A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers will the nurse give to the patient?

Choice A reason: A 32-year-old client who has benign breast disease does not have a contraindication for receiving oral contraceptives. Benign breast disease is not associated with an increased risk of breast cancer or thromboembolic events. However, the nurse should advise the client to perform regular breast self-examinations and report any changes.

Choice B reason: A 26-year-old client who has migraine headaches at the start of each menstrual cycle does not have a contraindication for receiving oral contraceptives. Migraine headaches that are related to the menstrual cycle may actually improve with oral contraceptives, as they can regulate the hormonal fluctuations. However, the nurse should monitor the client for any signs of stroke or hypertension, as these are rare but serious complications of oral contraceptives.

Choice C reason: A 28-year-old client who has a history of pelvic inflammatory disease does not have a contraindication for receiving oral contraceptives. Pelvic inflammatory disease is an infection of the reproductive organs that can cause infertility, chronic pain, and ectopic pregnancy. Oral contraceptives can reduce the risk of pelvic inflammatory disease by creating a thick cervical mucus that prevents the entry of bacteria. However, the nurse should remind the client that oral contraceptives do not protect against sexually transmitted infections, and that barrier methods should be used in addition.

Choice D reason: A 38-year-old client who reports smoking one pack of cigarettes every day has a contraindication for receiving oral contraceptives. Smoking increases the risk of cardiovascular diseases, such as myocardial infarction, stroke, and peripheral vascular disease. Oral contraceptives also increase the risk of these diseases, especially in women older than 35 years. Therefore, the combination of smoking and oral contraceptives can have a synergistic effect and cause serious harm. The nurse should recommend other methods of contraception for this client, such as intrauterine devices, implants, or injections.

Choice A reason: Hypokalemia is a low level of potassium in the blood. Furosemide is a loop diuretic that increases the excretion of water and electrolytes, including potassium. Hypokalemia can cause muscle weakness, cramps, arrhythmias, and digoxin toxicity.

Choice B reason: Hypoglycemia is a low level of glucose in the blood. Furosemide does not affect blood glucose levels or insulin secretion. Hypoglycemia may be caused by other factors such as diabetes medications, fasting, or alcohol intake.

Choice C reason: Weight gain is not an adverse effect of furosemide. Furosemide causes weight loss by reducing fluid retention and edema. Weight gain may be a sign of worsening heart failure or fluid overload.

Choice D reason: Increased blood pressure is not an adverse effect of furosemide. Furosemide lowers blood pressure by decreasing blood volume and cardiac preload. Increased blood pressure may be caused by other factors such as salt intake, stress, or kidney disease.