A patient with renal impairment is prescribed a medication that is primarily excreted by the kidneys. What adjustment should the nurse anticipate?

Choice A reason: Limit caffeine intake is not an instruction that the nurse should provide to the client who has asthma and a new prescription for inhaled fluticasone. Fluticasone is a medication that reduces inflammation and swelling in the airways, which can improve breathing and prevent asthma attacks. Fluticasone does not interact with caffeine or affect the heart rate or blood pressure. Caffeine is a stimulant that can cause nervousness, insomnia, or palpitations in some people, but it does not worsen asthma symptoms or interfere with fluticasone therapy. The nurse should advise the client to consume caffeine in moderation and avoid it before bedtime.

Choice B reason: Take the medication with meals is not an instruction that the nurse should provide to the client who has asthma and a new prescription for inhaled fluticasone. Fluticasone is a medication that reduces inflammation and swelling in the airways, which can improve breathing and prevent asthma attacks. Fluticasone is administered by inhalation, not by mouth, and it does not affect the digestion or absorption of food. The nurse should instruct the client to use the inhaler as prescribed, usually twice a day, regardless of the mealtimes.

Choice C reason: Rinse the mouth after administration is an instruction that the nurse should provide to the client who has asthma and a new prescription for inhaled fluticasone. Fluticasone is a medication that reduces inflammation and swelling in the airways, which can improve breathing and prevent asthma attacks. Fluticasone is a corticosteroid, which can cause side effects such as oral thrush, hoarseness, or sore throat if it remains in the mouth after inhalation. The nurse should instruct the client to rinse the mouth with water and spit it out after each dose of fluticasone to prevent these side effects. The nurse should also teach the client how to use the inhaler properly and check the inhaler technique regularly.

Choice D reason: Check the pulse after medication administration is not an instruction that the nurse should provide to the client who has asthma and a new prescription for inhaled fluticasone. Fluticasone is a medication that reduces inflammation and swelling in the airways, which can improve breathing and prevent asthma attacks. Fluticasone does not affect the heart rate or blood pressure, and it is not a rescue medication that should be used for acute asthma symptoms. The nurse should monitor the respiratory rate and the oxygen saturation of the client after administering fluticasone and advise the client to use a short acting bronchodilator, such as albuterol, for quick relief of wheezing or shortness of breath.

Choice A reason: This is incorrect. Reviewing the patient’s previous blood glucose levels may not be helpful in determining the correct dose of insulin, as the blood glucose level can fluctuate depending on various factors, such as food intake, activity, stress, and illness. The previous blood glucose levels may not reflect the current insulin needs of the patient¹.

Choice B reason: This is incorrect. No review is not an option before administering insulin, as insulin is a highalert medication that can cause serious harm if given incorrectly. The nurse should always check the patient’s blood glucose level, the insulin order, the insulin type, the insulin dose, the insulin expiration date, and the insulin injection site before giving insulin.

Choice C reason: This is correct. Reviewing the Regular insulin sliding scale for administration in the patient’s electronic medical record is the best action to determine the correct dose of insulin. A sliding scale is a chart of insulin dosages based on blood glucose level and mealtime. It is used to adjust the insulin dose according to the patient’s blood glucose level and insulin sensitivity. The nurse should follow the sliding scale protocol and verify the insulin dose with another nurse before administering it.

Choice D reason: This is incorrect. Reviewing the patient’s previous insulin administration doses may not be helpful in determining the correct dose of insulin, as the insulin dose may vary depending on the patient’s blood glucose level and insulin sensitivity. The previous insulin doses may not reflect the current insulin needs of the patient¹.