A nurse is planning discharge for a client diagnosed with heart failure. Which of the following discharge instructions should the nurse provide to improve activity intolerance?

Avoid all physical and emotional stress

Alternate active periods with rest periods

Gradually work up to strenuous activity

Include isometric exercises in the daily routine

Answer and Explanation

The Correct Answer is B

A. Avoid all physical and emotional stress: Completely avoiding activity is not recommended for heart failure patients, as physical deconditioning can worsen fatigue and functional capacity. Total inactivity may lead to muscle atrophy and decreased cardiac efficiency, which can further reduce activity tolerance.

B. Alternate active periods with rest periods: Balancing activity with scheduled rest periods helps patients conserve energy and prevent overexertion, which is critical for managing fatigue associated with heart failure. This approach allows gradual improvement in functional capacity while minimizing symptoms like dyspnea and palpitations.

C. Gradually work up to strenuous activity: Strenuous activity is not appropriate for most patients with heart failure, especially without medical clearance or structured cardiac rehabilitation. Overexertion can precipitate worsening heart failure symptoms or acute decompensation.

D. Include isometric exercises in the daily routine: Isometric exercises involve sustained muscle contraction and can increase afterload, potentially worsening cardiac workload in heart failure patients. Aerobic or light isotonic activities are safer and more effective for improving endurance and activity tolerance.

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Correct Answer is D

Explanation

A. Systolic blood pressure increase of 10 mm Hg at completion of ambulation: A mild increase in systolic blood pressure during physical activity is an expected physiological response. This level of change is within acceptable limits and does not contraindicate progression in cardiac rehabilitation.

B. Heart rate increase of 10 beats/min at completion of ambulation: A slight increase in heart rate with activity is normal as the cardiovascular system meets the body’s increased oxygen demand. Such minimal changes do not indicate intolerance to activity or risk during rehabilitation.

C. Respiratory rate of 20 during ambulation: A respiratory rate of 20 breaths per minute is within normal limits for an adult at rest or during light activity. This finding does not suggest respiratory compromise and does not preclude advancement in rehabilitation.

D. New onset of chest pain 8/10 during ambulation: The sudden development of severe chest pain during activity is a warning sign of myocardial ischemia or reinfarction. Progression in rehabilitation should be halted immediately, and the patient requires urgent assessment and intervention before any further ambulation is attempted.

A. Reinsert the tube into the chest tube insertion site B. Insert the end of the chest tube in a container of sterile water C. Auscultate the lung sounds in bilateral lung fields D. Apply a sterile dressing to the chest tube insertion site

Correct Answer is D

Explanation

A. Reinsert the tube into the chest tube insertion site: Reinserting a chest tube that has become dislodged is outside the scope of nursing practice and risks introducing infection and causing further trauma. Re-insertion must be performed by a qualified provider using sterile technique under appropriate conditions.

B. Insert the end of the chest tube in a container of sterile water: Placing the end of a dislodged chest tube into sterile water is appropriate only if the tube has disconnected from the drainage system but remains in the patient’s chest. In this scenario, the tube is lying on the floor, indicating it has been removed from the patient, so this action is not appropriate.

C. Auscultate the lung sounds in bilateral lung fields: Assessing lung sounds is important, but it is not the first priority. When a chest tube becomes dislodged from the patient, there is an immediate risk of air entering the pleural space and causing a tension pneumothorax. The insertion site must be addressed before further assessment.

D. Apply a sterile dressing to the chest tube insertion site: The priority is to immediately cover the insertion site with a sterile occlusive dressing (often taped on three sides) to prevent air from entering the pleural cavity and causing a life-threatening tension pneumothorax. This intervention directly addresses the most immediate physiological threat.

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A nurse is planning discharge for a client diagnosed with heart failure. Which of the following discharge instructions should the nurse provide to improve activity intolerance?

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