To control asthma, a client in a residential treatment facility uses a fluticasone propionate and salmeterol discus inhalation system, which provides an inhaled powdered form of these combined medications. Which instruction should the nurse provide to this client’s caregivers?
Explain that the client should not use the discus more than twice daily.
Clients using the discus may experience decreased blood pressure.
When using the discus, have the client breathe out rapidly into the mouthpiece.
Offer the discus to the client for use during an acute asthma attack.
The Correct Answer is A
Choice A Reason:
The fluticasone propionate and salmeterol discus inhalation system is designed to be used twice daily, approximately 12 hours apart. Using it more frequently can increase the risk of side effects without providing additional benefits. The medication is intended to provide long-term control of asthma symptoms, not immediate relief during an acute attack.
Choice B Reason:
There is no significant evidence to suggest that using the fluticasone propionate and salmeterol discus inhalation system causes decreased blood pressure. The primary side effects are related to the respiratory system, such as throat irritation, hoarseness, and oral thrush. Therefore, this instruction is not relevant to the proper use of the medication.
Choice C Reason:
When using the discus, the client should breathe out gently and away from the mouthpiece before inhaling the medication. Breathing out rapidly into the mouthpiece can cause the medication to be expelled from the device, reducing its effectiveness. Proper technique involves exhaling gently, then inhaling quickly and deeply through the mouthpiece.
Choice D Reason:
The fluticasone propionate and salmeterol discus inhalation system is not intended for use during an acute asthma attack. It is a maintenance medication designed to prevent asthma symptoms over time. For acute asthma attacks, a short-acting bronchodilator, such as albuterol, should be used. Using the discus during an acute attack will not provide the rapid relief needed.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason:
Taking sucralfate on an empty stomach at least 1 hour before meals is crucial for its effectiveness. Sucralfate works by forming a protective barrier over ulcers, and food can interfere with this process. Therefore, it is recommended to take sucralfate on an empty stomach to ensure maximum efficacy.
Choice B reason:
Administering an additional dose if a dose is missed is incorrect. If a dose is missed, it should be taken as soon as possible. However, if it is almost time for the next dose, the missed dose should be skipped, and the regular dosing schedule should be resumed. Doubling up on doses can lead to potential side effects and complications.
Choice C reason:
Scheduling doses with each meal and at bedtime is not appropriate for sucralfate. This medication should be taken on an empty stomach, not with meals. Taking it with food can reduce its effectiveness in treating peptic ulcers.
Choice D reason:
Continuing with the normal dose schedule after missing a dose is partially correct but lacks the specific instruction to skip the missed dose if it is almost time for the next one. The correct approach is to take the missed dose as soon as possible unless it is close to the next scheduled dose.
Correct Answer is A
Explanation
Choice A Reason:
St. John’s Wort is known to significantly decrease the blood concentrations of cyclosporine, a critical immunosuppressant used to prevent organ rejection in transplant patients. This herb induces the activity of cytochrome P450 enzymes, particularly CYP3A4, which increases the metabolism of cyclosporine, leading to lower plasma levels and a higher risk of graft rejection. This interaction is highly significant and requires immediate attention to adjust the client’s medication regimen and prevent further complications.
Choice B Reason:
While it is true that St. John’s Wort is commonly used to treat depression, this information is not as significant in the context of graft rejection. The primary concern is the herb’s interaction with cyclosporine, which directly impacts the effectiveness of the immunosuppressive therapy. Understanding the reason for using the herb is important, but it does not address the immediate risk of graft rejection.
Choice C Reason:
There is no substantial evidence to suggest that ingestion of St. John’s Wort reduces sodium intake. This statement does not relate to the herb’s interaction with cyclosporine or its impact on graft rejection. Therefore, it is not a significant concern in this scenario.
Choice D Reason:
Adding St. John’s Wort does not decrease the need for corticosteroids. In fact, the herb’s interaction with cyclosporine can lead to inadequate immunosuppression, potentially increasing the need for additional medications to manage graft rejection. This statement is incorrect and does not address the critical issue of cyclosporine metabolism.
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