The nurse is teaching a client who has been diagnosed with HIV about the antiretroviral medication regimen. Which statement provided by the client requires additional instruction by the nurse?

A) Serum ammonia level of 30 pg/dl (17.62 μmol /dL): Serum ammonia level is not directly affected by sodium polystyrene sulfonate administration. Ammonia levels are typically related to liver function and are not relevant in assessing the effectiveness of this medication for hyperkalemia.
B) Serum glucose level of 120 mg/dL (6.7 mmol/L): Serum glucose level is unrelated to the action of sodium polystyrene sulfonate. While hyperkalemia can sometimes lead to glucose metabolism abnormalities, the glucose level alone does not provide information about the medication's effectiveness.
C) Serum potassium level of 3.8 mEq/L (3.8 mmol/L): Sodium polystyrene sulfonate, also known as Kayexalate, is a medication used to treat hyperkalemia by exchanging sodium ions for potassium ions in the intestines, leading to potassium excretion through feces. A decrease in serum potassium level within the normal range indicates that the medication has been effective in lowering potassium levels, which is the intended therapeutic outcome in the context of treating hyperkalemia associated with acute kidney injury (AKI).
D) Hemoglobin level of 13.5 g/dL (135 g/L): Hemoglobin level is unrelated to the action of sodium polystyrene sulfonate. It reflects the oxygen-carrying capacity of red blood cells and is not directly influenced by potassium-lowering medications.

A) When using the discus, have the client breathe out rapidly into the mouthpiece: This instruction is incorrect because with dry powder inhalers (DPIs) like the fluticasone propionate and salmeterol discus, clients should exhale slowly and completely before inhaling the medication. Breathing out rapidly may cause the medication to be dispersed ineffectively, reducing its therapeutic benefit. By exhaling slowly, clients ensure better delivery of the medication to their lungs, maximizing its effectiveness in controlling asthma symptoms.
B) Explain that the client should not use the discus more than twice daily: This is the correct answer. Fluticasone propionate and salmeterol combination inhalers are typically used on a scheduled basis to maintain asthma control. Overuse of these medications can lead to increased risk of side effects, such as oral thrush or hoarseness from the steroid component (fluticasone propionate), or increased heart rate from the long-acting beta agonist (salmeterol). Moreover, exceeding the prescribed dose may not provide additional benefits in controlling asthma symptoms and can indicate inadequate control, necessitating a review of the treatment plan by the healthcare provider.
C) Offer the discus to the client for use during an acute asthma attack: Using a combination inhaler during an acute asthma attack is not appropriate. During acute exacerbations, clients should use short-acting bronchodilators (e.g., albuterol) for quick relief of symptoms. Combination inhalers like fluticasone propionate and salmeterol are intended for long-term maintenance therapy to prevent asthma symptoms, not for acute symptom relief.
D) Clients using the discus may experience decreased blood pressure: This statement is incorrect. Fluticasone propionate and salmeterol combination inhalers are not known to cause decreased blood pressure as a side effect. However, salmeterol, being a long-acting beta agonist, can potentially cause an increase in heart rate, especially when used excessively, but this is not related to blood pressure changes. It's essential to focus on the appropriate use and dosing schedule of the medication to achieve optimal asthma control and minimize adverse effects.