A nurse is teaching a guardian of a school-age child who has a new prescription for a fluticasone metered-dose inhaler. Which of the following information should the nurse include in the teaching? (Select all that apply.)
"Rinse your child's mouth following administration."
"Have your child take one inhalation as needed for shortness of breath."
"Shake the device prior to administration."
"A spacer will make it easier to use the device."
"Soak the inhaler in water after use
Correct Answer : A,C,D
A. "Rinse your child's mouth following administration." - This is important advice to prevent the development of oral thrush (a fungal infection) and to reduce the risk of irritation in the mouth and throat caused by the medication. After using a fluticasone inhaler, rinsing the mouth with water can help prevent these side effects.
C. "Shake the device prior to administration." - Shaking the inhaler before use ensures proper mixing of the medication and enhances its effectiveness.
D. "A spacer will make it easier to use the device." - A spacer is a device that attaches to the inhaler and helps the medication get into the lungs more effectively, especially for children who might have difficulty coordinating the timing of inhalation with activating the inhaler.
The other options:
B. "Have your child take one inhalation as needed for shortness of breath." - This instruction might not be accurate, as fluticasone is usually used as a maintenance medication to control chronic conditions like asthma. It's not typically used as a rescue inhaler for immediate shortness of breath.
E. "Soak the inhaler in water after use." - Soaking the inhaler in water after use is not a standard practice and is not necessary for proper administration or maintenance.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Increased blood pressure:
An elevated aPTT (activated partial thromboplastin time) suggests that the client is receiving heparin therapy. Heparin is an anticoagulant that prevents blood clotting. It's not likely to cause a significant increase in blood pressure directly. Changes in blood pressure may occur due to other factors, but they are not directly related to heparin therapy.
B. Decreased temperature:
Heparin administration does not typically have a direct effect on body temperature. Changes in body temperature might be due to other factors such as infection, but they are not a primary consideration when assessing the effects of heparin therapy.
C. Decreased respiratory rate:
Heparin administration is not known to directly affect respiratory rate. Changes in respiratory rate could be related to respiratory conditions, pain, or other factors unrelated to heparin therapy.
D. Increased pulse rate:
This is the correct choice. Heparin is known to affect the clotting process by inhibiting clot formation. An extended aPTT of 90 seconds indicates that the client's blood is taking longer to form clots than the normal range. This could lead to concerns about potential bleeding complications. Increased pulse rate could be an early sign of bleeding or decreased perfusion, as the body may attempt to compensate for reduced blood volume due to prolonged clotting times.
Correct Answer is D
Explanation
A. Administer the medication into the client's muscles.
Explanation: This is incorrect because enoxaparin is usually administered subcutaneously, not into the muscle.
B. Apply firm pressure to the injection site following administration.
Explanation: This is incorrect because while applying gentle pressure after a subcutaneous injection is common practice, it is not specific to enoxaparin.
C. Insert the syringe needle halfway into the client's skin.
Explanation: This is incorrect because the needle should be inserted fully into the subcutaneous tissue, not just halfway, for proper administration of enoxaparin.
D. Expel the air bubble from the syringe prior to injection.
Explanation: This is the correct action. Expelling air bubbles from the syringe prior to injection helps ensure accurate dosing and prevents air from being injected into the subcutaneous tissue.
When administering enoxaparin (low molecular weight heparin) subcutaneously, it's important to expel any air bubbles from the syringe before injection. Air bubbles can cause discomfort and inaccuracies in dosage. The nurse should gently tap the syringe to move air bubbles to the top and then push the plunger slightly to expel the air. The other options are not correct procedures for administering enoxaparin. It is typically injected into the subcutaneous tissue, not a muscle, and firm pressure is not typically applied after administration. The needle is fully inserted into the skin, not halfway.
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