Which of the following should the nurse include in her teaching plan to address home safety for an older adult client? (Select all that apply.)

A) XI: Cranial nerve XI, the spinal accessory nerve, is primarily responsible for motor function, particularly in the muscles involved in shoulder elevation and head rotation. It does not play a role in balance, so focusing on this nerve would not be relevant to the client’s complaint of balance issues.
B) VIII: Cranial nerve VIII, the vestibulocochlear nerve, is directly involved in hearing and balance. It transmits information from the inner ear to the brain regarding head position and motion, which are essential for maintaining balance. The client’s report of spontaneous loss of balance strongly suggests involvement of this nerve, making it the most appropriate focus for additional assessment.
C) IX: Cranial nerve IX, the glossopharyngeal nerve, is primarily associated with taste and the gag reflex. While it is important for swallowing and certain aspects of speech, it does not influence balance, so it would not be the primary concern in this situation.
D) X: Cranial nerve X, the vagus nerve, has extensive functions related to autonomic control of the heart, lungs, and digestive tract, as well as motor and sensory functions in the throat. Although it plays a significant role in the body, it does not directly influence balance, making it less relevant in this context.

A) Instruct the patient on Tripod positioning: Tripod positioning, where the patient leans forward with hands on their knees or a table, is beneficial for COPD patients. It helps improve ventilation by allowing the diaphragm to work more efficiently and aiding in the expansion of the lungs. This position also utilizes accessory muscles, which can help ease breathing and reduce the work of respiration.
B) Restrict the client's fluid intake to less than 2 L/day: Restricting fluid intake is generally not advisable for COPD patients unless there is a specific condition such as severe heart failure where fluid restriction is necessary. Adequate fluid intake helps to thin mucus, making it easier to expectorate and thus supports better lung function and overall respiratory health.
C) Provide the client with a low-protein diet: COPD patients typically require a higher-protein diet to maintain muscle mass and strength, which are crucial for overall health and respiratory function. A low-protein diet can lead to muscle wasting, including the respiratory muscles, which can worsen respiratory symptoms and functional status.
D) Have the client use the early-morning hours for exercise and activity: While regular exercise is important, the timing should be based on the client's individual preferences and tolerance. For some patients, early morning might not be the best time due to morning symptoms or fatigue. The exercise plan should be customized to fit the patient’s daily routine and energy levels.