lack of movement is a factor. This tool is critical, as exercise promotes intestinal transit, making it a key component in constipation assessment.

Choice D reason: Medication history is vital, as drugs like opioids, anticholinergics, or calcium supplements can cause constipation by slowing gut motility or altering fluid balance. Assessing medications identifies potential causes, making this tool essential for a comprehensive constipation evaluation to guide appropriate interventions.

Choice A reason: Prednisone causes hyperglycemia by increasing gluconeogenesis and insulin resistance, similar to other corticosteroids. Its lower mineralocorticoid activity does not significantly reduce this effect compared to other steroids. This statement is inaccurate, as prednisone’s glycemic impact is comparable, not less extreme, than other corticosteroids.

Choice B reason: Prednisone has minimal mineralocorticoid activity compared to steroids like hydrocortisone, resulting in less sodium and water retention. Mineralocorticoids promote renal sodium reabsorption, causing fluid retention. Prednisone’s glucocorticoid dominance reduces these effects, making this statement accurate for expected nursing observations during administration.

Choice C reason: Prednisone’s low mineralocorticoid activity leads to less, not more, sodium retention. It does not disproportionately affect water retention independently of sodium. This statement is inaccurate, as prednisone’s profile minimizes both sodium and water retention compared to steroids with higher mineralocorticoid effects.

Choice D reason: Prednisone causes hyperglycemia, but its effect is not more extreme than other corticosteroids like dexamethasone. Its glucocorticoid activity drives gluconeogenesis similarly across the class. This statement is inaccurate, as prednisone’s hyperglycemic effects are standard, not uniquely severe, among oral corticosteroids.