A nurse in a clinic is reviewing the home medications of client who has a history of asthma, and who is at the clinic to have a routine annual physical. Which statement made by the patient would indicate a need for further action by the nurse?

. Shellfish allergies are related to potential reactions to iodinated contrast media used in imaging studies, such as CT scans, rather than to spirometry. Spirometry does not involve contrast media or shellfish, so this question is not pertinent for this test.
B.A Metal implants are typically a concern for imaging tests like MRI, which involve strong magnetic fields. Spirometry, however, does not involve any imaging or use of magnetic fields, so metal implants do not affect spirometry results. Thus, this question is not relevant for spirometry preparation.
C. This is a relevant question for spirometry testing. Bronchodilators are medications used to open the airways and improve breathing. They can affect spirometry results if taken shortly before the test. For accurate assessment, the nurse needs to know if the client has used any bronchodilators, as they might need to adjust the testing protocol or account for the medication's effects on lung function.
D. Spirometry does not typically involve enclosed spaces that would trigger claustrophobia, as it is a breathing test usually performed with the client sitting comfortably in an open space. Claustrophobia is more relevant to imaging studies like MRIs or CT scans, where the client might be in a confined space.

A. Tachycardia (rapid heart rate) can occur in response to hypoxia (low oxygen levels), stress, or as a side effect of medications like albuterol. While tachycardia is a concerning sign in the context of an asthma exacerbation, it alone does not directly indicate the need for intubation and mechanical ventilation. It is often managed by addressing the underlying respiratory distress and improving oxygenation.
B. Anxiety is common in patients struggling to breathe, as they may feel frightened or panicked due to their difficulty breathing. However, anxiety itself is not an indicator for intubation and mechanical ventilation. It is a symptom of respiratory distress but does not directly assess the severity of the physiological need for mechanical support.
C. Hypotension (low blood pressure) in the context of an asthma exacerbation can be a sign of severe illness, possibly indicating shock or severe respiratory distress leading to reduced cardiac output. While hypotension is a serious concern, it is less directly related to the immediate need for intubation and mechanical ventilation compared to other indicators of respiratory failure.
D. Loud expiratory wheezing indicates significant airway obstruction but does not necessarily reflect the need for intubation and mechanical ventilation. Wheezing can be a sign of severe asthma but may not be sufficient on its own to necessitate intubation if the patient can still maintain adequate oxygenation and ventilation.