To control asthma, a client in a residential treatment facility uses a fluticasone propionate and salmeterol discus inhalation system, which provides an inhaled powdered form of these combined medications. Which instruction should the nurse provide to this client's caregivers?

When using the discus, have the client breathe out rapidly into the mouthpiece.

Offer the discus to the client for use during an acute asthma attack.

Clients using the discus may experience decreased blood pressure.

Explain that the client should not use the discus more than twice daily.

Answer and Explanation

The Correct Answer is D

Choice A reason: This is not a correct instruction for the nurse to provide to the client's caregivers. When using the discus, the client should breathe out slowly and gently away from the mouthpiece, not into it. Breathing out rapidly into the mouthpiece can cause the powder to disperse and reduce the amount of medication delivered to the lungs. The client should also rinse the mouthpiece with water after each use and dry it thoroughly.

Choice B reason: This is not a correct instruction for the nurse to provide to the client's caregivers. The discus is not intended for use during an acute asthma attack, as it does not provide immediate relief of bronchospasm. The discus is a combination of fluticasone, a corticosteroid that reduces inflammation, and salmeterol, a long-acting beta-agonist that relaxes the airway muscles. The discus is a maintenance therapy that should be used regularly to prevent asthma symptoms and exacerbations. The client should also have a rescue inhaler, such as albuterol, for quick relief of asthma attacks.

Choice C reason: This is not a correct instruction for the nurse to provide to the client's caregivers. Clients using the discus may experience increased blood pressure, not decreased, as a possible side effect of salmeterol. Salmeterol can stimulate the beta receptors in the heart and blood vessels, causing tachycardia, palpitations, and hypertension. The nurse should monitor the client's blood pressure and heart rate regularly and report any abnormal findings to the healthcare provider.

Choice D reason: This is the correct instruction for the nurse to provide to the client's caregivers. The discus should not be used more than twice daily, as it can increase the risk of adverse effects and reduce the effectiveness of the medication. The discus should be used once in the morning and once in the evening, about 12 hours apart, to provide optimal control of asthma symptoms. The nurse should teach the client and the caregivers how to use the discus correctly and safely, and to follow the prescribed dosage and schedule.

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Correct Answer is B

Explanation

Choice A reason: Measuring the client's urinary output is not the most appropriate action for the nurse to take. Although urinary output is an important indicator of renal function, it is not related to the color change of the urine. The nurse should monitor the client's fluid balance as part of the routine care, but it is not a priority.

Choice B reason: Explaining the color change is normal is the most appropriate action for the nurse to take. Carbidopa/levodopa can cause the urine to become dark brown or black, which is a harmless side effect. The nurse should reassure the client that this is not a sign of a serious problem and does not affect the effectiveness of the medication.

Choice C reason: Obtaining a specimen for a urine culture is not the most appropriate action for the nurse to take. A urine culture is used to diagnose a urinary tract infection (UTI), which is characterized by symptoms such as dysuria, frequency, urgency, and hematuria. The color change of the urine due to carbidopa/levodopa is not indicative of a UTI. The nurse should obtain a urine culture only if the client has signs or symptoms of a UTI.

Choice D reason: Encouraging an increase in oral intake is not the most appropriate action for the nurse to take. Although adequate hydration is important for the client's health, it is not related to the color change of the urine. The nurse should encourage the client to drink enough fluids to prevent dehydration, but it is not a priority.

A. Blood pressure 100/78 mm Hg. B. Double vision. C. Puffy, bleeding gums. D. Chronic insomnia.

Correct Answer is B

Explanation

Choice A reason: This is not an assessment finding that warrants immediate intervention by the nurse. Blood pressure 100/78 mm Hg is within the normal range for an adult, and it does not indicate any adverse effect of phenytoin. The nurse should monitor the blood pressure for any changes, but it is not a priority.

Choice B reason: This is an assessment finding that warrants immediate intervention by the nurse. Double vision, or diplopia, is a sign of phenytoin toxicity, which can occur due to overdose, drug interactions, or impaired metabolism. Double vision can impair the client's vision, balance, and coordination, and increase the risk of falls and injuries. The nurse should stop the phenytoin infusion, if applicable, and notify the healthcare provider. The nurse should also check the serum phenytoin level and other vital signs, and prepare to administer an antidote, such as fosphenytoin, if indicated.

Choice C reason: This is not an assessment finding that warrants immediate intervention by the nurse. Puffy, bleeding gums are a common side effect of phenytoin, which can cause gingival hyperplasia, or overgrowth of the gum tissue. Puffy, bleeding gums are not life-threatening, but they can affect the client's oral hygiene and appearance. The nurse should instruct the client to brush and floss the teeth regularly, and to visit a dentist for dental care.

Choice D reason: This is not an assessment finding that warrants immediate intervention by the nurse. Chronic insomnia is not a common or serious side effect of phenytoin, which is an anticonvulsant that can have sedative effects. Chronic insomnia may be caused by other factors, such as stress, pain, or caffeine intake. The nurse should assess the client's sleep pattern and quality, and provide education and counseling on sleep hygiene and relaxation techniques.

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To control asthma, a client in a residential treatment facility uses a fluticasone propionate and salmeterol discus inhalation system, which provides an inhaled powdered form of these combined medications. Which instruction should the nurse provide to this client's caregivers?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with Parkinson's disease who is taking carbidopa/levodopa reports the urine appears to be darker in color. Which action should the nurse take?

Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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