A nurse is caring for a child who has sickle cell anemia.
Which of the following findings is the priority for the nurse to report to the provider?

Using a metered-dose inhaler (MDI) correctly is all about timing and technique to ensure the medication actually reaches the lungs instead of just hitting the back of the throat. Here is the correct sequence of steps the nurse should teach the child: Choice A: Depress the canister while inhaling slowly. The child should start a slow, deep breath and press the canister at the beginning of that inhalation to draw the mist deep into the airways. Choice C: Hold breath for 10 seconds. Once the inhalation is complete, holding the breath allows the tiny droplets of medicine to settle into the lower lungs rather than being immediately exhaled. Choice B: Remove the inhaler from the mouth. After the breath-hold, the device is removed before exhaling to ensure no moisture from the breath gets into the mouthpiece. Choice D: Exhale slowly through the nose. A controlled exhale completes the process and prepares the child for a second puff if one was prescribed. Pro-Tips for Pediatric Use Shake it up: Always remind the child to shake the inhaler for 3-5 seconds before use. The "Wait" Rule: If a second puff of the same medication is needed, it’s best to wait about 30–60 seconds between inhalations. Spacer Benefits: For many children, using a spacer is highly recommended because it eliminates the need for perfect "press-and-breathe" coordination.

The correct answer is Choice D.

Choice A rationale

While explaining the procedure to the adolescent and their guardian is important, it is not the nurse’s primary responsibility to provide detailed explanations of the procedure. This should be done by the provider performing the procedure.

Choice B rationale

Witnessing the adolescent’s signature on the informed consent form is part of the nurse’s role, but it does not address the guardian’s lack of understanding about the procedure.

Choice C rationale

Requesting assistance from the anesthesiologist to clarify the misunderstanding is not appropriate, as the anesthesiologist may not be the best person to explain the procedure. The provider performing the procedure should be the one to provide clarification.

Choice D rationale

Notifying the provider who is scheduled to perform the procedure is the correct action. The provider is responsible for ensuring that the patient and their guardian fully understand the procedure and its risks and benefits before obtaining informed consent.