A patient receiving Morphine for postoperative pain relief displays slow, shallow breathing with a rate of 8 breaths/minute. The nurse recognizes this as a side effect called:

Choice A reason: This is incorrect. Fluticasone is a corticosteroid that is used to treat asthma and allergic rhinitis. It does not affect the patient's ability to exercise or engage in strenuous activity. In fact, exercise can help improve lung function and reduce inflammation.

Choice B reason: This is incorrect. Fluticasone does not affect the patient's potassium levels. Potassium is an electrolyte that is important for the function of the heart, muscles, and nerves. Some medications, such as diuretics, can lower potassium levels and require the patient to eat potassium rich foods, such as bananas, potatoes, and tomatoes. Fluticasone is not one of them.

Choice C reason: This is correct. Fluticasone can cause hyperglycemia, which is high blood sugar. This can occur because corticosteroids can increase the production of glucose in the liver and reduce the sensitivity of the cells to insulin, the hormone that regulates blood sugar. Hyperglycemia can cause symptoms such as increased thirst, hunger, urination, fatigue, and blurred vision. The patient should monitor their blood sugar levels regularly and report any changes to their doctor.

Choice D reason: This is incorrect. Fluticasone does not affect the patient's digestion or appetite. It can be taken with or without food. There is no need to avoid eating for 4 hours after taking Fluticasone. However, the patient should rinse their mouth with water after using Fluticasone inhaler or nasal spray, as this can help prevent oral thrush, a fungal infection that can cause white patches, soreness, and bleeding in the mouth.

Choice A reason: Administering the medication with meals only is not a valid adjustment for a medication that is primarily excreted by the kidneys. The food intake does not affect the renal clearance of the drug, unless it alters the pH of the urine or the blood flow to the kidneys. The nurse should follow the instructions on the medication label or the prescriber's order regarding the timing of the administration.

Choice B reason: No dose adjustment is required is an incorrect statement for a medication that is primarily excreted by the kidneys. The renal impairment can reduce the elimination of the drug and increase its concentration in the blood. This can cause adverse effects and toxicity. The nurse should consult with the prescriber or the pharmacist about the appropriate dose reduction or frequency change for the patient's level of renal function.

Choice C reason: Increasing the dose to ensure therapeutic effect is a dangerous and inappropriate adjustment for a medication that is primarily excreted by the kidneys. The renal impairment can reduce the elimination of the drug and increase its concentration in the blood. This can cause adverse effects and toxicity. The nurse should not increase the dose without the prescriber's order and should monitor the patient for signs of overdose or toxicity.

Choice D reason: Decreasing the dose to prevent toxicity is the correct and rational adjustment for a medication that is primarily excreted by the kidneys. The renal impairment can reduce the elimination of the drug and increase its concentration in the blood. This can cause adverse effects and toxicity. The nurse should consult with the prescriber or the pharmacist about the appropriate dose reduction or frequency change for the patient's level of renal function. The nurse should also monitor the patient for the therapeutic response and the adverse effects of the drug.