The nurse is caring for a patient, newly diagnosed with chronic obstructive pulmonary disease (COPD), who has an order for a budesonide inhaler. When planning medication teaching, the nurse will plan to include which potential side effects of this medication? (Select All That Apply)

Choice A reason: Chronic renal disease typically leads to metabolic acidosis, not alkalosis, due to the accumulation of acids that the kidney cannot excrete.

Choice B reason: Prolonged vomiting leads to the loss of hydrochloric acid from the stomach, which can result in metabolic alkalosis due to the imbalance caused by the loss of stomach acid.

Choice C reason: Hyperventilation leads to respiratory alkalosis due to the excessive exhalation of carbon dioxide, reducing hydrogen ion concentration in the blood.

Choice D reason: Obstructive sleep apnea is typically associated with respiratory acidosis, not metabolic alkalosis, due to episodes of hypoventilation during sleep.

Choice A reason: Potassium supplements can actually be important for patients on diuretic therapy, especially if they are taking loop diuretics like furosemide, which can cause potassium loss. However, it is important to monitor potassium levels and follow the physician's guidance on supplement use.

Choice B reason: Instructing the patient to take diuretics at bedtime is not recommended. Diuretics should be taken in the morning to avoid frequent urination during the night, which can disrupt sleep.

Choice C reason: Notifying the physician if weight increases by three pounds in one week is a key instruction for patients with heart failure. Rapid weight gain can indicate fluid retention and worsening heart failure, requiring prompt medical evaluation and adjustment of treatment.

Choice D reason: Administering diuretics in the morning and notifying the physician of decreased urine output is important, but the focus on notifying the physician about significant weight gain provides a more specific and actionable guideline for managing heart failure.