A nurse is providing discharge teaching to a client who has asthma and a new prescription for fluticasone/salmeterol. For which of the following adverse effects should the nurse instruct the client to report to the provider?

Rationale: A. Dry oral mucous membranes is incorrect because mild dryness of the mouth may occur with inhaled medications but is generally not harmful and does not require medical intervention. Clients can manage minor dryness by drinking water or using sugar-free lozenges. It does not indicate a serious adverse effect of fluticasone/salmeterol. B. Sedation is incorrect because fluticasone/salmeterol, which combines an inhaled corticosteroid (ICS) with a long-acting beta-agonist (LABA), does not produce central nervous system effects such as sedation. Sedation would be more relevant to systemic sedatives or other CNS-acting medications, not inhaled asthma therapies. C. Increased appetite is incorrect because inhaled corticosteroids have minimal systemic absorption, unlike oral corticosteroids, and do not typically affect appetite. While systemic steroids can lead to weight gain and increased appetite, inhaled formulations are designed to target the lungs with limited systemic exposure. D. White coating in the mouth is correct because it can indicate oral candidiasis, a common local adverse effect of inhaled corticosteroids. Inhaled corticosteroids like fluticasone suppress local immune responses in the mouth and oropharynx, allowing Candida albicans overgrowth. This infection may appear as white patches on the tongue, inner cheeks, or throat, and can cause discomfort, altered taste, or difficulty swallowing. Clients should be instructed to rinse the mouth and gargle with water after each inhalation, and use a spacer device with a metered-dose inhaler to reduce medication deposition in the mouth. If thrush develops, the client should report it to the provider for antifungal treatment.