The nurse is providing discharge education to a client diagnosed with heart failure. What should the nurse teach this client to do to assess fluid balance in the home setting?

A. "I have a difficult time falling asleep at night":

Difficulty falling asleep at night is not typically a direct symptom of iron-deficiency anemia. While anemia can lead to fatigue and general tiredness, which might affect sleep quality, insomnia or difficulty falling asleep may have various causes unrelated to anemia. These causes can include stress, anxiety, poor sleep hygiene, or other underlying medical conditions.

B. "I have an increase in my appetite":

This choice is not directly related to iron-deficiency anemia. While some individuals with anemia may experience changes in appetite, such as increased hunger, this symptom is not specific to iron-deficiency anemia alone. An increase in appetite can have various causes, including hormonal changes, dietary changes, medications, or psychological factors.

C. "I have difficulty breathing when walking 30 feet":

This choice is the correct answer. Difficulty breathing, especially during exertion like walking, is a hallmark symptom of iron-deficiency anemia. Anemia reduces the oxygen-carrying capacity of the blood, leading to inadequate oxygen delivery to tissues, which can result in shortness of breath, fatigue, and difficulty with physical activities.

D. "I feel hot all of the time":

Feeling hot all the time is not a specific symptom of iron-deficiency anemia. While anemia can cause symptoms such as fatigue, weakness, pale skin, and shortness of breath, it does not directly lead to a constant feeling of heat or warmth throughout the body. Feeling hot or experiencing excessive sweating could be due to other factors such as hormonal changes, fever, hyperthyroidism, or environmental conditions.

A. This result indicates muscle injury but does not specify the source.

This statement is partly correct. An elevated troponin I level does indicate muscle injury, specifically damage to the heart muscle. However, troponin I is highly specific to cardiac muscle, so an elevated level would indeed specify the source as cardiac or myocardial injury.

B. Because the client has a history of unstable angina, this is a poor indicator of myocardial injury.

This statement is incorrect. A history of unstable angina does not diminish the significance of an elevated troponin I level. In fact, unstable angina is itself a serious condition that can lead to myocardial injury or heart attack, and an elevated troponin I level in this context indicates ongoing or recent myocardial damage.

C. This is only an accurate indicator of myocardial damage when it reaches its peak in 24 hours.

This statement is not entirely accurate. While it is true that troponin I levels may continue to rise and peak within 12-24 hours after the onset of myocardial injury, an elevated troponin I level at any point is still a significant indicator of myocardial damage. It's essential to recognize elevated troponin I levels promptly to initiate appropriate interventions and monitor the client's cardiac status closely.

D. This is an accurate indicator of myocardial injury.

This statement is correct. An elevated troponin I level is a highly sensitive and specific marker of myocardial injury. It indicates damage to the heart muscle, which can occur due to conditions like unstable angina, heart attack (myocardial infarction), myocarditis, or other cardiac issues. Therefore, recognizing an elevated troponin I level in a client with unstable angina is crucial for proper management and further evaluation.