An adult client is admitted with AIDS and oral candidiasis manifested by several painful mouth ulcers. The nurse delegates oral care to the unlicensed assistive personnel (UAP) and discusses how to assist the client. Which instruction should the nurse provide the UAP?

Choice A reason: Rinsing the mouth after ipratropium use is unnecessary, as this anticholinergic bronchodilator does not cause oral candidiasis like corticosteroids. However, it is not harmful and does not indicate misunderstanding of critical administration technique. This action is less concerning than incorrect priming, which affects drug delivery.

Choice B reason: Attaching a spacer to the ipratropium inhaler is appropriate, as it improves drug delivery to the lungs by reducing oropharyngeal deposition. This enhances bronchodilation in COPD by ensuring more medication reaches the airways, indicating correct understanding and requiring no additional teaching.

Choice C reason: Priming the inhaler with 7 pumps is excessive and incorrect. Ipratropium inhalers typically require 2–3 priming sprays if unused for 24 hours. Over-priming wastes medication, reducing doses available for bronchodilation, and indicates a need for teaching to ensure proper administration for COPD management.

Choice D reason: Storing ipratropium at room temperature is correct, as extreme heat or cold can degrade the canister’s propellant, impairing drug delivery. This action shows understanding of proper storage to maintain the inhaler’s efficacy, requiring no further teaching for effective COPD treatment.

Choice A reason: Monitoring urine output assesses fluid status but does not directly prevent hypernatremia, which results from excess sodium or water loss. Reducing dietary sodium intake is more proactive, as urine output is a secondary indicator, making this instruction less effective for management.

Choice B reason: Using salt tablets after exercise is dangerous, as they increase sodium intake, worsening hypernatremia. This condition requires sodium reduction and water replacement, making this instruction harmful, as it exacerbates elevated serum sodium levels, risking neurological complications.

Choice C reason: Reviewing food labels for sodium content is critical, as hypernatremia results from high sodium intake or water loss. Limiting dietary sodium prevents further elevation of serum sodium, protecting against cerebral edema or seizures, making this the most effective discharge instruction.

Choice D reason: Drinking water when thirsty helps hydration but is reactive and insufficient for hypernatremia, which requires proactive sodium reduction. Thirst may be impaired in some patients, and dietary sodium control is more direct, making this instruction less comprehensive than label review.