A nurse assesses the heart rate of an adult client and notes it to be 52 beats per minute. What assessment should the nurse perform?

Choice A reason: Assessment of thoracic excursion or chest expansion is a vital part of the respiratory exam. The nurse should feel the hands move apart symmetrically as the client inhales deeply. This indicates that the musculoskeletal structures, the pleural membranes, and the underlying lung parenchyma are expanding uniformly on both the left and right sides of the thorax.

Choice B reason: Pain during expansion, or pleuritic pain, is a pathological finding that suggests inflammation of the parietal pleura. A student or new nurse should recognize that a normal assessment is painless. Feeling pain during this maneuver indicates a need for further investigation into conditions such as pleurisy, pulmonary embolism, or rib fractures.

Choice C reason: Crepitus is a tactile "crunching" or "popping" sensation caused by air trapped in the subcutaneous tissues, often referred to as subcutaneous emphysema. While this is an important finding to document if present, it is an abnormal condition resulting from trauma or air leaks and is not a feature of a normal respiratory assessment.

Choice D reason: A total lack of movement of the rib cage during deep inspiration would indicate severe respiratory compromise, such as neuromuscular paralysis or advanced restrictive lung disease. The goal of the assessment is to quantify the degree and symmetry of movement; therefore, "no movement" would be a critical clinical finding rather than an expected result.

Choice A reason: Switching to oral corticosteroids is not indicated for long-term asthma maintenance due to the high risk of systemic adverse effects, including adrenal suppression, osteoporosis, and hyperglycemia. Inhaled corticosteroids remain the gold standard because they deliver localized anti-inflammatory action directly to the bronchial mucosa with minimal systemic absorption and fewer side effects.

Choice B reason: Scheduled follow-up visits establish a therapeutic alliance and allow the nurse to provide positive reinforcement and longitudinal support. Regular monitoring enables the clinician to identify specific barriers to adherence, such as a busy lifestyle, and implement behavioral cues or digital reminders to integrate medication administration into the client's daily routine effectively.

Choice C reason: Instructing a client to use an inhaled corticosteroid only when symptoms occur is a clinical error. Inhaled corticosteroids are maintenance "controller" medications designed for daily use to reduce chronic airway inflammation. They are not "rescue" medications; using them inconsistently fails to prevent the remodeling and hyperresponsiveness characteristic of poorly controlled asthma.

Choice D reason: While providing written instructions on inhaler technique is an essential component of asthma education, it does not directly address the primary problem of forgetfulness or poor adherence. The client's issue is a behavioral one related to scheduling, not a lack of psychomotor skill or misunderstanding of how the device functions during use.