A new graduate nurse is about to go on their first job interview. Which of the following is a good recommendation for the new graduate nurse?

• Asthma: The client’s symptoms of wheezing, chest tightness, and persistent dry cough, especially worsening at night, are characteristic of asthma. The presence of bilateral wheezing and a low pulse oximetry reading of 90% indicate that the client is experiencing bronchoconstriction and reduced airflow, which are hallmark features of an asthma exacerbation.
• Plan to administer bronchodilator: Administering a bronchodilator is essential in treating asthma as it helps relax the bronchial muscles, leading to bronchodilation and improved airflow. This intervention is crucial for alleviating wheezing and shortness of breath associated with an asthma attack.
• Measure the client's peak airflow: Measuring peak airflow using a peak flow meter helps assess the severity of the asthma and the effectiveness of the bronchodilator therapy. It provides objective data on the client’s lung function, allowing the nurse to evaluate changes in the client’s condition over time and make necessary adjustments to the treatment plan.
• Prepare to administer an antibiotic: This action is not appropriate for asthma since antibiotics are ineffective against viral conditions and are typically used for bacterial infections such as pneumonia. Since the client is experiencing asthma symptoms rather than an infection, this intervention does not address the underlying problem.
• Request a prescription for a diuretic: This action is also not appropriate in this scenario. Diuretics are used to manage fluid overload conditions, such as pulmonary edema or heart failure, and would not be indicated for a client with asthma experiencing wheezing and shortness of breath.
• Teach the client pursed lip breathing: This technique is more commonly used in COPD to prevent airway collapse rather than in asthma, where bronchodilators provide more immediate relief.
• Oxygen saturation: Monitoring oxygen saturation is critical for assessing the effectiveness of treatment in clients with asthma. A low oxygen saturation level indicates inadequate oxygenation, which necessitates immediate intervention. Tracking this parameter helps ensure the client is receiving adequate oxygen during their treatment.
• Pulmonary function tests: While pulmonary function tests are useful for assessing long-term lung function, they provide valuable information on how well the lungs are functioning. Pulmonary function tests (PFTs), including forced expiratory volume in one second (FEV1) and peak expiratory flow rate (PEFR), help evaluate the degree of airway obstruction and response to treatment. Monitoring PFTs over time provides insight into asthma control and treatment effectiveness.
• Weight: Monitoring weight is not a primary concern in managing asthma exacerbations. While it can be relevant in certain chronic conditions or for assessing fluid retention, it is not directly related to monitoring respiratory status or the effectiveness of asthma treatment.
• Temperature: While it is important to monitor temperature in general to identify potential infections, it is not specifically relevant to assessing asthma status unless there are other indications of an underlying infection contributing to the respiratory symptoms. In the context of asthma management, oxygen saturation and peak airflow are more critical parameters.
• Urine output: Monitoring urine output is not a direct indicator of asthma status. It is more relevant in assessing kidney function and fluid balance, which are not primary concerns in the acute management of asthma exacerbations.
• COPD typically presents with a long history of smoking, chronic cough, and progressive respiratory symptoms. In this scenario, the client is a nonsmoker, and the acute nature of the symptoms is more indicative of asthma rather than COPD.
• Pulmonary edema often presents with symptoms such as cough with frothy sputum, severe shortness of breath, and hypoxia, typically related to heart failure. The client’s symptoms are more consistent with asthma rather than fluid overload.
• Pneumonia: Pneumonia usually presents with symptoms such as productive cough, fever, chills, and localized lung findings. While wheezing can occur, the lack of fever and the specific nighttime worsening of symptoms align more closely with asthma than with pneumonia.
• Asthma: The client’s symptoms of wheezing, chest tightness, and dry cough, especially worsening at night, are characteristic of asthma. The presence of bilateral wheezing and a low pulse oximetry reading indicate bronchoconstriction and reduced airflow, consistent with an asthma exacerbation.

A. Limit oral fluids to minimize labored breathing: This action is not appropriate, as adequate hydration is important for thinning mucus secretions, making it easier for the client to expectorate them. Limiting fluids could lead to thicker secretions, which may worsen the client’s respiratory distress and increase the difficulty of clearing secretions. Therefore, this approach is not suitable for a client with pneumonia and respiratory compromise.
B. Perform pursed-lip breathing to expel trapped carbon dioxide from the alveoli: While pursed-lip breathing can help with exhalation and improve oxygenation, it does not directly address the need to mobilize and clear copious secretions. This technique is beneficial in managing dyspnea and improving ventilation but is not the priority action when the client has significant secretions that need to be cleared.
C. Lie in a low Fowler's position to promote lung expansion: A low Fowler's position (30 degrees) is less effective for promoting lung expansion compared to higher Fowler's positions. Semi-Fowler's (30-45 degrees) or high Fowler's (greater than 45 degrees) positions are more beneficial for improving lung expansion and facilitating breathing in clients with respiratory distress. Therefore, this option does not provide the most effective intervention for the client's condition.
D. Perform hourly incentive spirometry to inflate lungs and mobilize secretions: This is the priority action for the nurse to encourage, as incentive spirometry is specifically designed to help inflate the lungs and improve lung function. It promotes deep breathing, which can enhance ventilation, prevent atelectasis, and facilitate the mobilization of secretions. Regular use of incentive spirometry is essential in managing pneumonia and can significantly improve respiratory outcomes for the client.