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?
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.
Clients using the discus may experience decreased blood pressure.
Explain that the client should not use the discus more than twice daily.
The Correct Answer is D
Choice A reason: This is not a correct instruction for the nurse to provide to the client's caregivers. When using the discus, the client should breathe out slowly and gently away from the mouthpiece, not into it. Breathing out rapidly into the mouthpiece can cause the powder to disperse and reduce the amount of medication delivered to the lungs. The client should also rinse the mouthpiece with water after each use and dry it thoroughly.
Choice B reason: This is not a correct instruction for the nurse to provide to the client's caregivers. The discus is not intended for use during an acute asthma attack, as it does not provide immediate relief of bronchospasm. The discus is a combination of fluticasone, a corticosteroid that reduces inflammation, and salmeterol, a long-acting beta-agonist that relaxes the airway muscles. The discus is a maintenance therapy that should be used regularly to prevent asthma symptoms and exacerbations. The client should also have a rescue inhaler, such as albuterol, for quick relief of asthma attacks.
Choice C reason: This is not a correct instruction for the nurse to provide to the client's caregivers. Clients using the discus may experience increased blood pressure, not decreased, as a possible side effect of salmeterol. Salmeterol can stimulate the beta receptors in the heart and blood vessels, causing tachycardia, palpitations, and hypertension. The nurse should monitor the client's blood pressure and heart rate regularly and report any abnormal findings to the healthcare provider.
Choice D reason: This is the correct instruction for the nurse to provide to the client's caregivers. The discus should not be used more than twice daily, as it can increase the risk of adverse effects and reduce the effectiveness of the medication. The discus should be used once in the morning and once in the evening, about 12 hours apart, to provide optimal control of asthma symptoms. The nurse should teach the client and the caregivers how to use the discus correctly and safely, and to follow the prescribed dosage and schedule.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: This is not the first action for the nurse to take. Applying oxygen face mask may help the client with shortness of breath, but it does not address the underlying cause of the respiratory depression, which is the overdose of morphine. The nurse should first remove the source of the excess morphine and then provide oxygen therapy as needed.
Choice B reason: This is the first action for the nurse to take. Removing the morphine patches is the most urgent and effective way to stop the further absorption of the drug and reduce the risk of life-threatening complications, such as respiratory arrest, coma, or death. The nurse should remove all the patches from the client's body and dispose of them safely. The nurse should also notify the healthcare provider and prepare to administer a narcotic reversal drug, such as naloxone, if indicated.
Choice C reason: This is not the first action for the nurse to take. Administering a narcotic reversal drug may be necessary to reverse the effects of the morphine overdose, but it is not the most immediate intervention. The nurse should first remove the morphine patches to prevent further exposure and then assess the client's level of consciousness, respiratory rate, and oxygen saturation. The nurse should follow the healthcare provider's orders and the facility's protocol for administering a narcotic reversal drug.
Choice D reason: This is not the first action for the nurse to take. Monitoring blood pressure may be important to assess the client's hemodynamic status, but it is not the most critical intervention. The nurse should first remove the morphine patches to prevent further deterioration and then monitor the client's vital signs, including blood pressure, pulse, and temperature. The nurse should also watch for signs of hypotension, shock, or cardiac arrest.
Correct Answer is C
Explanation
Choice A reason: Diarrhea is not a contraindication for phenylephrine, which is a decongestant that reduces swelling and mucus in the nasal passages. However, the nurse should monitor the client's fluid and electrolyte balance and provide adequate hydration.
Choice B reason: Bronchitis is not a contraindication for phenylephrine, which may help relieve some of the symptoms of bronchitis, such as nasal congestion and cough. However, the nurse should also encourage the client to use other measures, such as steam inhalation, expectorants, and rest.
Choice C reason: Hypertension is a contraindication for phenylephrine, which can increase blood pressure and heart rate by constricting blood vessels. The nurse should report this condition to the healthcare provider and withhold the medication until further orders.
Choice D reason: Edema is not a contraindication for phenylephrine, which does not affect fluid retention or distribution. However, the nurse should assess the cause of edema and monitor the client's weight and urine output.
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