The nurse is monitoring a client taking a potassium sparing diuretic. Which of the following findings would prompt the nurse to notify the health care provider?

Choice A reason: Vasoconstriction is the desired therapeutic effect of phenylephrine in this context. Phenylephrine is a medication that stimulates the alpha1 receptors on the blood vessels, causing them to constrict or narrow. This increases the resistance to blood flow and raises the blood pressure. Phenylephrine is used as a vasopressor to treat hypotension, which is a condition of low blood pressure that can cause dizziness, fainting, or organ damage. The nurse should monitor the blood pressure and the peripheral pulses of the patient after administering phenylephrine.

Choice B reason: Bronchodilation is not the desired therapeutic effect of phenylephrine in this context. Phenylephrine is a medication that stimulates the alpha1 receptors on the blood vessels, causing them to constrict or narrow. It has no effect on the beta2 receptors on the bronchial smooth muscle, which are responsible for bronchodilation or widening of the airways. Phenylephrine is not used to treat respiratory conditions, such as asthma or chronic obstructive pulmonary disease, that cause bronchoconstriction or narrowing of the airways. The nurse should assess the respiratory rate and the breath sounds of the patient after administering phenylephrine.

Choice C reason: Diuresis is not the desired therapeutic effect of phenylephrine in this context. Phenylephrine is a medication that stimulates the alpha1 receptors on the blood vessels, causing them to constrict or narrow. It has no effect on the kidney function or the urine output. Phenylephrine is not used to treat fluid retention or edema, which are conditions of excess fluid in the body that can cause swelling, weight gain, or heart failure. The nurse should measure the urine output and the specific gravity of the patient after administering phenylephrine.

Choice D reason: Decreased heart rate is not the desired therapeutic effect of phenylephrine in this context. Phenylephrine is a medication that stimulates the alpha1 receptors on the blood vessels, causing them to constrict or narrow. It has little or no effect on the beta1 receptors on the heart, which are responsible for increasing the heart rate and the contractility. Phenylephrine may actually cause a reflex bradycardia, which is a slow heart rate that occurs when the baroreceptors in the blood vessels sense an increase in blood pressure and send signals to the brain to lower the heart rate. Phenylephrine is not used to treat tachycardia, which is a fast heart rate that can cause palpitations, chest pain, or arrhythmias. The nurse should monitor the electrocardiogram and the heart rate of the patient after administering phenylephrine.

Choice A reason: Limit caffeine intake is not an instruction that the nurse should provide to the client who has asthma and a new prescription for inhaled fluticasone. Fluticasone is a medication that reduces inflammation and swelling in the airways, which can improve breathing and prevent asthma attacks. Fluticasone does not interact with caffeine or affect the heart rate or blood pressure. Caffeine is a stimulant that can cause nervousness, insomnia, or palpitations in some people, but it does not worsen asthma symptoms or interfere with fluticasone therapy. The nurse should advise the client to consume caffeine in moderation and avoid it before bedtime.

Choice B reason: Take the medication with meals is not an instruction that the nurse should provide to the client who has asthma and a new prescription for inhaled fluticasone. Fluticasone is a medication that reduces inflammation and swelling in the airways, which can improve breathing and prevent asthma attacks. Fluticasone is administered by inhalation, not by mouth, and it does not affect the digestion or absorption of food. The nurse should instruct the client to use the inhaler as prescribed, usually twice a day, regardless of the mealtimes.

Choice C reason: Rinse the mouth after administration is an instruction that the nurse should provide to the client who has asthma and a new prescription for inhaled fluticasone. Fluticasone is a medication that reduces inflammation and swelling in the airways, which can improve breathing and prevent asthma attacks. Fluticasone is a corticosteroid, which can cause side effects such as oral thrush, hoarseness, or sore throat if it remains in the mouth after inhalation. The nurse should instruct the client to rinse the mouth with water and spit it out after each dose of fluticasone to prevent these side effects. The nurse should also teach the client how to use the inhaler properly and check the inhaler technique regularly.

Choice D reason: Check the pulse after medication administration is not an instruction that the nurse should provide to the client who has asthma and a new prescription for inhaled fluticasone. Fluticasone is a medication that reduces inflammation and swelling in the airways, which can improve breathing and prevent asthma attacks. Fluticasone does not affect the heart rate or blood pressure, and it is not a rescue medication that should be used for acute asthma symptoms. The nurse should monitor the respiratory rate and the oxygen saturation of the client after administering fluticasone and advise the client to use a short acting bronchodilator, such as albuterol, for quick relief of wheezing or shortness of breath.