The nurse, who is caring for a client diagnosed with coronary artery disease, prioritizes the problem of impaired tissue perfusion in the plan of care. Which outcome would be most appropriate? The client will:

Choice A reason: Placing the patch on the anterior chest is not the best discharge instruction for this client. Clonidine is a drug that lowers blood pressure by stimulating alpha-2 receptors in the brain. ¹ The patch delivers the drug through the skin and into the bloodstream. ² The patch should be applied to a hairless area on the upper arm or torso, not the chest, to ensure proper absorption and avoid irritation. ³

Choice B reason: Removing the patch if a headache develops is not a good discharge instruction for this client. Headache is a common side effect of clonidine, especially when starting or changing the dose. ² Removing the patch abruptly may cause a rebound increase in blood pressure, which can be dangerous. ³ The client should keep the patch on for 7 days, unless instructed otherwise by the provider, and report any severe or persistent headaches.

Choice C reason: Rotating the application sites and inspecting the skin is the best discharge instruction for this client. Rotating the sites helps prevent skin irritation and allergic reactions from the patch. ³ Inspecting the skin helps detect any signs of infection, inflammation, or rash that may require medical attention. The client should also wash the old site with soap and water after removing the patch. ²

Choice D reason: Monitoring weight on a daily basis is not a necessary discharge instruction for this client. Weight is not a sensitive indicator of the effectiveness or safety of clonidine therapy. Weight may be monitored periodically to assess the client's fluid status and possible signs of heart failure, which clonidine can help prevent. ¹ However, this is not a priority action for the client using the patch.

Choice A reason: It is not the best intervention to exclude the family from the exercise program. Family involvement can provide support, motivation, and accountability for the client. Family members can also participate in the exercise program and benefit from its positive effects on blood pressure and overall health.

Choice B reason: This is the best intervention to help the client maintain the exercise program. Adapting the program to the client's needs and abilities ensures that the exercise is appropriate, safe, and effective for the client. It also increases the client's confidence, satisfaction, and adherence to the program.

Choice C reason: Providing the client with specific details of how to perform the exercises is an important intervention, but not the best one. The client may still have difficulties or barriers to maintaining the exercise program, such as lack of time, resources, or motivation. The nurse should also assess the client's readiness, preferences, and goals for the exercise program.

Choice D reason: Reassuring the client that they will be able to do the exercise program is a supportive intervention, but not the best one. The client may not feel reassured if the exercise program is too challenging, unrealistic, or unappealing for them. The nurse should also monitor the client's progress, feedback, and outcomes of the exercise program.