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 into the box on the right, placing them in the selected order of performance. Use all steps.)

A. The vital signs are stable and within normal limits. The slight drop in blood pressure post-dialysis is expected and not immediately concerning.

B. The client's weight decreased from 90 kg (198 lb) to 86.4 kg (190 lb) after dialysis. While weight loss is expected due to fluid removal during dialysis, this significant decrease (3.6 kg or approximately 8 lb) may need closer monitoring to ensure the client is not becoming dehydrated or losing more fluid than is safe.

C. The blood glucose levels are within an acceptable range for a client with type 2 diabetes mellitus. The slight decrease from 134 mg/dL to 75 mg/dL is not unusual given the time between measurements and the client's food intake.

D. The presence of a bruit and thrill at the AV fistula site indicates that it is functioning correctly, which is an expected finding.

E. The presence of crackles in the left lower lobe and an unproductive cough on the morning of Day 2 is concerning. These symptoms could indicate fluid overload or early signs of pulmonary edema, which require further evaluation and possible intervention.

F. The AV fistula site is noted to be ecchymotic and warm, with a bruit and thrill still present. While a bruit and thrill are expected findings, the ecchymosis and warmth could indicate a developing infection or trauma at the site, which necessitates further follow-up to prevent complications.

A. Epoetin alfa is used to stimulate the production of red blood cells, so an increase in hematocrit levels would indicate a therapeutic effect. This is particularly important in clients with chronic renal disease, who often suffer from anemia due to decreased erythropoietin production by the kidneys.

B. The erythrocyte sedimentation rate (ESR) is a nonspecific measure of inflammation and is not used to monitor the effectiveness of epoetin alfa therapy.

C. The leukocyte count measures white blood cells and is not affected by or used to assess the effectiveness of epoetin alfa.

D. The platelet count measures platelets in the blood and is not related to the therapeutic effects of epoetin alfa, which targets red blood cell production.