A client with plaque psoriasis receives a new prescription for betamethasone valerate lotion. Which instruction should the nurse include in client teaching?

The nurse should program the infusion pump to deliver 200 mL/hr.

Although the medication dosage is 400 mg, the infusion pump rate is determined by the total volume of the IV fluid (including the medication) and the desired infusion time.

In this case:

Total volume of IV bag (D,W): 200 mL

Infusion time: 1 hour

Since the medication is already diluted in the 200 mL bag, the entire volume needs to be delivered over the course of the hour. Therefore, the nurse should program the pump to deliver the full 200 mL of the solution at a rate of:

200 mL / 1 hour = 200 mL/hr

A) When using the discus, have the client breathe out rapidly into the mouthpiece: This instruction is incorrect because with dry powder inhalers (DPIs) like the fluticasone propionate and salmeterol discus, clients should exhale slowly and completely before inhaling the medication. Breathing out rapidly may cause the medication to be dispersed ineffectively, reducing its therapeutic benefit. By exhaling slowly, clients ensure better delivery of the medication to their lungs, maximizing its effectiveness in controlling asthma symptoms.
B) Explain that the client should not use the discus more than twice daily: This is the correct answer. Fluticasone propionate and salmeterol combination inhalers are typically used on a scheduled basis to maintain asthma control. Overuse of these medications can lead to increased risk of side effects, such as oral thrush or hoarseness from the steroid component (fluticasone propionate), or increased heart rate from the long-acting beta agonist (salmeterol). Moreover, exceeding the prescribed dose may not provide additional benefits in controlling asthma symptoms and can indicate inadequate control, necessitating a review of the treatment plan by the healthcare provider.
C) Offer the discus to the client for use during an acute asthma attack: Using a combination inhaler during an acute asthma attack is not appropriate. During acute exacerbations, clients should use short-acting bronchodilators (e.g., albuterol) for quick relief of symptoms. Combination inhalers like fluticasone propionate and salmeterol are intended for long-term maintenance therapy to prevent asthma symptoms, not for acute symptom relief.
D) Clients using the discus may experience decreased blood pressure: This statement is incorrect. Fluticasone propionate and salmeterol combination inhalers are not known to cause decreased blood pressure as a side effect. However, salmeterol, being a long-acting beta agonist, can potentially cause an increase in heart rate, especially when used excessively, but this is not related to blood pressure changes. It's essential to focus on the appropriate use and dosing schedule of the medication to achieve optimal asthma control and minimize adverse effects.