A charge nurse is teaching a newly licensed nurse about the facility’s computerized documentation system.

Which of the following information should the nurse include?

The correct answer is choice C. Blow into the meter as hard and quickly as possible.

This is because a peak flow meter measures how fast you can push air out of your lungs when you blow out as hard and as fast as you can.

This is called peak expiratory flow rate (PEFR) or peak expiratory flow (PEF). It shows how open the airways are in the lungs and can help detect early signs of worsening asthma.

Choice A is wrong because maintaining a semi-Fowler’s position during testing is not necessary. You can sit or stand up straight, but make sure you do it the same way each time.

Choice B is wrong because placing tongue on the mouthpiece of the meter can block the air flow and affect the accuracy of the measurement. You should close your lips tightly on the mouthpiece instead.

Choice D is wrong because recording the average of the readings is not recommended.

You should record the highest of the three readings on a sheet of paper, calendar or in your asthma diary. This is your daily peak flow.

Normal ranges for peak flow vary depending on age, height, gender and race. You can use a chart or calculator to find out your predicted normal peak flow based on these factors. However, it is more important to find out your personal best peak flow by performing peak flow testing twice a day for two weeks when your asthma is under good control. Your personal best peak flow will be used to create your asthma action plan with your healthcare provider.

The correct answer is choice C: “Do you have thoughts of harming yourself?”.

This is the priority question for the nurse to ask the client because it assesses the client’s risk for suicide, which is a serious and potentially life-threatening complication of conduct disorder. The nurse should use a direct and nonjudgmental approach when asking about suicidal ideation and plan.

Choice A: “How do you get along with your peers at school?” is wrong because it is not the most urgent question to ask the client.

While it is important to assess the client’s social relationships and possible peer rejection, this can be done after addressing the client’s safety and mental status.

Choice B: “Do you have a criminal record?” is wrong because it is not relevant to the client’s current condition and might make the client feel defensive or stigmatized.

The nurse should avoid asking questions that imply blame or judgment and focus on the client’s strengths and coping skills.

Choice D: “How do you manage your behavior?” is wrong because it is not appropriate for the nurse to ask the client in an emergency department setting.

This question might imply that the client is responsible for their conduct disorder, which is a complex and multifactorial mental health condition. The nurse should collaborate with the client and their family to develop a behavior management plan that involves positive reinforcement, limit setting, and consistent consequences.

Normal ranges: According to the DSM-5, conduct disorder is characterized by a persistent pattern of behavior that violates the rights of others or societal norms.

The symptoms of conduct disorder include aggression, deceitfulness, destruction of property, serious rule violations, and lack of remorse.

Conduct disorder can cause significant impairment in social, academic, or occupational functioning. The prevalence of conduct disorder is estimated to be 4% among children and adolescents.

The risk factors for conduct disorder include genetic factors, neurobiological factors, environmental factors, and psychological factors.