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 A
Explanation
A. This option is appropriate because the client's low white blood cell count (3,100/mm³) suggests they are at risk for infection due to chemotherapy-induced immunosuppression. Using an electric shaver reduces the risk of cuts and nicks that could potentially lead to infections.
B. This option is not necessary based on the client's current lab results. Negative pressure isolation rooms are typically reserved for clients with severely compromised immune systems, such as those with very low neutrophil counts (neutropenia). A white blood cell count of 3,100/mm³ is within a range where standard precautions are usually sufficient.
C. This option addresses food safety precautions for clients with neutropenia (low white blood cell count). Raw vegetables, including salads, have a higher risk of harboring bacteria that could cause infections. Therefore, cooked vegetables are safer for clients with compromised immune systems.
D. This option is appropriate because chemotherapy-induced thrombocytopenia (low platelet count of 280,000/mm³) increases the risk of bleeding. Forceful blowing of the nose can traumatize the nasal mucosa and increase the risk of nosebleeds. Dabbing the nose gently is a safer method to avoid nosebleeds.
Correct Answer is C
Explanation
A. The soles of the feet are not typically assessed for cyanosis because they are not a reliable indicator of central cyanosis. Cyanosis is best evaluated in areas where mucous membranes are visible.
B. Similar to the soles of the feet, the palms of the hands are not a reliable indicator of central cyanosis. Cyanosis is not typically visible on the palms unless there are severe systemic circulation issues.
C. The oral mucosa (inside the mouth) is a reliable area to assess for central cyanosis. The nurse can inspect the lips, tongue, and buccal mucosa for a bluish discoloration, which indicates decreased arterial oxygen saturation.
D. The nail beds are also a reliable indicator of central cyanosis. The nurse can assess the color of the nail beds and look for bluish discoloration, which can be more apparent in darker-skinned individuals compared to the lips and oral mucosa.
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