The nurse is developing a teaching plan for a client with peripheral arterial disease (PAD) who has a history of a myocardial infarction (MI) and smokes two packs of cigarettes daily. Which instruction has the greatest priority?

Choice A reason: Withholding further opioid analgesics might be considered if the lack of bowel sounds is due to opioid-induced ileus. However, this is not the immediate action the nurse should take. The nurse should first document the finding and continue to assess the client's condition.

Choice B reason: Obtaining a prescription for a laxative might be appropriate if the client is experiencing constipation. However, administering a laxative without further assessment and documentation of the bowel sounds could lead to complications. The nurse should document the finding first and then collaborate with the healthcare provider for further interventions.

Choice C reason: Documenting the assessment finding is the most appropriate initial action. This ensures that the lack of bowel sounds is recorded in the client's medical record, which is crucial for ongoing monitoring and communication with the healthcare team. Proper documentation also helps in tracking changes in the client's condition and making informed decisions about subsequent care.

Choice D reason: Preparing to insert a nasogastric tube might be necessary if the client develops symptoms of bowel obstruction or other complications. However, this action should follow the documentation and further assessment of the client's condition. The nurse should document the finding first to provide a basis for any further interventions.

Choice A reason: Gaining weight over six months can affect overall health and potentially exacerbate asthma symptoms by increasing the workload on the respiratory system. However, it is not an immediate trigger for asthma exacerbation.

Choice B reason: A family member contracting viral influenza poses a risk of the client catching the virus, which can exacerbate asthma. However, it is not a direct trigger of the asthma exacerbation unless the client actually contracts the virus.

Choice C reason: A family history of lung disease can indicate a genetic predisposition to respiratory issues, but it is not an immediate trigger for an asthma exacerbation.

Choice D reason: Cleaning with household supplies is a significant trigger for asthma exacerbation. Many cleaning products contain strong chemicals that can irritate the airways and provoke an asthma attack. This is the most immediate and direct cause of the client's asthma complications among the given options.