Question

a nurse in an outpatient clinic is preparing to provide education to a client who has asthma.
exhibit 1 exhibit 2 exhibit 3
nurses notes
3 months ago:
client reports experiencing shortness of breath and coughing for the past month. reports that they had an upper respiratory infection about a month ago that has improved. however, the shortness of breath and coughing continues and is worse at night and when exercising outside in the cold. denies productive cough, sinus pain, and chest pain. denies smoking.
no nasal drainage. inspiratory wheezing auscultated bilaterally. no accessory muscle use.
provider order pulmonary function test. results reviewed by provider and prescriptions ordered.
today:
during the past 4 weeks, the client reports experiencing shortness of breath and coughing while exercising outside. they are using their albuterol inhaler approximately 3 times a week. inspiratory wheezing auscultated bilaterally. no accessory muscle use.
a nurse is preparing to provide education to a client about their medications during their second clinic visit.
for each potential teaching intervention, click to specify if the teaching is indicated or not indicated. there must be at least 1 selection in every row. there does not need to be a selection in every column.
intervention indicated not indicated
instruct the client to take montelukast when they are experiencing shortness of breath.
instruct the client to rinse their mouth with water and gargle after using their budesonide/formoterol inhaler.
instruct the client to increase their fluid intake and suck on hard candy.
instruct the client to use the budesonide/formoterol inhaler for long - term management of asthma.
obtain blood level of medications to ensure that they are therapeutic.
instruct the client to notify the provider if they experience behavioral changes, such as agitation, depression, or suicidal thinking.
instruct the client to use the albuterol inhaler 5 min after exercising.
instruct the client to take montelukast in the

Explanation:

To determine the indicated/not indicated status for each intervention, we analyze based on asthma medication and management knowledge:

1. Instruct the client to take montelukast when they are experiencing shortness of breath: Montelukast is a leukotriene modifier for long - term control, not a rescue medication. So, this is Not Indicated.
2. Instruct the client to rinse their mouth with water and gargle after using their budesonide/formoterol inhaler: Budesonide is a corticosteroid; rinsing/gargling prevents oral thrush. So, this is Indicated.
3. Instruct the client to increase their fluid intake and suck on hard candy: These actions help with dry mouth (a common issue with inhalers) and respiratory mucosa hydration. So, this is Indicated.
4. Instruct the client to use the budesonide/formoterol inhaler for long - term management of asthma: Budesonide/formoterol is a combination of a corticosteroid and a long - acting beta - agonist (LABA) for long - term asthma control. So, this is Indicated.
5. Obtain blood level of medications to ensure that they are therapeutic: Routine blood levels for asthma medications (montelukast, inhaled corticosteroids/LABAs) are not standard. So, this is Not Indicated.
6. Instruct the client to notify the provider if they experience behavioral changes, such as agitation, depression, or suicidal thinking: Montelukast has a black box warning for neuropsychiatric events. So, this is Indicated.
7. Instruct the client to use the albuterol inhaler 5 min after exercising: Albuterol is a rescue inhaler; it should be used before exercise (for prevention) or at the onset of symptoms, not after. So, this is Not Indicated.
8. Instruct the client to take montelukast in the [assuming daily, e.g., evening as per usual dosing]: Montelukast is taken daily (often in the evening) for long - term control. If the instruction is about proper daily dosing (not for acute symptoms), this would be Indicated (but the first montelukast intervention was for acute symptoms, which was Not Indicated). Since the question's last intervention is cut off, but based on the visible part, for the first montelukast intervention (for acute symptoms) it's Not Indicated.

Answer:

1. Instruct the client to take montelukast when they are experiencing shortness of breath: Not Indicated
2. Instruct the client to rinse their mouth with water and gargle after using their budesonide/formoterol inhaler: Indicated
3. Instruct the client to increase their fluid intake and suck on hard candy: Indicated
4. Instruct the client to use the budesonide/formoterol inhaler for long - term management of asthma: Indicated
5. Obtain blood level of medications to ensure that they are therapeutic: Not Indicated
6. Instruct the client to notify the provider if they experience behavioral changes, such as agitation, depression, or suicidal thinking: Indicated
7. Instruct the client to use the albuterol inhaler 5 min after exercising: Not Indicated

(For the last, partially visible montelukast instruction, if it's about daily dosing, it would be Indicated; if about acute symptoms, Not Indicated)