A client with emphysema is reporting difficulty breathing and exhibiting audible wheezing. The nurse administers albuterol as prescribed for the third time within the last 12 hours. Which assessment finding warrants immediate intervention by the nurse?

Choice A reason: Priming an ipratropium inhaler typically requires 2 pumps, not 7, to ensure proper dosing. Excessive priming wastes medication and may reduce the inhaler’s lifespan. This action indicates misunderstanding of device preparation, necessitating further teaching to ensure effective administration and therapeutic outcomes.

Choice B reason: Attaching a spacer device enhances ipratropium delivery by improving aerosol deposition in the lungs, especially in COPD patients with poor inhalation technique. This is correct, as spacers reduce oropharyngeal deposition, minimizing side effects and maximizing bronchodilation, requiring no additional teaching.

Choice C reason: Storing ipratropium at room temperature is correct, as extreme temperatures can degrade the medication’s efficacy. This action aligns with manufacturer guidelines, ensuring the inhaler’s stability and effectiveness, indicating proper understanding and eliminating the need for further teaching on storage.

Choice D reason: Rinsing the mouth after ipratropium use is appropriate, as it reduces local side effects like dry mouth or throat irritation from residual medication. This correct action prevents complications, showing proper technique and understanding, so no additional teaching is required for this step.

Choice A reason: Over-enunciating syllables emphasizes pronunciation, which may help with clarity but does not directly address hearing impairment. Age-related hearing loss (presbycusis) often involves difficulty processing rapid speech. Slowing speech is more effective, as over-enunciation may distort natural speech patterns, reducing comprehension in older adults with hearing deficits.

Choice B reason: Shouting increases volume but can distort speech and cause discomfort, worsening communication for those with presbycusis. High-frequency hearing loss in older adults makes loud sounds less effective, as they struggle with pitch discrimination. Slower, clear speech better facilitates understanding than shouting, which may also seem aggressive.

Choice C reason: Decreasing speaking speed enhances comprehension in older adults with hearing loss. Presbycusis impairs processing of rapid speech, particularly high-frequency sounds. Slow, clear speech allows more time for auditory processing, improving understanding without distorting sound or relying on less effective nonverbal cues, making it the optimal intervention.

Choice D reason: Exaggerating nonverbal expressions relies on visual cues, which does not address auditory comprehension. While gestures may supplement communication, they are insufficient for conveying detailed medical questions. Hearing-impaired clients primarily need auditory adjustments, like slower speech, to process verbal information effectively, making nonverbal exaggeration less appropriate.