A nurse assesses a client who is prescribed fluticasone and notes oral lesions.
What action would the nurse take?

Choice A rationale

Cystic fibrosis primarily affects exocrine glands, leading to thick, viscous secretions that obstruct the pancreatic ducts. This obstruction prevents the release of pancreatic enzymes (e.g., lipase, amylase, protease) into the small intestine, impairing the digestion of fats, carbohydrates, and proteins, thus requiring exogenous enzyme supplementation.

Choice B rationale

Water-soluble minerals like sodium, potassium, and chloride are generally absorbed through active transport or diffusion in the intestines. While fluid and electrolyte imbalances can occur in CF, the primary digestive issue is enzyme deficiency, not a direct lack of water-soluble mineral absorption, although some may be affected indirectly.

Choice C rationale

Fat-soluble vitamins (A, D, E, K) require pancreatic lipase for their absorption, as they are dissolved in dietary fats. Due to the impaired fat digestion in CF, malabsorption of these vitamins is common, necessitating supplementation, but the fundamental issue addressed by enzymes is overall nutrient digestion, not just vitamins.

Choice D rationale

Salt supplements are often required in cystic fibrosis due to excessive sodium and chloride loss in sweat, particularly during hot weather or exercise. However, salt supplements do not directly facilitate the digestion and absorption of macronutrients; their role is to maintain electrolyte balance and prevent dehydration.

Choice A rationale

Swimming is often recommended for asthmatic children because the warm, humid air around a swimming pool helps to keep airways moist, reducing the likelihood of exercise-induced bronchoconstriction. The horizontal body position also facilitates easier breathing and lessens the impact of gravity on respiratory effort.

Choice B rationale

Gymnastics involves short bursts of intense activity and often takes place in indoor environments where air quality might be variable or allergens present. The sudden, high-intensity exertion without sustained rhythmic breathing can trigger exercise-induced asthma, making it less ideal for asthmatic children due to fluctuating energy demands.

Choice C rationale

Baseball involves intermittent activity with periods of rest, allowing for recovery between bursts of exertion. This stop-and-go nature, combined with playing outdoors in potentially open air, generally makes it a suitable sport for children with asthma as it reduces the continuous strenuous effort that can trigger bronchospasm.

Choice D rationale

Cross-country skiing, especially in cold, dry air, is a significant trigger for exercise-induced bronchoconstriction in asthmatic individuals. The combination of intense, sustained exertion and breathing cold, dry air rapidly irritates and constricts the airways, making it a high-risk activity for asthmatic children.

Choice E rationale

Distance running involves prolonged, continuous, and often high-intensity aerobic activity, which can lead to significant increases in minute ventilation. This sustained exertion, especially in varying environmental conditions, is a common and potent trigger for exercise-induced asthma, making it a challenging sport for many asthmatic children.