A nurse is providing education to a client who has chronic obstructive pulmonary disease and will begin using fluticasone by metered dose inhaler every 12 hours for maintenance. Which of the following instructions should the nurse include?

"Use this inhaler as the first-line medication to relieve acute symptoms."

"Inspect your mouth daily for signs of thrush."

"Check your heart rate before each dose."

"Skip the morning dose if you do not have any symptoms."

Answer and Explanation

The Correct Answer is B

A.   Fluticasone is a corticosteroid inhaler used for maintenance therapy to reduce inflammation in the airways over time. It is not a rescue medication for acute symptoms. Clients with COPD should use short-acting bronchodilators (such as albuterol) as their first-line treatment for relieving acute symptoms like shortness of breath or wheezing.
B.   This statement is correct. Fluticasone is a corticosteroid medication that, when inhaled, can increase the risk of developing oral candidiasis (thrush). Clients should be instructed to rinse their mouth with water and spit after using the inhaler to minimize this risk. Inspecting the mouth daily for signs of white patches, soreness, or difficulty swallowing is important. If thrush develops, clients may need antifungal treatment.
C.   This statement is not necessary for fluticasone inhaler use. Fluticasone is not known to significantly affect heart rate. Monitoring heart rate before each dose is more relevant for medications that can cause changes in heart rate, such as bronchodilators (e.g., beta-agonists). However, clients should monitor for symptoms like palpitations or rapid heart rate and report them to their healthcare provider.
D.   Fluticasone is a maintenance medication that should be taken regularly as prescribed, regardless of symptoms. Skipping doses can lead to worsening of COPD symptoms and exacerbations. Clients should adhere to the prescribed dosing schedule to achieve optimal control of their condition.

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Correct Answer is C

Explanation

A. Defibrillation is not typically indicated for atrial fibrillation. Atrial fibrillation involves disorganized electrical activity in the atria rather than a shockable rhythm like ventricular fibrillation or ventricular tachycardia. Therefore, emergency defibrillation is not appropriate for a client with persistent atrial fibrillation.
B. CABG is a surgical procedure used to improve blood flow to the heart muscle by bypassing blocked coronary arteries. It is primarily indicated for clients with significant coronary artery disease that cannot be managed effectively with medications or less invasive
C. Anticoagulant therapy, such as with medications like warfarin or direct oral anticoagulants (DOACs), is crucial for clients with atrial fibrillation. AFib predisposes individuals to an increased risk of stroke due to the potential formation of blood clots in the atria. Anticoagulants help prevent clot formation and reduce the risk of stroke.
D. Diuretics are medications that increase urine output and are often used to manage fluid overload or congestion in conditions such as heart failure or volume overload. However, diuretic therapy alone does not address the underlying rhythm abnormality of atrial fibrillation.

A. Retropulsion B. Impaired handwriting C. Muscle soreness and pain D. Slow movements

Correct Answer is A

Explanation

A. Retropulsion is a classic manifestation of postural instability in Parkinson's disease. It refers to a tendency to lose balance and fall backward, especially when attempting to initiate walking or when challenged with external forces.
B. Impaired handwriting, also known as micrographia, is associated with bradykinesia (slowness of movement) in Parkinson's disease. It manifests as progressively smaller and more cramped handwriting.

C. Muscle soreness and pain can occur in Parkinson's disease, but they are not typically directly associated with postural instability. They may occur due to rigidity (muscle stiffness) or abnormal postures maintained over time.
D. Slow movements, or bradykinesia, are a hallmark feature of Parkinson's disease and are characterized by a gradual reduction in the speed and fluidity of voluntary movements. While related to motor symptoms in Parkinson's disease, slow movements are not specific to postural instability.

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A nurse is providing education to a client who has chronic obstructive pulmonary disease and will begin using fluticasone by metered dose inhaler every 12 hours for maintenance. Which of the following instructions should the nurse include?

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Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

The classic manifestations associated with Parkinson's disease are tremor, rigidity, bradykinesia, and postural instability. The nurse understands that a finding related to postural instability includes which of the following?

Correct Answer is A

Explanation

A nurse is providing education to a client who has chronic obstructive pulmonary disease and will begin using fluticasone by metered dose inhaler every 12 hours for maintenance. Which of the following instructions should the nurse include?

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