Which adverse effect can result if tetracycline is administered to children younger than 8 years of age?

Choice A reason: Oral decongestants like pseudoephedrine are not inherently more potent than nasal sprays like oxymetazoline. Both stimulate alpha-adrenergic receptors to constrict nasal blood vessels, but nasal sprays often provide more rapid, localized relief. Potency depends on dose and delivery, not route, making this incorrect.

Choice B reason: Oral decongestants do not have an immediate onset. They require absorption through the gastrointestinal tract, with effects starting in 30-60 minutes. Nasal sprays act within minutes due to direct mucosal application, making them faster for acute sinus symptom relief, unlike slower-acting oral forms.

Choice C reason: Oral decongestants typically have a longer duration of action (4-6 hours for pseudoephedrine) compared to nasal sprays (often shorter unless long-acting). Shorter duration is not a benefit, as prolonged relief is preferred for sinus congestion, making this an incorrect advantage of oral administration.

Choice D reason: Oral decongestants avoid rebound congestion, a common issue with nasal sprays like oxymetazoline, which can cause rhinitis medicamentosa with prolonged use. Oral agents like pseudoephedrine act systemically, reducing nasal congestion without local dependence, making them safer for extended use without worsening symptoms upon discontinuation.

Choice A reason: Immunosuppression is not significantly increased with inhaled fluticasone and hydrochlorothiazide. Fluticasone has minimal systemic absorption, limiting systemic immunosuppression. Hydrochlorothiazide, a diuretic, does not enhance immune suppression but affects electrolytes, making hypokalemia a more relevant concern in this combination.

Choice B reason: Increased clearance of fluticasone is unlikely with hydrochlorothiazide. Fluticasone is metabolized by hepatic CYP3A4, and hydrochlorothiazide does not significantly induce this enzyme. Drug interactions affecting clearance are minimal, and the primary concern is the additive effect on potassium levels, not fluticasone metabolism.

Choice C reason: Reduced clearance of fluticasone is not a known interaction with hydrochlorothiazide. Fluticasone’s low systemic absorption and hepatic metabolism are unaffected by hydrochlorothiazide, which primarily affects renal electrolyte excretion. The combination does not increase fluticasone’s systemic side effects but may exacerbate electrolyte imbalances.

Choice D reason: Hydrochlorothiazide, a thiazide diuretic, promotes potassium excretion, causing hypokalemia. Inhaled fluticasone has minimal systemic effects but may contribute to hypokalemia when combined with systemic corticosteroids. The nurse should monitor potassium levels, as the diuretic’s effect is the primary driver of this electrolyte imbalance in this scenario.