A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects?

A. Albuterol is a bronchodilator that provides quick relief by relaxing the muscles around the airways, making it essential to use before a corticosteroid like beclomethasone, which reduces inflammation. Using albuterol first allows for better delivery of the beclomethasone to the airways.

B. I will use both medications immediately after exercising. Albuterol may be used as a rescue inhaler before exercise to prevent exercise-induced bronchospasm, but beclomethasone is a maintenance medication and should not be used immediately after exercising unless prescribed.

C. "If my breathing begins to feel tight, I will use the beclomethasone inhaler immediately.” Beclomethasone is a long-term control medication, not a rescue inhaler. If breathing feels tight or there is an asthma attack, the client should use the albuterol inhaler for immediate relief.

D. I will administer the medications 10 minutes apart.While there is no strict rule about the timing between inhaler uses, the albuterol should be used first to open the airways, and while waiting a few minutes is acceptable, the emphasis should be on using albuterol before beclomethasone rather than a specific time frame.

White coating in the mouth: A white coating in the mouth could be a sign of a fungal infection such as oral thrush. Fluticasone, which is a corticosteroid, can increase the risk of developing fungal infections. Therefore, the nurse should instruct the client to report any signs of oral thrush or other unusual changes in the mouth, such as white patches or discomfort, to the provider.
Prompt identification and treatment of oral thrush are necessary to prevent its progression and ensure effective management of the client's condition.
Dry oral mucous membranes: Dry oral mucous membranes are not typically associated with fluticasone/salmeterol use. However, if the client experiences persistent or severe dryness in the mouth or any other unusual oral symptoms, it should be reported to the provider. Dry mouth can sometimes occur as a side effect of medications or indicate other underlying issues that need to be addressed.
Sedation: Sedation is not a common side effect of fluticasone/salmeterol. If the client experiences excessive drowsiness or sedation that interferes with their daily activities, it may be important to report this to the provider. While sedation is not a typical adverse effect of this medication, individual responses can vary, and it is essential to ensure appropriate monitoring and management.
Increased appetite is not typically associated with fluticasone/salmeterol use. It is not a commonly reported adverse effect of the medication. However, if the client experiences significant and unexplained changes in appetite that are concerning or persistent, it may be worth mentioning to the provider during a follow-up appointment or as part of ongoing monitoring.