The nurse is caring for a client currently taking oxymetazoline. Which of the following statements should the nurse include regarding oxymetazoline?
Limit use of the drug to 3 days to prevent rebound nasal congestion
This drug may be used in maintenance treatment for asthma
This medication may take up to a week to see effects
Take this drug at bedtime because it may cause drowsiness
The Correct Answer is A
A. Limit use of the drug to 3 days to prevent rebound nasal congestion: Oxymetazoline is a topical nasal decongestant that can lead to rebound congestion if used for more than three consecutive days. This condition, known as rhinitis medicamentosa, can worsen nasal congestion rather than alleviate it, making it crucial for clients to adhere to this guideline.
B. This drug may be used in maintenance treatment for asthma: Oxymetazoline is not indicated for the maintenance treatment of asthma. It is a nasal decongestant, primarily used for temporary relief of nasal congestion due to colds or allergies, and does not address the underlying inflammation in asthma.
C. This medication may take up to a week to see effects: In fact, oxymetazoline provides rapid relief of nasal congestion, typically within minutes of administration. Clients should expect to feel its effects much sooner rather than having to wait a week, which can lead to misuse or overuse of the medication.
D. Take this drug at bedtime because it may cause drowsiness: Oxymetazoline is not known to cause drowsiness; rather, it works as a decongestant. Patients are usually advised to use it during the day as needed, and it should not be specifically recommended for bedtime use
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Correct Answer is B
Explanation
A. Hypertension: Fluticasone, a corticosteroid, is not typically associated with causing hypertension directly. However, chronic use can lead to fluid retention and hypertension in some individuals, but it is not a primary concern compared to other side effects.
B. Fungal infections: This is a significant adverse effect associated with inhaled corticosteroids like fluticasone. Prolonged use can increase the risk of oral thrush and other fungal infections due to the immunosuppressive effects of corticosteroids. Monitoring for signs of infection is crucial.
C. Decreased immunity: While long-term use of systemic corticosteroids can lead to decreased immune function, inhaled fluticasone is less likely to cause significant immunosuppression. However, it can still impact local immunity in the airways, making monitoring for infections more relevant than generalized immune suppression.
D. Hypoglycemia: Fluticasone is not known to cause hypoglycemia. In fact, corticosteroids typically can lead to increased blood glucose levels rather than lowering them, especially with chronic use, making this option inaccurate in the context of monitoring for adverse effects.
Correct Answer is C
Explanation
A) Administer albuterol via inhalation device to the client: This task cannot be delegated to the unlicensed assistive personnel (UAP). Administering medications, especially inhaled bronchodilators like albuterol, requires a licensed nurse to ensure proper technique, monitor the client for adverse effects, and assess the effectiveness of the treatment.
B) Performing initial respiratory assessment to determine baseline respiratory rate: This task also cannot be delegated to the UAP. Assessing respiratory status, including determining baseline respiratory rate and identifying any abnormalities, requires critical thinking and clinical judgment that a nurse must perform.
C) Assist the client with oral hygiene following inhaled corticosteroid administration by the nurse: This task can be delegated to the UAP. Assisting with oral hygiene is within the scope of practice for UAPs, and it is essential after administering inhaled corticosteroids to help prevent oral thrush and maintain oral health.
D) Assess the client's lung sounds to determine if wheezing is present: This task cannot be delegated to the UAP. Assessing lung sounds is a critical nursing assessment that requires the knowledge and skills of a licensed nurse to interpret findings and make clinical decisions based on the assessment.