A nurse is assessing a client who has heart failure and a new prescription for metoprolol. Which of the following findings should the nurse identify as an adverse effect of the medication?

Choice A reason: The statement that "the spacer should make a whistling sound as you inhale" is not accurate. A whistling sound from the spacer may indicate that the air is being inhaled too quickly and that the user needs to slow down. The purpose of the spacer is to hold the medication released from the inhaler so that it can be inhaled more easily and effectively into the lungs, not to produce a whistling sound.

Choice B reason: Holding one's breath for 10 seconds after inhaling the medication allows for better deposition of the medication in the lungs. This pause gives the medication time to settle in the airways rather than being exhaled too quickly. It is a recommended practice to maximize the effectiveness of the inhaled medication.

Choice C reason: Cleaning the spacer is important to ensure that it works correctly and is free of any residue or debris that could obstruct the medication's path. However, the instruction to "clean the spacer daily with cold water" is incomplete. After rinsing with cold water, the spacer should be left to air dry without rinsing or wiping, as this can create static that affects medication delivery.

Choice D reason: Waiting 30 seconds between puffs is recommended to allow the user to breathe normally for a short period and to prepare for the next dose of medication. This time interval helps to ensure that the second puff is not rushed and that the medication from the first puff has had time to act.

Choice A reason : While eating fresh fruits and vegetables is generally healthy, it does not specifically indicate an understanding of AIDS-related teaching. Some fruits and vegetables need to be carefully handled to avoid potential infections.

Choice B reason : Wearing gloves and washing hands after changing a cat's litter box is correct as it helps prevent the transmission of infections, such as toxoplasmosis, which can be particularly harmful to individuals with AIDS.

Choice C reason : Taking clothes to the dry cleaners for sterilization is unnecessary and does not reflect an understanding of AIDS-related precautions.

Choice D reason : Wiping up areas soiled with body fluids with alcohol and disposing of the trash is a good practice for infection control, but it is not as directly related to the client's understanding of AIDS-specific precautions as choice b.