A nurse is providing education to a client who has chronic obstructive pulmonary disease and will begin using fluticasone by metered dose inhaler every 12 hours for maintenance. Which of the following instructions should the nurse include?
"Use this inhaler as the first-line medication to relieve acute symptoms."
"Inspect your mouth daily for signs of thrush."
"Check your heart rate before each dose."
"Skip the morning dose if you do not have any symptoms."
The Correct Answer is B
A. Fluticasone is a corticosteroid inhaler used for maintenance therapy to reduce inflammation in the airways over time. It is not a rescue medication for acute symptoms. Clients with COPD should use short-acting bronchodilators (such as albuterol) as their first-line treatment for relieving acute symptoms like shortness of breath or wheezing.
B. This statement is correct. Fluticasone is a corticosteroid medication that, when inhaled, can increase the risk of developing oral candidiasis (thrush). Clients should be instructed to rinse their mouth with water and spit after using the inhaler to minimize this risk. Inspecting the mouth daily for signs of white patches, soreness, or difficulty swallowing is important. If thrush develops, clients may need antifungal treatment.
C. This statement is not necessary for fluticasone inhaler use. Fluticasone is not known to significantly affect heart rate. Monitoring heart rate before each dose is more relevant for medications that can cause changes in heart rate, such as bronchodilators (e.g., beta-agonists). However, clients should monitor for symptoms like palpitations or rapid heart rate and report them to their healthcare provider.
D. Fluticasone is a maintenance medication that should be taken regularly as prescribed, regardless of symptoms. Skipping doses can lead to worsening of COPD symptoms and exacerbations. Clients should adhere to the prescribed dosing schedule to achieve optimal control of their condition.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. This option is not directly related to preventing exacerbations in COPD. While managing fluid intake may be important for individuals with certain cardiovascular or renal conditions, it is not a recognized strategy for preventing COPD exacerbations.
B. Influenza vaccination is highly recommended for individuals with COPD. Respiratory infections, such as influenza (flu), can trigger exacerbations in COPD. By receiving an annual influenza vaccine, the client can reduce the risk of developing influenza-related exacerbations and complications.
C. Pursed-lip breathing is a breathing technique that can help improve ventilation and decrease the work of breathing for individuals with COPD. It can be beneficial during exacerbations or episodes of dyspnea (shortness of breath). While it does not directly prevent exacerbations, it is a useful technique to manage symptoms and potentially reduce the severity of exacerbations.
D. The tripod position, where a person leans forward with hands supported on their knees or another surface, can help COPD patients during exacerbations by allowing better chest expansion and improving breathing mechanics. It can relieve dyspnea and help stabilize breathing. While it does not prevent exacerbations, it is a helpful technique during episodes of increased respiratory distress.
Correct Answer is B
Explanation
A. Atrial flutter typically presents with a regular atrial rate (usually around 250-350 beats per minute) and a characteristic "sawtooth" pattern of flutter waves (F-waves) on the ECG. This condition would not present with irregular ventricular rates and is less likely based on the ECG findings described.
B. Atrial fibrillation is identified by an irregularly irregular rhythm and the absence of P-waves on the ECG, which is replaced by erratic activity.
C. Unstable angina presents with chest pain or discomfort due to reduced blood flow to the heart muscles, usually related to atherosclerotic plaque rupture or erosion. It does not cause the ECG findings described (absence of P-waves and irregular ventricular rate).
D. PACs are early atrial depolarizations that can cause palpitations but do not typically result in the absence of P-waves or irregular ventricular rates as described in the scenario.
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