A nurse is teaching a client who has asthma how to use a metered-dose inhaler (MDI). The nurse identifies the sequence of steps the client should follow. (Move the steps, placing them in the selected order of performance. Use all steps.)

A. The ASO titer is a blood test used to detect streptococcal infections, particularly post-streptococcal sequelae like rheumatic fever or glomerulonephritis. It is not related to tuberculosis.
B. The Purified Protein Derivative (PPD) test, also known as the tuberculin skin test (TST), is specifically used to identify exposure to the tuberculosis bacteria. If a person has been exposed, the immune system will react to the PPD injection, causing a localized skin reaction that can be measured after 48-72 hours.
C. While a chest X-ray is an important tool for diagnosing active tuberculosis or assessing lung involvement, it is not the initial test for determining exposure to TB. It is usually ordered after a positive PPD test or when there are clinical symptoms of TB.
D. C-reactive protein (CRP) is a nonspecific marker of inflammation and infection in the body. It does not specifically indicate exposure to tuberculosis and is not used for TB testing.

A. Hypertension, or high blood pressure, is a common condition in older adults but is not a specific indicator of pneumonia. While blood pressure can fluctuate with illness, it does not directly relate to the diagnosis of pneumonia.
B. Acute confusion is a critical and relevant sign in older adults with pneumonia. This demographic may experience altered mental status due to factors like hypoxia (low oxygen levels), fever, or dehydration. Confusion is often one of the first signs of infection in older patients, making it a significant assessment finding.
C. Hematemesis, which is the vomiting of blood, is not associated with pneumonia. It typically indicates a gastrointestinal issue, such as bleeding from ulcers or varices, rather than respiratory problems. Therefore, this finding would not be relevant to a pneumonia diagnosis.
D. While a cough is indeed a symptom of pneumonia, a dry hacking cough is less typical. Pneumonia generally presents with a productive cough (producing sputum) rather than a dry cough. A dry cough might suggest conditions like bronchitis or asthma.