The nurse administering a nasal medication via an atomizer bottle should:

A) Measure liquid medication by bringing liquid medication cup to eye level: This is the correct action. Measuring liquid medications at eye level ensures accuracy and helps the nurse confirm the correct dosage, minimizing the risk of administration errors.

B) Crush enteric-coated medication and place it in a medication cup with water: This option is incorrect. Enteric-coated medications are designed to dissolve in the intestine, not in the stomach, and crushing them can alter their effectiveness and increase the risk of side effects. These medications should be administered whole.

C) Place all of the client's medications in the same cup, except medications with assessments: This option is not advisable without knowing how the medications interact. Certain medications may have specific requirements for administration and should not be mixed together, as this could lead to confusion or adverse reactions.

D) Remove the medication from the wrapper and place it in a cup labeled with the client's information: While labeling is crucial for safety, medications should ideally be kept in their original packaging until administration to prevent confusion and ensure that the nurse has all necessary information about the medication at hand. Medications should only be removed when preparing for immediate administration.

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).