An older adult female client is hospitalized with a fractured femur. During a routine nursing assessment, she repeatedly asks the nurse to “speak up” so that she can hear the questions. Which action is best for the nurse to take?

Choice A reason: A heart rate of 120 beats/minute requires immediate intervention, as albuterol, a beta-agonist, stimulates cardiac beta-1 receptors, causing tachycardia. In emphysema, repeated dosing increases cardiovascular stress, risking arrhythmias or ischemia, necessitating evaluation to adjust therapy or address potential overdose effects.

Choice B reason: Respiratory rate of 28 breaths/minute is elevated but expected in emphysema with dyspnea. Albuterol aims to reduce bronchospasm, and this rate does not indicate immediate danger compared to tachycardia, which poses a cardiovascular risk, making it less urgent.

Choice C reason: Oxygen saturation of 90% is low but common in emphysema exacerbations. Albuterol improves airflow, and supplemental oxygen may address hypoxia. While concerning, this is less immediately life-threatening than tachycardia, which indicates potential albuterol toxicity, requiring urgent intervention.

Choice D reason: Peak expiratory flow at 60% reflects airflow limitation in emphysema, improved by albuterol. While low, it is not as urgent as tachycardia, which signals cardiovascular strain from repeated albuterol doses, posing a greater immediate risk to the client’s stability.

Choice A reason: Explaining the five positions for postural drainage is correct, as COPD clients benefit from varied postures to drain mucus from different lung segments. Positioning enhances gravity-assisted clearance, improving airway patency and gas exchange, ensuring the client understands the procedure for effective participation.

Choice B reason: Performing drainage after meals is incorrect, as it risks aspiration and discomfort due to gastric pressure in COPD clients with hyperinflated lungs. Timing drainage between meals ensures safety and efficacy, making this approach inappropriate for mucus clearance.

Choice C reason: Obtaining an ABG before drainage is unnecessary unless respiratory distress is evident. Postural drainage is routine in COPD to clear mucus, and ABGs monitor acid-base status, not procedure efficacy, making this choice irrelevant for standard drainage preparation.

Choice D reason: Instructing shallow, fast breathing is incorrect, as it reduces tidal volume, worsening mucus clearance in COPD. Deep, slow breathing enhances drainage by mobilizing secretions, making this approach counterproductive to the goal of improving airway clearance during the procedure.