A nurse is planning to apply a transdermal analgesic cream prior to inserting an IV for a preschool-age child. Which of the following actions should the nurse plan to take? (Select all that apply)

A. Apply petroleum jelly to the client's lips after oral care: Applying petroleum jelly to the client's lips can help prevent dryness and cracking, particularly in immobile clients who may have difficulty maintaining moisture in their oral mucosa. This action helps promote comfort and prevent complications such as lip fissures and discomfort during oral care. Therefore, it is an appropriate action for the nurse to take.
B. Use the thumb and index finger to keep the client's mouth open: Forcing the client's mouth open with the thumb and index finger can be uncomfortable and may cause injury. Gentle techniques should be employed to maintain the client's mouth open if necessary, such as using a mouth prop or asking the client to open their mouth voluntarily.
C. Turn the client on his side before starting oral care: Turning the client on their side is an essential safety measure, particularly for immobile clients, to prevent aspiration and facilitate drainage of oral secretions during oral care. This position helps ensure that any excess fluid or debris can drain out of the mouth rather than pooling in the back of the throat, reducing the risk of aspiration pneumonia. Therefore, it is an appropriate action for the nurse to take.
D. Use a stiff toothbrush to clean the client's teeth: Using a stiff toothbrush can cause injury to the client's gums and oral tissues, especially if the client is immobile or has delicate oral tissues due to medical conditions or treatments. A soft-bristled toothbrush or sponge applicator should be used for oral care to avoid trauma and ensure thorough but gentle cleaning.

A. Clubbing of the fingers: Clubbing of the fingers is a common finding in clients with advanced emphysema. It is characterized by bulbous enlargement of the fingertips and nail changes, including increased curvature and softening of the nail beds. Clubbing results from chronic hypoxia and tissue oxygen deprivation, which leads to vascular changes and tissue proliferation in the fingertips.
B. Deep respirations: Deep respirations are not typically associated with emphysema. Instead, clients with emphysema often exhibit shallow, rapid respirations due to decreased lung elasticity and air trapping, which impair effective ventilation. As a compensatory mechanism, clients may adopt a pursed-lip breathing pattern to facilitate expiration and reduce airway collapse.
C. Bradycardia: Bradycardia is not a characteristic finding in clients with emphysema. Instead, clients with emphysema commonly experience tachycardia, which is a compensatory response to hypoxia and increased work of breathing. Tachycardia helps maintain cardiac output and tissue perfusion in the setting of impaired gas exchange.
D. Barrel chest: Barrel chest is a classic physical finding in clients with emphysema. It results from hyperinflation of the lungs and loss of lung elasticity, leading to a permanent increase in the anteroposterior diameter of the chest. This change in chest shape contributes to the characteristic appearance of a rounded, barrel-like chest.
E. Dyspnea: Dyspnea, or shortness of breath, is a hallmark symptom of emphysema. Clients with emphysema often experience dyspnea, especially with exertion, due to air trapping, decreased lung function, and impaired gas exchange. Dyspnea can significantly impact the client's quality of life and functional status, requiring careful management and symptom relief interventions.