A nurse teaches the client about the prescribed buccal medication. Which statement by the client indicates teaching by the nurse is successful?

A) A client who has a question about her daily medications: While it's important to address questions regarding medications, this client does not present an immediate clinical concern that requires urgent attention.

B) A client who needs discharge teaching about an antibiotic: Although discharge teaching is important, it is not an immediate priority compared to the potential instability of a client with chest pain.

C) A client who just received nitroglycerin for chest pain: This is the correct choice. A client who has received nitroglycerin needs to be closely monitored for its effects, including blood pressure and relief of chest pain. This situation is potentially critical, making it the highest priority for assessment.

D) A client who would like some acetaminophen (Tylenol) for a mild headache: While this request should be addressed, it is not as urgent as the need to assess the client who has recently received nitroglycerin. Managing a mild headache is less critical compared to monitoring a client with chest pain.

A. "I should wait 20 to 30 seconds between puffs and 2 to 5 minutes between inhalations of different medications. I should administer the inhaled steroids first followed by the bronchodilator."

Explanation:

• Inhaled bronchodilators (such as albuterol) should be administered before inhaled steroids (such as fluticasone). This is because bronchodilators help open up the airways, allowing better delivery of the steroid medication to the lungs.
• Steroids should not be given first because they are not effective in immediately opening the airways, which can reduce the effectiveness of the steroid if given before a bronchodilator.

Here’s a breakdown of the other options, which are correct:

• B: Correct. The proper technique is to remove the mouthpiece cover, shake the inhaler well (2 to 5 seconds), and then insert the inhaler into the spacer.
• C: Correct. Rinsing the mouth with warm water and spitting it out after using an inhaled steroid is important to prevent oral thrush (a fungal infection).
• D: Correct. The proper technique involves closing the mouth around the spacer mouthpiece, pressing the MDI to release the medication, inhaling slowly and deeply for about 5 seconds, and holding the breath for about 10 seconds to allow for better absorption.

Thus, A is the statement that requires further teaching because the client has the incorrect sequence of medication administration (steroid first, bronchodilator second).