A nurse is caring for a client.

The nurse is assessing the client. Select the 4 findings that require immediate follow-up.

A. Place the client in a supine position: The supine position can worsen dyspnea by limiting diaphragmatic movement and decreasing lung expansion. Clients with respiratory distress should be positioned upright or semi-Fowler’s to facilitate breathing.

B. Instruct the client to perform diaphragmatic breathing: Diaphragmatic breathing helps improve oxygenation and ventilation by promoting deeper, more efficient breaths. It also reduces accessory muscle use and can decrease anxiety associated with shortness of breath.

C. Increase oxygen flow rate to 4 L/min: Oxygen should be titrated to maintain target saturation (usually 92–94% for COPD risk patients). The client’s current oxygen saturation is 92% on 2 L/min, so increasing the flow is unnecessary at this time.

D. Assess the client's breath sounds: Ongoing assessment of breath sounds is essential to monitor for changes such as wheezing, crackles, or diminished air entry, which guide interventions and evaluate response to therapy.

E. Restrict the client's fluid intake: Fluid restriction is not indicated in this client’s current presentation. Adequate hydration helps thin secretions, making coughing and airway clearance more effective.

F. Perform chest percussion and vibration: Chest physiotherapy techniques like percussion and vibration can help loosen and mobilize secretions, improving airway clearance in clients with productive cough and retained secretions.

A. Encourage the client to participate in a diabetes mellitus support group: While support groups are beneficial for emotional support and ongoing education, this intervention is not the priority during the initial home visit. It is more appropriate once the client’s knowledge and self-care skills have been assessed.

B. Determine the client's level of health literacy: Assessing health literacy is the first priority because it guides the nurse in tailoring education and interventions. Understanding the client’s ability to comprehend and apply health information ensures that teaching about diabetes management, such as glucose monitoring and medication administration, is effective and safe.

C. Verify the client's comfort level regarding how to use a glucometer: Ensuring the client can correctly use a glucometer is important, but this step should follow the assessment of health literacy. Tailoring instruction to the client’s literacy level improves comprehension and accuracy in self-monitoring.

D. Provide low-carbohydrate recipes for the client: Providing dietary resources supports diabetes management but is secondary to assessing the client’s understanding and ability to implement self-care. Without first evaluating literacy and comprehension, these resources may not be effectively utilized.