Final answer:
The addition of Flonase to John's medication regimen may cause a manic episode due to his bipolar 1 disorder.
Step-by-step explanation:
The addition of Flonase to John's medication regimen may cause a manic episode due to his bipolar 1 disorder. Flonase contains fluticasone, which is a corticosteroid. Corticosteroids can potentially induce or worsen manic symptoms in individuals with bipolar disorder. It is important for the PMHNP to monitor John closely for any signs of mania, such as increased energy, irritability, impulsivity, and decreased need for sleep.