A nurse in an outpatient clinic is assessing a client who is pregnant for unsafe behaviors during pregnancy. Which of the following findings indicates a need for further evaluation?

Rationale:

A. Use a loud tone of voice when speaking with the client: Clients with visual impairments do not necessarily have hearing loss. Speaking loudly is unnecessary and may be perceived as disrespectful or startling. Clear, calm, and descriptive communication is more appropriate.

B. Rearrange client’s bedside table items frequently: Frequently moving personal items creates confusion and increases the risk of accidents or frustration for a visually impaired client. Consistent item placement enhances safety and independence.

C. Guide the client by walking parallel with them: Walking parallel without physical or verbal guidance may not be helpful. It’s more effective to offer the client your arm so they can follow your movement and safely navigate their surroundings.

D. Remove objects from client's path to the bathroom: Clearing obstacles from the client's walking path reduces the risk of tripping and falls. This is a key safety intervention for clients with reduced visual sensory perception and promotes independent, safe mobility.

Rationale:

• Instruct client to avoid foods that have been fermented or aged: This dietary restriction applies to monoamine oxidase inhibitors (MAOIs), not trazodone, which is a serotonin antagonist and reuptake inhibitor (SARI).
• Encourage client to sleep until later in the morning: Oversleeping can disrupt circadian rhythms and worsen fatigue. A consistent, balanced sleep schedule is more therapeutic.
• Advise client to notify provider if pregnant: Trazodone is a category C medication and should only be used in pregnancy if the benefits outweigh the risks. The provider must be informed if the client is or may become pregnant.
• Encourage high-calorie finger foods: The client has experienced weight loss and decreased appetite. Nutrient-dense, easy-to-eat foods can support caloric intake without requiring full meals.
• Advise client to rise slowly from sitting position: Trazodone can cause orthostatic hypotension. Educating the client to change positions slowly helps prevent dizziness and potential falls.
• Encourage naps during the day when client is tired: Daytime napping can interfere with nighttime sleep and may reduce trazodone’s effectiveness in establishing a healthy sleep pattern.
• Encourage a regular sleep-wake schedule: Trazodone is often prescribed for sleep difficulties. A consistent routine supports sleep hygiene and enhances the medication’s effectiveness.