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Exhibit 1 Nurses’ Notes Today: A client presents to the clinic today with reports of shortness of breath while walking and a cough for the past 3 months. Current smoker, reports smoking 1 pack per day for the past 55 years. History of hypertension, hyperlipidemia, and depression. Alert and oriented to person, place, and time. Dyspneic while walking in clinic. Shallow, rapid breaths. Bilateral expiratory wheezing. Nonproductive, dry cough. No pleural friction rub. No cyanosis, accessory muscle use, or pursed lip breathing. Sinus tachycardia rhythm, S1 S2, no murmurs or extra heart sounds. Radial and pedal pulses +1 bilaterally. Pedal edema of lower extremities +1. Chest x-ray, pulmonary function test, and laboratory tests ordered. Provider reviewed results. Prescriptions ordered. Exhibit 2 Vital Signs Today: Temperature 37.05° C (98.7° F) Heart rate 96/min Respiratory rate 30/min Blood pressure 144/88 mm Hg Oxygen saturation 94% on room air Pain of 0 on a scale of 0 to 10 Exhibit 3 Provider Prescriptions Today: Prednisone 60 mg once a day by mouth for 14 days Fluticasone/salmeterol 250 mcg/50 mcg 1 inhalation twice a day Albuterol MDI 2 inhalation every 4 to 6 hr as needed for shortness of breath Exhibit 4 Diagnostic Results Today: Chest x-ray: Hyperinflation of bilateral lungs and flattened diaphragm present. Pulmonary Function Test: 49% FVC1 (Forced Expiratory Volume in 1 second) Question: The client is at risk for developing Target 1, Target 2 and Target 3. Options: dry mouth oral candidiasis constipation liver damage increased intraocular pressure drowsiness bradycardia bone loss hyperglycemia muscle twitching

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