A nurse is planning to administer the first dose of iron dextran intermittent IV bolus for a client who has iron-deficiency anemia. Which of the following interventions should the nurse plan to take?

A) High-pitched bowel sounds: High-pitched bowel sounds, also known as "tinkling" sounds, are characteristic of mechanical bowel obstructions. These sounds are created by the intestines as they try to move contents past the obstruction, resulting in increased peristaltic activity. In the case of intussusception, where one segment of the intestine telescopes into another, the obstruction can cause these distinctive high-pitched sounds due to the narrowing of the bowel lumen.

B) Abdominal bruit: An abdominal bruit is a swishing sound heard over the abdomen, usually indicating turbulent blood flow through narrowed arteries. It is commonly associated with vascular conditions such as atherosclerosis or renal artery stenosis. It is not related to bowel obstruction, as bowel sounds in obstruction cases are generally due to changes in peristaltic activity rather than blood flow.

C) Bruising on the flank area: Bruising on the flank area, known as Grey Turner's sign, is typically seen in conditions involving retroperitoneal hemorrhage, such as severe pancreatitis or trauma. It is not a symptom of bowel obstruction. Bowel obstruction symptoms generally relate to the gastrointestinal tract and include abdominal pain, distension, and altered bowel sounds.

D) Coffee-ground emesis: Coffee-ground emesis is vomit that appears like coffee grounds, indicating the presence of partially digested blood. This is a sign of upper gastrointestinal bleeding, often due to peptic ulcers or gastritis. In mechanical bowel obstruction, vomiting is more likely to contain bile (bilious vomiting) and may occur if the obstruction is high in the small intestine. The appearance of coffee-ground emesis is not typical for bowel obstructions and indicates a different type of gastrointestinal issue.

A) Request return instructions in the client's own words:
Asking the client to repeat instructions in their own words is an effective strategy for ensuring understanding, especially for individuals with low health literacy. This technique, known as the "teach-back" method, allows the nurse to assess the client’s comprehension and clarify any misunderstandings.

B) Provide brochures that reflect a seventh-grade reading level:
While providing materials at a lower reading level can be helpful, it may not be sufficient for individuals with very low health literacy. It is essential to use multiple strategies, including verbal communication and interactive methods, to ensure understanding.

C) Limit teaching materials to written information:
Relying solely on written information is not advisable for clients with low health literacy. Visual aids, demonstrations, and verbal explanations should be included to enhance comprehension and retention of information.

D) Avoid repetition of information within each session:
Repetition is actually beneficial for clients with low health literacy. Repeating key information helps reinforce learning and ensures that the client retains the essential points discussed during the teaching sessions.