A nurse is caring for a client who had a stroke involving the right cerebral hemisphere. The nurse should monitor for which of the following findings?

Choice A reason: No fluctuations in the water seal chamber. This finding indicates that the lung has expanded and there is no more air leaking from the pleural space. Fluctuations in the water seal chamber are normal when the client breathes, but they should stop when the lung is fully expanded.

Choice B reason: No reports of pleuritic chest pain. This finding does not indicate that the lung has expanded, as pleuritic chest pain can be caused by other factors, such as inflammation or infection of the pleura. Pleuritic chest pain is a sharp pain that worsens with breathing or coughing.

Choice C reason: Occasional bubbling in the water seal chamber. This finding does not indicate that the lung has expanded, as occasional bubbling can be normal or due to a small air leak. Continuous bubbling, however, indicates a large air leak and requires immediate attention.

Choice D reason: Oxygen saturation of 95%. This finding does not indicate that the lung has expanded, as oxygen saturation can be normal or high even with a collapsed lung. Oxygen saturation is the percentage of hemoglobin that is bound to oxygen in the blood.

Choice A reason: This is incorrect. Taking the albuterol before taking the cromolyn is not necessary. Albuterol and cromolyn are both used to treat asthma, but they have different mechanisms of action. Albuterol is a bronchodilator that relaxes the muscles around the airways and opens them up, making it easier to breathe. Cromolyn is a mast cell stabilizer that prevents the release of substances that cause inflammation and allergy symptoms in the airways. Albuterol is used to relieve acute asthma attacks, while cromolyn is used to prevent chronic asthma symptoms. The nurse should advise the client to use albuterol as needed for quick relief, and to use cromolyn regularly as prescribed to prevent asthma flareups.

Choice B reason: This is incorrect. Using both medications immediately after exercising is not recommended. Exercise can trigger asthma symptoms in some people, such as wheezing, coughing, or shortness of breath. This is called exercise induced bronchoconstriction (EIB) or exercise induced asthma (EIA). The nurse should advise the client to use albuterol 15 to 30 minutes before exercising to prevent EIB or EIA, and to avoid exercising in cold, dry, or polluted air. The nurse should also instruct the client to use cromolyn at least 15 minutes before exercising, as it takes time to work and does not provide immediate relief. The nurse should also tell the client to stop exercising and use albuterol if asthma symptoms occur during or after exercising.

Choice C reason: This is incorrect. Using cromolyn immediately if the breathing begins to feel tight is not effective. Cromolyn is not a rescue medication that can provide quick relief of asthma symptoms. It is a preventive medication that works by reducing the inflammation and sensitivity of the airways over time. The nurse should advise the client to use albuterol instead of cromolyn if the breathing begins to feel tight, as albuterol can rapidly open up the airways and ease the breathing. The nurse should also instruct the client to seek medical attention if the albuterol does not work or if the symptoms get worse.

Choice D reason: This is correct. Administering the medications 10 minutes apart is good practice. Cromolyn and albuterol can be used together to treat asthma, but they should not be mixed in the same nebulizer, as they may not be compatible and may lose their effectiveness. The nurse should instruct the client to use separate nebulizers for each medication, and to wait at least 10 minutes between each nebulization to allow the medication to reach the lungs and avoid irritation of the airways. The nurse should also teach the client how to use the nebulizer properly, and how to clean and store it after each use.