A client who has asthma receives a new prescription for a corticosteroid inhaler. The client expresses concern about taking steroid medications. Which information should the nurse provide the client about the use of this maintenance inhaler?

Rationale for Correct Choices:

• Rupture: Aneurysm rupture is the most serious and immediate complication of an abdominal aortic aneurysm (AAA). The client’s gnawing back and abdominal pain, along with a pulsatile abdominal mass and bruit, suggest that the aneurysm is unstable.
• Hypertension: Chronic high blood pressure exerts continuous force on arterial walls, weakening the aortic structure and promoting aneurysm formation and progression. It significantly increases the likelihood of rupture once an aneurysm is present.

Rationale for Incorrect Choices:

• Dissection: Dissection involves a tear in the intimal layer of the artery, creating a false lumen. Although serious, it is more commonly associated with thoracic aortic aneurysms rather than abdominal ones. The client's symptoms and findings are more consistent with rupture.
• Occlusion: Aneurysm-related occlusion refers to blockage of blood flow, which is less common in abdominal aneurysms. The client’s peripheral pulses are normal (2+), indicating adequate distal perfusion. There’s no sign of limb ischemia or thrombotic complications.
• Smoking: Smoking is a known risk factor for developing aneurysms but is not the most direct or strongest predictor of rupture. Its role is more associated with aneurysm formation and progression. Hypertension more specifically correlates with increased rupture risk.
• Hyperlipidemia: High lipid levels contribute to atherosclerosis, which can lead to aneurysm development over time. However, like smoking, it is not as strongly associated with aneurysm rupture as hypertension.

Rationale for Correct Choices:

• Stroke: The combination of facial droop, garbled speech, and sudden onset of symptoms in an older adult is strongly indicative of a stroke. The extremely elevated blood pressure supports this diagnosis as hypertension is a major risk factor and often occurs during acute cerebrovascular events.
• Garbled speech: Sudden difficulty in articulating words is a common symptom of both ischemic and hemorrhagic strokes. It reflects disruption of brain areas responsible for language, making this a key diagnostic indicator of a neurologic emergency.

Rationale for Incorrect Choices:

• Malignant hypertension: While the blood pressure is dangerously high, malignant hypertension typically presents with signs of end-organ damage like chest pain, vision changes, or renal impairment. It is not primarily defined by focal neurological signs like facial droop or speech issues.
• Intoxication: Although alcohol can cause slurred speech, it does not explain the presence of facial asymmetry. Stroke must be prioritized in differential diagnosis when focal deficits are present, regardless of alcohol intake.
• Allergic reaction: Facial droop and garbled speech are not typical of an allergic reaction, which more commonly presents with symptoms such as urticaria, airway swelling, or hypotension.
• Neurological deficits: This term is accurate but too broad. Specific symptoms such as “garbled speech” provide clearer clinical evidence of stroke and should be used over general terms.
• Report of alcohol consumption: While relevant to the history, this is not a clinical finding that explains the observed neurological signs. It may distract from recognizing a true medical emergency like stroke.
• Vital signs: Although the blood pressure is elevated, vital signs alone are not sufficient evidence for stroke. Neurological symptoms are more specific and diagnostic.