A nurse is assessing a client who reports nausea and vomiting for the past 24 hr. Which of the following findings should indicate to the nurse that the client is experiencing dehydration?

Choice A reason: Ambulating in the hallway 1 hour before bedtime may increase stimulation and alertness, making it harder for the client to fall asleep. While exercise is beneficial earlier in the day, late evening activity can interfere with sleep onset.

Choice B reason: Avoiding fluids before bedtime helps reduce nocturia but does not directly address difficulty falling asleep. This intervention is more appropriate for clients with frequent nighttime urination rather than insomnia.

Choice C reason: Scheduling routine care tasks during hours when the client is awake is the correct answer because it minimizes nighttime disturbances. By aligning care with the client’s natural wakefulness, the nurse promotes uninterrupted rest and supports healthy sleep hygiene. This intervention directly addresses difficulty falling asleep by reducing external interruptions.

Choice D reason: Leaving the television on at night introduces light and noise, both of which disrupt melatonin secretion and sleep quality. Television use before bed is linked to delayed sleep onset and poor sleep efficiency.

Choice A reason: Muscle weakness is a sign of hypokalemia, which can predispose the client to digoxin toxicity. Educating the client to report muscle weakness ensures early detection of electrolyte imbalance and prevents complications such as arrhythmias. This teaching is directly related to digoxin safety and is essential for client self-monitoring.

Choice B reason: Reporting weight gain is important in heart failure management, but the threshold is typically 2 pounds in a day or 5 pounds in a week, not one-half pound. A small daily fluctuation is normal and does not necessarily indicate fluid overload. Therefore, this teaching is inaccurate and could lead to unnecessary concern.

Choice C reason: Digoxin does not increase blood pressure. Its primary effects are to increase myocardial contractility (positive inotrope) and slow conduction through the AV node (negative chronotrope). Teaching the client to expect increased blood pressure would be misleading and incorrect.

Choice D reason: Not all clients prescribed digoxin require a diuretic. Diuretics may be used in heart failure to manage fluid overload, but they are not universally prescribed alongside digoxin. Furthermore, diuretics can increase the risk of hypokalemia, which complicates digoxin therapy. Therefore, this statement is inaccurate as a blanket teaching.