A nurse cares for a patient who is prescribed nasal fluticasone. Which teaching is most appropriate for the patient?

Choice A rationale Gargling with saline is typically recommended after using an inhaled corticosteroid like fluticasone delivered via a metered-dose inhaler (MDI) or dry powder inhaler (DPI) to prevent oral candidiasis (thrush), not for a nasal spray formulation. The primary concern with nasal use is local irritation. Choice B rationale Reporting persistent dryness of the nasal mucosa is the most appropriate teaching because fluticasone is a nasal corticosteroid that can cause local side effects such as mucosal irritation, dryness, burning, and epistaxis (nosebleeds). These local effects warrant assessment by the provider, potentially requiring a dose change or a lubricant. Choice C rationale Advising monthly diabetes screening is not routine for nasal fluticasone, as the systemic absorption of inhaled or nasal corticosteroids is generally low. While high-dose or prolonged oral corticosteroids can increase blood glucose (normal fasting plasma glucose: 70–100 mg/dL), this is an unlikely effect for the nasal formulation. Choice D rationale Discontinuing daily rights (presumably referring to daily activities or routine care) for the duration of treatment is irrelevant and incorrect. Nasal fluticasone is a maintenance medication for allergy or inflammation and should not interfere with daily life or necessitate limiting routine self-care. Choice E rationale Fluticasone is a corticosteroid used for the maintenance control of allergic rhinitis or inflammation, and it is not effective for the acute relief of asthma or allergy symptoms. Short-acting bronchodilators are used for acute relief, as corticosteroids require time to reduce inflammation. Choice F rationale Vigorously shaking the canister for two minutes is excessive and incorrect. While many MDI inhalers require a brief shake, a nasal spray typically only requires a gentle shake, if any, before use. Over-shaking is unnecessary and does not improve drug delivery or efficacy. Choice G rationale Limiting intake of vitamin C while taking this medication is unnecessary and incorrect. There is no significant scientific interaction between nasal fluticasone, a glucocorticoid, and vitamin C (ascorbic acid). Dietary limitations are not generally required for nasal corticosteroid use.