A nurse is reinforcing discharge teaching with a client who has heart failure. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)
Alternate activity and rest.
Reduce sodium intake to 2 g per day.
Consume a low-fiber diet.
Gradually increase activity each day.
Eat small, frequent meals each day.
Correct Answer : A,B,D,E
A. Alternate activity and rest. Clients with heart failure should balance activity and rest to prevent overexertion and minimize cardiac workload. Frequent rest periods help conserve energy and reduce symptoms such as dyspnea and fatigue.
B. Reduce sodium intake to 2 g per day. Limiting sodium intake helps prevent fluid retention and reduces the risk of worsening heart failure. Excess sodium contributes to increased blood volume and exacerbates symptoms such as edema and shortness of breath.
C. Consume a low-fiber diet. A low-fiber diet is not necessary for heart failure management. Adequate fiber intake is beneficial for preventing constipation, which can increase strain during bowel movements and lead to hemodynamic stress. A high-fiber diet is generally encouraged.
D. Gradually increase activity each day. Clients should slowly increase their activity level based on tolerance to improve cardiovascular function. Overexertion should be avoided, but regular, controlled exercise helps maintain mobility and enhance overall heart health.
E. Eat small, frequent meals each day. Eating smaller meals reduces gastric distension and minimizes pressure on the diaphragm, which can help alleviate shortness of breath. Large meals can increase metabolic demands and contribute to discomfort in clients with heart failure.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. "Turn on fans in the facility to circulate air." Fans should not be turned on during a chemical disaster because they can spread contaminants throughout the facility, increasing exposure to toxic substances.
B. "Open the fireplace dampers in the day room." Opening fireplace dampers can allow contaminated air to enter the facility, increasing the risk of exposure. Sealing off potential entry points for hazardous chemicals is a priority in these situations.
C. "Cover the electrical outlets with wet towels." While sealing gaps and vents can help reduce chemical exposure, using wet towels over electrical outlets is not an effective protective measure. Instead, doors, windows, and ventilation systems should be sealed as much as possible to prevent outside air from entering.
D. "Move clients to a room above ground with few windows." In an external chemical disaster, sheltering in place is essential. A room above ground is preferable because many chemicals are heavier than air and can accumulate in lower levels. Selecting a space with few windows helps minimize exposure by reducing potential entry points for contaminants.
Correct Answer is D
Explanation
A. "I should enable the airbag when my baby is in the front seat of the car." Airbags deploy with significant force and can cause severe injury or fatal trauma to an infant in a car seat, especially if placed in the front seat. The safest position for an infant is in the back seat, rear-facing, as this provides the best protection in the event of a crash. If the front seat must be used, the airbag should be deactivated to prevent impact injuries.
B. "I should position the car seat's retainer clip at the level of my baby's belly button." The car seat’s retainer clip should be positioned at armpit level to properly secure the harness and keep the baby restrained during a collision. If the clip is placed too low, such as at the belly button, the harness straps may not fit snugly around the shoulders, increasing the risk of the baby slipping out of the seat upon impact.
C. "I should place my baby in the car seat at a 90-degree angle." A 90-degree angle is too upright for a newborn and can lead to airway obstruction due to the infant's weak neck muscles and large head size. The car seat should be reclined at approximately 45 degrees to maintain an open airway and prevent the baby’s head from falling forward, which could restrict breathing and cause positional asphyxia.
D. "I should keep my baby rear-facing in the car seat until she is 2 years old." Rear-facing car seats provide optimal protection by supporting the baby’s head, neck, and spine in the event of a crash, reducing the risk of serious injury. The American Academy of Pediatrics recommends keeping infants in a rear-facing position until at least the age of 2 or until they exceed the car seat's height and weight limits. This positioning distributes crash forces more evenly across the child's body, minimizing the risk of spinal cord and head injuries.
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