A nurse is assessing a client who has heart failure. Which of the following client statements should indicate to the nurse that the client needs a referral for cardiac rehabilitation?

Rationale:

A. "Keep your elbow in a flexed position." Keeping the elbow in a flexed position increases the risk of contractures, particularly in the case of upper body burns. The goal is to keep the joints extended to prevent the development of contractures.

B. "Remain in a side-lying position." A side-lying position is not ideal for preventing contractures in the upper body. The client should be positioned to minimize pressure on the burn areas and encourage joint mobility, often with the client in a supine or elevated position.

C. "Place a firm pillow under your head." Placing a firm pillow under the head might cause the neck to flex, which could lead to neck contractures. A proper head and neck alignment should be maintained to avoid such complications.

D. "Wear splints on your wrists." Wearing splints on the wrists helps to keep the joints in proper alignment and prevents contractures by maintaining wrist extension. This is an appropriate intervention for clients with upper body burns to promote healing and function.

Rationale:

A. "I have never heard of any holistic treatment that is effective." This response is dismissive. It is important for the nurse to acknowledge the client’s concerns without shutting down the discussion or disregarding the client’s preferences.

B. "Tell me what you know about chemotherapy." This response uses therapeutic communication by exploring the client’s understanding, beliefs, and concerns. It is open-ended, nonjudgmental, and promotes client education and shared decision-making. This approach helps the nurse identify misconceptions and provide appropriate information while respecting the client’s autonomy.

C. "You should ask your provider about your plan."This deflects responsibility and does not address the client’s concerns or promote understanding.

D. "The best way to treat your cancer is chemotherapy." This statement is prescriptive and does not acknowledge the client’s preferences or values. A more collaborative approach would involve discussing treatment options, risks, and benefits, while providing the client with the opportunity to make an informed decision.