A nurse is providing teaching to a school-age child about using an inhaler with a mouthpiece to manage asthma exacerbation. Identify the order in which the nurse should instruct the client to perform the steps. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

A) A school-age child who is 2 days postoperative following an appendectomy and has a nasogastric tube: While this child requires regular monitoring and care, they are in a stable postoperative phase and do not show signs of acute distress that necessitate immediate attention over other clients.

B) A preschooler awaiting discharge instructions prior to leaving the hospital: This client is stable enough to be considered for discharge. While discharge instructions are important, they do not take priority over a client with potential respiratory distress.

C) A toddler who has a respiratory rate of 54/min: This client exhibits a significantly elevated respiratory rate, which can indicate respiratory distress or a serious underlying condition. Immediate assessment and intervention are necessary to ensure the toddler's airway and breathing are managed appropriately.

D) A school-age child who reports nausea following chemotherapy: While nausea following chemotherapy is uncomfortable and needs management, it is a known side effect and typically not life-threatening. This client's condition is less urgent compared to a toddler showing signs of potential respiratory distress.

A) "If you experience angina, take a 10-minute rest period, then resume exercise."
It's important for clients to stop exercising immediately and consult a healthcare provider if they experience angina during exercise. Resting and then resuming exercise can be unsafe without medical advice, as angina indicates insufficient blood flow to the heart.

B) "Stop exercising if your heart rate increases by 20 beats per minute from baseline."
An increase in heart rate during exercise is expected, and stopping at a 20 BPM increase may be overly cautious. Clients should be taught to monitor for excessive fatigue or symptoms like dizziness, but a 20 BPM increase alone isn't necessarily a concern.

C) "Limit your exercise to an indoor facility to avoid exposure to the sun."
While excessive sun exposure can be a concern for some individuals, limiting exercise to indoors is unnecessary unless there are specific contraindications. Clients should be encouraged to exercise in environments they enjoy, with appropriate sun protection if outdoors.

D) "Begin by walking half a mile two times a day for the first week."
This recommendation is a reasonable starting point for postoperative exercise. Walking is a low-impact exercise that can help improve cardiovascular health gradually. Clients should gradually increase their activity level based on their tolerance and healthcare provider's advice.