# A client on budesonide turbuhaler reports white patches on the tongue and inner cheeks that scrape off easily. Which is the nurse's most appropriate action?

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> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client on budesonide turbuhaler reports white patches on the tongue and inner cheeks that scrape off easily. Which is the nurse's most appropriate action?

## Option

1. Apply hydrocortisone cream to the mouth
2. Notify the provider — likely oral candidiasis from ICS deposition; topical nystatin treatment may be prescribed and reinforce rinse-and-spit technique **✔ Correct answer**
3. Reassure the client that this is normal
4. Discontinue all medications until plaques resolve

**Correct answer: 2**

## Explanation

Correct (2): White scrapeable plaques on tongue/buccal mucosa in an ICS user = oropharyngeal candidiasis. Topical antifungal (nystatin oral suspension swish-and-swallow QID × 7-14 days) typically treats it. Reinforce rinse-and-spit after each ICS use and use a spacer for MDI. (1) Not normal. (3) Stopping ICS risks asthma loss of control. (4) Topical steroids worsen candidiasis.

## In-depth explanation

Memory Tip ICS thrush = "White, Wipes-off, Wet (saliva)." Differentiate from leukoplakia (does NOT scrape off, premalignant).

## Clinical scenario

Scenario 56-year-old male on budesonide DPI for 4 months reports white scrapeable plaques on tongue/buccal mucosa, mild discomfort. Denies fever or constitutional symptoms.

## Key concepts

- **Oral candidiasis (thrush)** — White scrapeable fungal plaques; common ICS adverse effect.
- **Nystatin oral suspension** — Topical antifungal swish-and-swallow QID; first-line for ICS-related thrush.
- **Rinse-and-spit prevention** — Standard ICS counseling; reduces but does not eliminate thrush risk.

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