The unlicensed assistive personnel (UAP) notifies the nurse of these vital signs for a client on the medical-surgical unit: temperature 97.6°F, respirations 20, pulse 122, and BP 98/72. Which actions should the nurse do next?

Choice A reason: Dilated and reactive pupils are unrelated to albuterol’s effect. Albuterol, a bronchodilator, relaxes bronchial smooth muscles to improve airflow in emphysema. Pupil changes may indicate neurological or systemic issues but are not a direct indicator of albuterol’s effectiveness in relieving bronchoconstriction and respiratory distress.

Choice B reason: Decreased respiratory rate indicates albuterol’s therapeutic effect in emphysema. Albuterol relaxes constricted airways, improving airflow and reducing the work of breathing. This leads to a slower, more effective respiratory rate, reflecting better oxygenation and relief of bronchospasm, making it the primary sign of therapeutic success.

Choice C reason: Urine output of 50 mL/hr is normal but unrelated to albuterol’s effect. Albuterol targets bronchial smooth muscles to relieve bronchoconstriction in emphysema, improving respiratory function. Urine output reflects renal function, not airway improvement, making it an irrelevant indicator of albuterol’s therapeutic effectiveness in this context.

Choice D reason: A heart rate of 100 beats/minute may occur as a side effect of albuterol’s beta-adrenergic stimulation but is not the primary therapeutic indicator. Albuterol aims to improve airflow and reduce respiratory distress, evidenced by a decreased respiratory rate, not tachycardia, which is a secondary effect.

Choice A reason: A 30-pack-year smoking history indicates COPD risk but not acute distress. Smoking is a chronic factor, not an immediate symptom requiring urgent assessment. Clients with active respiratory distress, like accessory muscle use, take priority due to immediate risks of hypoxia.

Choice B reason: A 52-year-old in a tripod position using accessory muscles indicates severe respiratory distress in COPD, reflecting hypoxia or hypercapnia. This posture and muscle use signal increased work of breathing, requiring immediate assessment to prevent respiratory failure, making this client the highest priority.

Choice C reason: Dependent edema and clubbed fingers in a 68-year-old suggest chronic COPD with possible cor pulmonale. These are chronic findings, not acute distress. Clients with immediate respiratory compromise, like accessory muscle use, take priority due to the risk of rapid decompensation.

Choice D reason: Chronic cough with thick secretions is common in COPD but less urgent than acute respiratory distress. Secretions contribute to airway obstruction, but tripod positioning and accessory muscle use indicate immediate hypoxia risk, requiring priority assessment over chronic symptoms.