A nurse is caring for a client who has asthma and is taking fluticasone. The nurse should monitor the client
for which of the following adverse effects?

This statement indicates an understanding of the teaching, as weight loss is one of the most effective ways to decrease the number of nightly apneic episodes in clients who are obese and have obstructive sleep apnea. Obstructive sleep apnea is a condition in which the upper airway collapses or becomes blocked during sleep, causing pauses in breathing and hypoxia. Obesity is a major risk factor for obstructive sleep apnea, as excess fat tissue around the neck and throat can narrow the airway and increase its collapsibility. Losing weight can reduce the pressure on the airway and improve its patency.

b) "I sleep better if I take a sleeping pill at night." This statement indicates a lack of understanding of the teaching, as sleeping pills are not recommended for clients who have obstructive sleep apnea. Sleeping pills can worsen the condition by relaxing the muscles of the throat and tongue, which can further obstruct the airway and decrease the arousal response to hypoxia. The nurse should advise the client to avoid sleeping pills and other sedatives or alcohol before bedtime.
c) "It might help if I tried sleeping only on my back." This statement indicates a lack of understanding of the teaching, as sleeping on the back is not helpful for clients who have obstructive sleep apnea. Sleeping on the back can increase the risk of airway obstruction by allowing gravity to pull the tongue and soft palate backward, which can block the airway and cause snoring and apnea. The nurse should suggest that the client try sleeping on the side or elevate the head of the bed to prevent this.
d) "I should get a humidifier to run at my bedside at night." This statement indicates a lack of understanding of the teaching, as a humidifier is not likely to decrease the number of nightly apneic episodes in clients who have obstructive sleep apnea. A humidifier can moisten the air and ease breathing for clients who have dry or irritated nasal passages, but it does not address the underlying cause of airway obstruction or hypoxia. The nurse should inform the client that a humidifier may not be effective for obstructive sleep apnea and may increase the risk of infection or mold growth if not cleaned properly.

Clubbing of the fingers is a sign of chronic hypoxia, which occurs in emphysema due to impaired gas exchange and reduced oxygen delivery to the tissues.

The other options are not correct because:

1. Dyspnea is a common symptom of emphysema, but it is not a specific finding that indicates the presence of the condition.
2. Barrel chest is a result of hyperinflation of the lungs, which can occur in emphysema, but it can also be seen in other respiratory disorders such as asthma or cystic fibrosis.
3. Deep respirations are not typical of emphysema, as the client tends to breathe shallowly and rapidly to minimize the work of breathing.
4. Bradycardia is not associated with emphysema, as the client usually has tachycardia due to increased sympathetic stimulation and reduced cardiac output.