A nurse is teaching a client who is at 38 weeks of gestation about a contraction stress test. Which of the following statements should the nurse include in the teaching?

Rationale:

A. Provide information about stress management.: Stress is a major trigger for vasospastic episodes in Raynaud’s disease because it increases sympathetic nervous system activity, causing further arterial constriction. Stress-reduction techniques such as deep breathing, biofeedback, or relaxation exercises helps reduce the frequency and severity of attacks.

B. Administer epinephrine for acute episodes.: Epinephrine causes vasoconstriction, which would worsen Raynaud’s symptoms by further reducing blood flow to the extremities. During an acute episode, warming the affected areas and avoiding additional vasoconstrictors is essential. Epinephrine is not indicated as a treatment and can intensify ischemic discomfort

C. Maintain a cool temperature in the client's room.: Cold temperatures are one of the most common triggers for vasospasm in Raynaud’s disease. A cool environment increase the likelihood of an episode by promoting peripheral vasoconstriction. The nurse should provide a warm environment and encourage protective clothing to maintain circulation.

D. Give a glucocorticoid steroid twice per day.: Steroids are not a standard treatment for Raynaud’s because the condition is related to vasospasm rather than inflammatory processes. Routine steroid use would expose the client to unnecessary adverse effects without addressing the underlying problem. Management strategies focus instead on warmth, lifestyle modification, and vasodilator medications when needed.

Rationale:

A. "Use an electric razor when shaving while taking this medication.": Warfarin is an anticoagulant that increases the risk of bleeding. Using an electric razor reduces the risk of cuts and subsequent bleeding, which is an important safety measure for clients on warfarin therapy.

B. "Take a dose of the medication every 5 minutes for a maximum of three doses": This instruction is inappropriate and unrelated to warfarin. Warfarin is taken orally once daily, and frequent dosing in short intervals could lead to serious bleeding complications.

C. "Avoid taking this medication with milk products.": Milk does not significantly affect warfarin absorption or activity. The client should be cautioned about foods high in vitamin K, such as leafy greens, because they can interfere with warfarin’s anticoagulant effect.

D. "This medication can cause hearing loss.": Hearing loss is not a known adverse effect of warfarin. The primary concerns are bleeding risks, bruising, and interactions with other medications or foods.