A nurse is teaching a client who has asthma about how to use a metered-dose inhaler with a spacer. Which of the following pieces of information should the nurse include in the teaching?

Choice A reason: White rice is considered a low-potassium food, making it a suitable option for someone with chronic kidney disease who needs to limit their potassium intake. One cup of cooked white rice contains approximately 54 mg of potassium, which is significantly lower than the other options listed.

Choice B reason: Nonfat yogurt can vary in potassium content, but on average, a 1/2 cup serving may contain around 200 to 300 mg of potassium. While it is a nutritious choice, it contains more potassium than white rice and should be consumed in moderation by individuals with potassium restrictions.

Choice C reason: A medium baked potato with skin is high in potassium, with one potato containing over 900 mg of potassium. This makes it an unsuitable choice for someone who needs to limit their potassium intake due to chronic kidney disease.

Choice D reason: Peanut butter contains a moderate amount of potassium. Two tablespoons of peanut butter can have around 150 to 200 mg of potassium. Although it's not as high in potassium as a baked potato, it still contains more potassium than white rice.

Choice A reason: Encouraging family members to press the PCA button for the client is not recommended. The PCA device is designed to be used by the patient to manage their own pain. Allowing someone other than the patient to administer the medication can lead to over-sedation or respiratory depression. The patient must have control over the PCA device to ensure that they are receiving the medication based on their pain level and not someone else's perception of their pain.

Choice B reason: Monitoring the client's respiratory status every 4 hours is important but may not be sufficient for a patient receiving morphine via a PCA device. According to clinical guidelines, respiratory rate, sedation, and pain scores must be recorded more frequently after the initiation of PCA therapy—typically every 15 minutes for the first hour, then every 30 minutes for the next 2 hours, and hourly until 24 hours post-operation. This is to ensure early detection of any adverse effects such as respiratory depression, which is a risk with opioid administration.

Choice C reason: Teaching the client how to self-medicate using the PCA device is the correct action. Patient education is crucial for the effective use of PCA. The patient should be instructed on how to use the device, including when to press the button and the importance of only the patient controlling the button. This empowers the patient to manage their pain effectively and safely, ensuring that they receive the medication when needed and reducing the risk of over-sedation or under-medication.

Choice D reason: Administering an oral opioid for breakthrough pain may be necessary if the PCA does not adequately control the patient's pain. However, this should be done cautiously and typically under the guidance of a pain management team or physician. Breakthrough pain medication is usually reserved for instances where the PCA is not providing sufficient pain relief, and the patient's pain is assessed to be higher than what can be managed by the PCA alone.