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The side effect that indicates a need for monitoring when a client is on dexamethasone is a high serum glucose level. Dexamethasone is a corticosteroid that can cause hyperglycemia due to its effects on glucose metabolism. It can increase liver gluconeogenesis and decrease glucose uptake in peripheral tissues. This potential to raise blood sugar levels is particularly significant in patients with pre-existing diabetes or those at risk for developing diabetes. Therefore, close monitoring of serum glucose levels is essential to prevent complications associated with elevated blood sugar, such as hyperglycemic crises.

While increased weight gain, delayed incisional wound healing, and emotional stability may also warrant attention, the direct and immediate impact of corticosteroids on blood glucose levels makes the monitoring of serum glucose a critical concern when a client is on dexamethasone therapy.