A nurse is teaching a client who has asthma how to use a metered-dose inhaler (MDI). The nurse identifies the sequence of steps the client should follow. (Move the steps, placing them in the selected order of performance. Use all steps.)

A. Rhonchi are abnormal lung sounds that result from obstruction or secretions in larger airways. They are more commonly associated with conditions like chronic bronchitis or COPD rather than tuberculosis. While TB can lead to various lung sounds, rhonchi are not a hallmark of the disease.
B. Weight gain is generally not associated with tuberculosis. In fact, TB often leads to weight loss due to factors like loss of appetite, increased metabolic demand, and systemic effects of the infection. Patients with active TB frequently present with cachexia (wasting) or weight loss, not weight gain.
C. Hemoptysis, or coughing up blood, is a significant and classic symptom associated with tuberculosis, especially in cases involving pulmonary TB. It occurs due to the erosion of blood vessels in the lungs as the disease progresses. This makes it a strong correlating finding with a diagnosis of tuberculosis.
D. Frothy sputum is more characteristic of pulmonary edema or conditions such as congestive heart failure. In tuberculosis, sputum may be mucoid or purulent and sometimes contains blood, but it is not typically described as frothy.

A. Bradypnea, or a slow respiratory rate, is concerning but not typically associated with asthma exacerbations. In asthma, patients usually experience tachypnea (increased respiratory rate) as they try to compensate for difficulty breathing.
B. A decreased respiratory rate in an asthma patient can be alarming, but it may not necessarily indicate an immediate need for intervention unless it’s associated with other severe symptoms. In general, asthma patients often have an increased respiratory rate due to respiratory distress.
C. While crackles can indicate fluid in the lungs and may suggest an underlying issue, they are not the most immediate concern in a patient with asthma. Crackles can occur in various conditions, and they alone may not necessitate urgent intervention.
D. Diminished breath sounds are a critical finding in asthma patients. This may indicate severe airway obstruction or a lack of air movement due to severe bronchospasm. In the context of asthma, diminished breath sounds can signify that the patient is not able to move air effectively, which requires immediate intervention to prevent respiratory failure.