RN Nursing · Bronchodilator and Anti-Inflammatory Respiratory Medications · Practice question
A nurse assesses a client who has been using fluticasone by metered-dose inhaler for several weeks and notes white patches on the tongue and oral mucosa. What is the nurse's best action to address this finding?
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Advise the client to increase the fluticasone dose to better control inflammation
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✓
Instruct the client to rinse the mouth and gargle with water after each inhalation to prevent fungal infection
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Reassure the client that mild hand tremor is a common side effect and no additional action is needed
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Explain that nasal stuffiness during pollen season is unrelated to inhaler use and requires no teaching
Answer & explanation
Correct: Instruct the client to rinse the mouth and gargle with water after each inhalation to prevent fungal infection
White patches on the tongue and oral mucosa are classic signs of oral candidiasis, a fungal superinfection commonly associated with inhaled corticosteroid use such as fluticasone. The inhaled steroid deposits in the oral cavity and oropharynx, suppressing local immune defenses and allowing Candida albicans to proliferate. The most important preventive and corrective teaching intervention is to instruct the client to rinse the mouth thoroughly with water and gargle after each use of the inhaler. This practice removes residual corticosteroid from the oral mucosa and significantly reduces the risk of fungal overgrowth. The nurse should also report the findings so antifungal treatment such as nystatin swish-and-swallow can be prescribed. Advising the client to increase the fluticasone dose would worsen the fungal infection by further immunosuppressing the local oral environment. Reassuring the client about hand tremor is irrelevant to the oral finding and addresses a different medication side effect entirely. Explaining that nasal stuffiness is unrelated dismisses the actual clinical finding and misses an opportunity for essential client education. The correct response directly addresses the cause of the oral candidiasis and empowers the client with a simple preventive measure.
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