# Situation: A 34-year-old woman is being discharged from the medical ward after treatment for an asthma exacerbation. Her discharge medicines are a salbutamol pressurized metered-dose inhaler (pMDI) as needed for symptoms and a fluticasone pMDI, two puffs twice daily, both to be used with a spacer. She is also given a peak flow meter and a written asthma action plan. She finished elementary school and says she is "not good with reading." Before discharge, the nurse asks her to explain how she will use her two inhalers at home. Which statement shows that she needs **FURTHER** teaching?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629748  
> language: ko  
> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: A 34-year-old woman is being discharged from the medical ward after treatment for an asthma exacerbation. Her discharge medicines are a salbutamol pressurized metered-dose inhaler (pMDI) as needed for symptoms and a fluticasone pMDI, two puffs twice daily, both to be used with a spacer. She is also given a peak flow meter and a written asthma action plan. She finished elementary school and says she is "not good with reading."

Before discharge, the nurse asks her to explain how she will use her two inhalers at home. Which statement shows that she needs **FURTHER** teaching?

## 보기

1. "If I need the salbutamol more and more often, I will call the clinic."
2. "After the fluticasone, I will rinse my mouth with water and spit."
3. "I will keep using the fluticasone twice a day even when I feel fine."
4. "When I wheeze, I will take extra puffs of the fluticasone." **✔ 정답**

**정답: 4**

## 해설

Fluticasone is an inhaled corticosteroid that controls airway inflammation over time; it does not relieve an attack. Wheezing is treated with the reliever, salbutamol. The other statements are correct: rinsing and spitting prevents oral candidiasis, the controller is used daily even without symptoms, and rising reliever use signals poor control that needs review.

## 심화 해설

Controller versus reliever
Asthma treatment uses two different kinds of inhaler. The reliever, here salbutamol (albuterol), is a short-acting beta-2 agonist that relaxes airway smooth muscle within minutes and is used when symptoms occur. The controller, here fluticasone, is an inhaled corticosteroid that reduces airway inflammation gradually over days to weeks and is taken every day on schedule. A client who says she will take extra puffs of fluticasone when she wheezes has confused the controller with the reliever, so she needs further teaching. Extra steroid puffs do not open the airway during an attack, and relying on them delays the salbutamol she actually needs.

Why the other statements are correct
Calling the clinic when she needs salbutamol more and more often is exactly right: increasing reliever use is a sign of poor control and means the treatment plan should be reviewed. Rinsing the mouth with water and spitting after fluticasone prevents oral candidiasis and hoarseness from steroid deposited in the mouth and throat. Continuing the controller twice a day even when she feels fine is also correct, because inflammation persists between symptoms and stopping the controller when she feels well is one of the most common causes of repeat exacerbations.

| Feature | Salbutamol (reliever) | Fluticasone (controller) |
| --- | --- | --- |
| Drug class | Short-acting beta-2 agonist | Inhaled corticosteroid |
| Onset | Minutes | Days to weeks |
| When used | As needed for wheeze or breathlessness | Every day, even without symptoms |
| Key teaching | Rising use means poor control | Rinse mouth and spit after use |

Teaching a client with limited reading skills
She finished elementary school and says she is not good with reading, so the nurse should rely on teach-back and demonstration rather than written instructions alone. Labeling the inhalers (for example, "every day" and "when wheezing"), using simple pictures on the written asthma action plan, and having her show the spacer technique all support understanding. The question itself is a teach-back check: the nurse asks her to explain the plan in her own words and listens for the error.

Exam takeaway
Key point! For "needs further teaching" questions, find the statement that is unsafe or incorrect. In asthma, the classic error is using the inhaled corticosteroid as a rescue drug or stopping it when symptoms improve. Wheezing is treated with the reliever; the controller is taken every day regardless of symptoms. Rising reliever use reported to the clinic, steroid mouth rinsing, and daily controller use all show correct understanding.

## 임상 시나리오

Two Inhalers, Two JobsDischarge teaching after an asthma exacerbation
Salbutamol is the reliever: it opens the airways within minutes and is used for wheeze or breathlessness. Needing it more often means asthma is poorly controlled and the clinic should review treatment.

Fluticasone is the controller: an inhaled corticosteroid taken twice a day every day, even when she feels well. She rinses her mouth and spits after each dose to prevent oral thrush.

Use teach-back, demonstration with the spacer, and simple labeled or pictured instructions for a client with limited reading skills.

CautionA client who plans to take extra controller puffs for wheezing needs further teaching; the steroid does not relieve an acute attack.

## 핵심 개념

- **Reliever inhaler** — A fast-acting bronchodilator, such as salbutamol, used as needed to relieve wheezing and breathlessness.
- **Controller inhaler** — A medicine, such as an inhaled corticosteroid, taken daily to reduce airway inflammation and prevent attacks.
- **Inhaled corticosteroid** — A steroid delivered to the airways that controls inflammation over days to weeks but does not relieve acute bronchospasm.
- **Oral candidiasis** — A fungal mouth infection that can follow inhaled steroid use and is prevented by rinsing and spitting.
- **Teach-back** — A method in which the client explains instructions in her own words so the nurse can confirm understanding.

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