A client with a history of chronic obstructive pulmonary disease (COPD) receives a new prescription for an ipratropium inhaler. Which action indicates to the nurse that additional teaching is needed?

Choice A reason: Priming the inhaler with 7 pumps is an incorrect action, as it wastes the medication and reduces the number of doses available. The nurse should teach the client that ipratropium inhaler only needs to be primed once when it is first used, or if it has not been used for more than 3 days. To prime the inhaler, the client should spray it into the air away from the face until a fine mist appears.Choice B reason: Rinsing the mouth after each use is a correct action, as it prevents dry mouth and irritation caused by the medication. Ipratropium is an anticholinergic drug that blocks the action of acetylcholine, a neurotransmitter that stimulates the secretion of saliva and mucus. The nurse should teach the client to rinse the mouth with water or mouthwash after using the inhaler, and to drink plenty of fluids to stay hydrated.Choice C reason: Storing the medication at room temperature is a correct action, as it preserves the quality and effectiveness of the medication. The nurse should teach the client to store the ipratropium inhaler at room temperature, away from heat, moisture, and direct sunlight. The nurse should also instruct the client to check the expiration date and the dose counter of the inhaler, and to replace it when it is empty or expired.Choice D reason: Attaching spacer device to the inhaler is a correct action, as it improves the delivery and absorption of the medication. A spacer is a device that attaches to the mouthpiece of the inhaler and creates a chamber that holds the medication until the client inhales it. The nurse should teach the client to use a spacer with the ipratropium inhaler, as it can reduce the risk of side effects, such as coughing, throat irritation, and hoarseness. The nurse should also teach the client how to clean and maintain the spacer device.