A nurse is providing discharge teaching to a client who will be receiving total parenteral nutrition (TPN) at home.
Which of the following instructions should the nurse include? (Select all that apply.)

Choice A rationale

While heartburn can occur shortly after eating, it is the frequent episodes of heartburn and regurgitation that are more commonly associated with hiatal hernia.

Choice B rationale

Dysphagia (difficulty swallowing) and odynophagia (painful swallowing) can occur with other esophageal conditions but are not the primary symptoms of hiatal hernia.

Choice C rationale

Frequent bouts of heartburn and regurgitation after food intake are classic symptoms of hiatal hernia, due to the herniation of the stomach through the diaphragm allowing acid to reflux into the esophagus.

Choice D rationale

Bloating and postprandial fullness can occur, but they are not as commonly associated with hiatal hernia as heartburn and regurgitation.

Choice A rationale

Administering packed RBCs is important but is not the highest priority. Stabilizing the client’s hemodynamic status is critical first.

Choice B rationale

Elevating the client's feet can help with blood circulation but does not address the immediate need to stabilize blood pressure and fluid volume.

Choice C rationale

Initiating a dopamine IV infusion can help with hypotension, but it is not the first action. Stabilizing the client with fluids is a higher priority.

Choice D rationale

Increasing the client's IV fluid rate is the highest priority to address hypotension and ensure adequate blood volume before administering blood products or other medications. .