A client is discharged to home after a radical mastectomy with two drainage tubes. Which statement by the client would indicate that further teaching is required?

A. Lower the head of the client’s bed in Trendelenburg position: Placing the client in Trendelenburg can increase venous return and worsen pulmonary congestion in someone with elevated CVP and PAWP, making this unsafe.

B. Document CVP and continue to monitor: While ongoing monitoring is important, it does not address the client’s acute fluid overload and heart failure exacerbation. Immediate intervention is needed.

C. Increase IV fluid infusion per protocol: The client already shows signs of volume overload (CVP 18 mmHg, PAWP 21 mmHg, low ejection fraction, and high BNP). Increasing fluids would exacerbate pulmonary congestion and worsen hypoxia.

D. Administer IV diuretic medication: The client’s elevated CVP, PAWP, and BNP, along with low SpO₂ and signs of fluid overload, indicate acute decompensated heart failure. Administering a diuretic is the priority to reduce preload, relieve pulmonary congestion, and improve oxygenation.

A. Client with a pulse of 118 beats/min: Mild tachycardia is common postoperatively due to pain, anxiety, or hypovolemia. While it requires monitoring, it is not immediately life-threatening.

B. Client with a blood pressure of 90/50 mm Hg: Hypotension warrants assessment and monitoring, as it may indicate fluid loss or bleeding, but it is less immediately critical than severe respiratory depression.

C. Client with a temperature of 96 F (35.6 C): Mild hypothermia is expected after anesthesia and can be managed with warming measures. It is not an immediate threat to airway or life.

D. Client with a respiratory rate of 6 breaths/min: A respiratory rate this low indicates severe respiratory depression, which can rapidly lead to hypoxia and cardiac arrest. Ensuring airway patency and providing ventilation support takes priority over other vital sign abnormalities.