A nurse is providing teaching to a client who has heart failure and a decreased cardiac output. Which of the following information should the nurse include in the teaching?

Restrict daily exercise

Encourage 3 large meals per day.

Limit dietary salt intake

Obtain weight once per week.

Answer and Explanation

The Correct Answer is C

Rationale:

A. Restrict daily exercise: Clients with heart failure benefit from regular, moderate activity as tolerated to improve cardiac efficiency and prevent deconditioning. Restricting all exercise can worsen functional status and is not recommended unless specifically limited by the healthcare provider.

B. Encourage 3 large meals per day: Large meals can increase cardiac workload and exacerbate heart failure symptoms due to increased blood flow demands during digestion. Smaller, more frequent meals are preferable to reduce strain on the heart.

C. Limit dietary salt intake: Reducing sodium intake helps prevent fluid retention and edema, which can exacerbate heart failure and increase cardiac workload. Teaching clients to limit salt is a key intervention to manage decreased cardiac output and maintain stable fluid balance.

D. Obtain weight once per week: Daily weight monitoring is recommended for clients with heart failure to detect fluid retention early. Weekly weights may delay recognition of sudden fluid accumulation, increasing the risk of decompensation.

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Correct Answer is A

Explanation

Rationale:

A. Slow down the oxytocin infusion: Contractions occurring every 50 seconds and lasting 2 minutes indicate severe uterine hyperstimulation, which reduces placental blood flow and contributes to late decelerations. Slowing or stopping the oxytocin helps decrease contraction intensity and frequency, improving fetal oxygenation.

B. Administer oxygen at 2 L/min per nasal cannula: Oxygen administration can support fetal oxygenation, but 2 L/min via nasal cannula delivers minimal benefit in an acute distress situation. Oxygen would be used as a supportive measure after correcting the cause of the late decelerations. The first action is reducing uterine activity by adjusting the oxytocin infusion.

C. Place the client in a lithotomy position for delivery: Lithotomy positioning is used during the second stage of labor but is inappropriate when the fetus shows signs of distress. It does not relieve uterine hyperstimulation or improve placental blood flow. Positioning that enhances perfusion, such as side-lying, would be more beneficial after reducing the oxytocin.

D. Increase the rate of IV fluid infusion of lactated Ringers: Increasing IV fluids may help improve maternal circulation, but it does not directly resolve contractions that are too frequent or prolonged. Fluids can be an adjunct intervention but should not occur before decreasing oxytocin in the presence of late decelerations.

A. A client who has a complete femur fracture and reports a pain level of 7 on a scale from 0 to 10 B. A client who has left shoulder pain and S-T elevation on a 12-lead ECG C. A client who has Clostridium difficile and a temperature of 38.5° C(101.5°F) D. A client who has orthostatic hypotension and 4 pitting edema in the lower extremities

Correct Answer is B

Explanation

Rationale:

A. A client who has a complete femur fracture and reports a pain level of 7 on a scale from 0 to 10: Severe pain is significant and requires timely management, but it is not immediately life-threatening compared to acute cardiac events. Pain control should follow stabilization of critical conditions.

B. A client who has left shoulder pain and S-T elevation on a 12-lead ECG: ST-segment elevation indicates a possible acute myocardial infarction, which is a life-threatening emergency. Prompt assessment and intervention are crucial to prevent cardiac damage or death, making this the highest priority.

C. A client who has Clostridium difficile and a temperature of 38.5°C (101.5°F): Fever and infection require attention, but this client is currently stable compared with someone experiencing an acute myocardial infarction. Infection control and monitoring can follow stabilization of higher-priority emergencies.

D. A client who has orthostatic hypotension and 4+ pitting edema in the lower extremities: These findings indicate fluid imbalance and cardiovascular compromise, but they are not as immediately life-threatening as an acute STEMI. Monitoring and management should follow urgent cardiac care.

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A nurse is providing teaching to a client who has heart failure and a decreased cardiac output. Which of the following information should the nurse include in the teaching?

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