A nurse is reinforcing teaching with a client who has COPD about purse-lipped breathing. Which of the following statements should the nurse make?

A. Expiratory wheeze

Expiratory wheeze is a high-pitched, musical sound heard primarily during expiration. It occurs when air passes through narrowed airways due to bronchoconstriction, inflammation, and increased mucus production, which are characteristic features of an acute asthma exacerbation. Expiratory wheezes are commonly heard upon auscultation of the chest in individuals experiencing asthma exacerbations.

B. Pleural friction rub

Pleural friction rub is a dry, crackling or grating sound heard during both inspiration and expiration. It typically occurs when the inflamed pleural surfaces rub against each other during breathing. Pleural friction rub is associated with conditions such as pleurisy (inflammation of the pleura) or pleural effusion (accumulation of fluid in the pleural space), rather than asthma exacerbations.

C. Fine rales

Fine rales, also known as fine crackles, are brief, high-pitched, discontinuous sounds heard primarily during inspiration. They are typically associated with conditions involving the small airways and alveoli, such as pulmonary fibrosis or congestive heart failure. Fine rales are not commonly heard in asthma exacerbations.

D. Rhonchi

Rhonchi are low-pitched, snoring or rattling sounds heard primarily during expiration. They result from the passage of air through airways obstructed by thick mucus or secretions. While rhonchi may be heard in individuals experiencing asthma exacerbations, they are less characteristic than expiratory wheezes, which are more commonly associated with asthma exacerbations. Rhonchi are often associated with conditions such as chronic bronchitis or pneumonia.

A. Asking the provider to repeat another radiograph of the chest.

This option is not the most appropriate action in this scenario. While a chest radiograph may be useful in certain situations to assess for complications such as pneumothorax or pneumonia, it is not typically the first intervention for an asthma exacerbation with increased wheezing and decreased oxygen saturation. In this acute situation, the priority is to provide immediate treatment to alleviate the client's symptoms and improve oxygenation.

B. Increasing oxygen to maintain an oxygen saturation of 95% or greater in the client.

While maintaining adequate oxygenation is important, especially in a client with asthma exacerbation, it is not the first-line intervention in this scenario. Oxygen supplementation may be necessary, but the priority is to address the underlying bronchospasm causing the decreased oxygen saturation. Therefore, this option may be considered after initiating appropriate bronchodilator therapy.

C. Requesting the pharmacy to dispense 10 mL of dextromethorphan PO.

This option is not appropriate for managing an asthma exacerbation. Dextromethorphan is a cough suppressant and does not address the underlying bronchospasm characteristic of asthma exacerbations. In fact, suppressing cough may hinder the clearance of mucus and exacerbate respiratory distress. Therefore, this intervention is not indicated and may delay appropriate treatment.

D. Instructing respiratory therapy to administer a PRN albuterol aerosol.

This is the correct action in this scenario. Albuterol is a short-acting bronchodilator commonly used to relieve bronchospasm and improve airflow in clients experiencing asthma exacerbations. Administering albuterol via aerosolized inhalation helps to quickly deliver the medication directly to the airways, providing rapid relief of symptoms such as wheezing and improving oxygenation. Therefore, instructing respiratory therapy to administer a PRN albuterol aerosol is the most appropriate intervention to address the client's acute symptoms.