Which effect would a nurse anticipate might occur in a patient receiving inhaled fluticasone who is also prescribed hydrochlorothiazide for hypertension?

Increased risk for immunosuppression

Increased clearance of fluticasone, decreasing risk for side effects

Reduced clearance of fluticasone, increasing risk for side effects

Increased risk for hypokalemia

Answer and Explanation

The Correct Answer is D

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.

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Correct Answer is ["A","D"]

Explanation

Choice A reason: Using a corticosteroid inhaler like fluticasone for asthma attacks is incorrect. Corticosteroids reduce inflammation over days, not immediately, and are for maintenance. Acute attacks require short-acting beta-agonists like albuterol for rapid bronchodilation, indicating a need for further patient education on inhaler roles.

Choice B reason: Cleaning the inhaler casing weekly with warm soapy water is correct. This prevents drug residue buildup, ensuring proper dose delivery and reducing infection risk. Removing the canister and drying the casing properly maintains inhaler function, reflecting appropriate understanding of maintenance.

Choice C reason: Rinsing the mouth with water and spitting it out after using a corticosteroid inhaler is correct. This removes residual drug, preventing oral candidiasis by reducing fungal growth in the oral cavity. It reflects proper understanding of post-inhalation hygiene, requiring no further instruction.

Choice D reason: Gargling and swallowing after using a corticosteroid inhaler is incorrect. Swallowing residual corticosteroid can increase systemic absorption, raising the risk of side effects like adrenal suppression. Rinsing and spitting out is necessary to minimize oral thrush and systemic effects, indicating a need for correction.

A. When the asthma symptoms improve, the dosage schedule can be tapered and eventually discontinued. B. It needs to be taken every day on a continuous schedule, even if symptoms improve. C. The patient needs to keep it close by at all times to treat acute asthma attacks. D. The proper technique for inhalation must be followed.

Correct Answer is B

Explanation

Choice A reason: Montelukast is not tapered or discontinued when symptoms improve, as it is a maintenance therapy for asthma. Stopping it may lead to recurrence of inflammation, as it blocks leukotriene receptors, preventing bronchoconstriction and inflammation, requiring consistent use for sustained control.

Choice B reason: Montelukast, a leukotriene receptor antagonist, requires daily oral administration to maintain its anti-inflammatory effects by blocking leukotriene D4 receptors. Continuous use prevents asthma exacerbations, even during symptom-free periods, ensuring long-term airway stability and reducing the risk of flare-ups.

Choice C reason: Montelukast is not used for acute asthma attacks due to its slow onset (hours). It is a maintenance therapy, not a rescue medication like albuterol, which provides rapid bronchodilation. Patients should carry beta-agonists, not montelukast, for acute symptom relief.

Choice D reason: Montelukast is an oral tablet, not an inhaled medication, so inhalation technique is irrelevant. Its action involves systemic leukotriene receptor blockade, reducing airway inflammation. Proper administration requires consistent daily dosing, not device-specific techniques, making this instruction incorrect for montelukast.

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Which effect would a nurse anticipate might occur in a patient receiving inhaled fluticasone who is also prescribed hydrochlorothiazide for hypertension?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is providing instructions to a patient who has a new prescription for a corticosteroid metered-dose inhaler. Which statement by the patient indicates that further instruction is needed? (Select all that apply)

Correct Answer is ["A","D"]

Explanation

The prescriber has changed the patient’s medication regimen to include the leukotriene receptor antagonist (LTRA) montelukast to treat asthma. The nurse will emphasize which point about this medication?

Correct Answer is B

Explanation

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