A client has a new prescription for diclofenac, a nonsteroidal antiinflammatory drug (NSAID). Which information in the client's history is of greatest concern to the nurse in monitoring the client's response to this medication?

A) Use the cream only on intact skin: This is correct advice as applying betamethasone cream to broken or infected skin can exacerbate the condition or lead to systemic absorption and side effects. Ensuring the cream is applied only to intact skin helps prevent complications.

B) Apply the cream to the area for 2 weeks: This instruction is appropriate depending on the severity of the eczema and the prescribing healthcare provider’s guidance. Typically, topical corticosteroids like betamethasone are used for a prescribed duration, often not exceeding 2 weeks to avoid potential side effects.

C) Cover the site with an occlusive dressing: This indicates a need for further teaching. Occlusive dressings are generally not recommended with topical corticosteroids unless specifically instructed by a healthcare provider. They can increase the absorption of the medication, potentially leading to more side effects, such as thinning of the skin.

D) Limit exposure to direct sunlight: This is good advice because corticosteroids can increase skin sensitivity to sunlight, leading to potential sunburn or other skin issues. Clients should be advised to protect their skin from excessive sun exposure while using such medications.

A. Clients using the discus may experience decreased blood pressure:
Fluticasone propionate and salmeterol are a combination of a corticosteroid and a long-acting beta-agonist. While they help control asthma, they are not typically associated with decreased blood pressure. Instead, potential side effects might include increased heart rate or hypertension.

B. Explain that the client should not use the discus more than twice daily:
Fluticasone propionate and salmeterol combination inhalers are usually prescribed for twice-daily use to maintain control of asthma symptoms. Using the inhaler more frequently than prescribed could lead to increased side effects or diminished effectiveness.

C. When using the discus, have the client breathe out rapidly into the mouthpiece:
The correct technique for using a dry powder inhaler involves inhaling deeply and forcefully to ensure the medication reaches the lungs. Breathing out rapidly into the mouthpiece is incorrect and will not deliver the medication effectively.

D. Offer the discus to the client for use during an acute asthma attack:
The discus is used for long-term control and prevention of asthma symptoms, not for immediate relief during an acute asthma attack. A rescue inhaler, typically containing a short-acting beta-agonist like albuterol, is used for acute symptoms.