A 38-year-old client with rheumatoid arthritis has taken prednisone 20 mg every morning for 4 weeks during a flare and is being discharged with a written taper plan. The nurse evaluates the client's understanding of the teaching. Which client statement indicates a need for further teaching?

Quick answer
Option 2 needs further teaching: vomiting that prevents doses requires prompt contact with the provider.

Why this is correct
Daily prednisone at 20 mg for 4 weeks can suppress the hypothalamic-pituitary-adrenal axis. If the client cannot keep doses down, cortisol levels fall while illness increases stress demands, which can cause adrenal crisis with hypotension and shock. Clients on longer courses are taught to seek care when vomiting prevents a dose, since an injected steroid may be needed.

Easy analogy or mental picture
Long-term prednisone is like leaning on a crutch while your own leg muscle weakens: if the crutch disappears suddenly during a stumble (illness), you fall.

Memory hook
Can't keep the steroid down? Call, don't wait.

NCLEX decision rule
In teaching-evaluation items, find the statement that would lead to missed, doubled, or abruptly stopped doses of a high-risk medication.

Why the other choices are wrong
Morning dose with breakfast (option 1): correct, because morning dosing mimics the natural cortisol rhythm and food reduces gastric irritation. Calling before changing the dose (option 3): correct, and it can look wrong to learners who expect clients to self-adjust for flares; dose changes should be directed by the provider. Calcium and vitamin D (option 4): correct, because glucocorticoids reduce bone density and supplementation is commonly recommended for longer courses.