Medical Surgical COPD #4


The nurse is caring for a client with a diagnosis of chronic obstructive pulmonary disease (COPD). The nurse received a new order for a metered-dose inhaler (MDI) and immediately notifies the health care provider because of which important finding?


  1. The client has severe arthritis in both hands.
    • Rationale:

      This answer is correct because a client with severe arthritis may not be able to manipulate a MDI effectively, and the health provider needs to be aware since arthritis may interfere with proper administration of the inhaled therapy, resulting in insufficient or over-dosage.

  2. The client is a smoker.
    • Rationale:

      This answer is not correct because while complications occur as a result of smoking, it will not be the most important finding associated with using a MDI. The fact that the client is a smoker will not interfere with the client’s ability to correctly use the MDI.

  3. Long-acting anticholinergic should be contraindicated in persons with COPD.
    • Rationale:

      This answer is not correct because long-term anticholinergics are a part of the plan of care for COPD clients. There is no need to contact the health care provider regarding a prescription for long-term anticholinergics.

  4. The client is hard of hearing.
    • Rationale:

      This answer is not correct because being hard of hearing does not affect using the MDI. The nurse would need only to verify that the client can demonstrate proper use of the MDI but there is not a need to contact the health care provider because of a hearing impairment.


The focus of this question is choosing the most critical finding to report to the health care provider regarding a client with a new order for a metered dose inhaler (MDI). MDI’s are prescribed to clients with respiratory conditions such as asthma, and the ability to properly use the MDI is critical to client safety.


Learning Outcomes

MDIs are often prescribed to clients with COPD, asthma, and other respiratory illnesses. They are used to deliver respiratory medications directly to the lungs when the client inhales. The medication is contained within a pressurized canister and the inhaler has a mouthpiece at the end. In order for the client to receive the medication fully with each dose, the inhaler must be used properly. A client with arthritis will not be able to manipulate the inhaler properly in order to receive the full dose and this finding should be reported to the prescribing provider.

Test Taking Tip

When answering questions that require notification of the provider try to picture yourself in the role of the nurse and ask yourself which of these answer choices is worthy of making that call. This question focuses on the use of a newly prescribed metered-dose inhaler and the fact that the client’s arthritis could significantly impair the client’s ability to use it properly and could place the client’s safety at risk.

Video Rationale