A nurse is providing discharge teaching to an older adult client following a left total hip arthroplasty. Which of the following instructions should the nurse include in the teaching?

• Decrease the client’s oxygen to 1 L/min via nasal cannula: The client’s oxygen saturation has decreased to 90% on 2 L/min, indicating hypoxemia. Reducing oxygen flow could worsen tissue hypoxia and increase the risk of organ dysfunction. Oxygen therapy should be maintained or adjusted to achieve adequate saturation, not reduced without medical indication.

• Hold the client’s metoprolol: Metoprolol is a beta-blocker essential for rate control in atrial fibrillation and for improving heart failure outcomes. Holding the medication could worsen tachycardia, reduce cardiac output, and exacerbate heart failure symptoms. Continuation is necessary unless contraindications such as severe bradycardia or hypotension develop.

• Restrict the client’s fluid intake to 2 L per day: The client’s weight has increased by 1.8 kg (4 lb) in one day, indicating fluid retention due to worsening heart failure. Limiting fluid intake helps reduce preload and manage edema. Fluid restriction is a standard intervention in acute decompensated heart failure to prevent further fluid overload and pulmonary congestion.

• Weigh the client daily: Daily weights are critical for monitoring fluid status in clients with heart failure. Rapid weight gain signals worsening fluid retention, guiding diuretic adjustments and other interventions. This allows early detection of exacerbations and reduces the risk of hospitalization.

• Increase the dosage of furosemide: The client exhibits signs of fluid overload: weight gain, decreased oxygen saturation, elevated BNP, and atrial fibrillation. Increasing the loop diuretic helps remove excess fluid, reduce pulmonary congestion, and improve oxygenation. Adjustments must be guided by the client’s renal function, electrolytes, and blood pressure.

• Begin a 24-hour urine collection for the client: A 24-hour urine collection is not immediately necessary for acute fluid management in heart failure. While it may provide data on kidney function, daily weights, intake/output monitoring, and electrolytes are more practical for assessing volume status and guiding treatment in this context.

A. "The best way to treat your cancer is chemotherapy.": This response is directive and does not explore the client’s perspective or provide an opportunity for discussion. It may make the client feel dismissed and does not promote therapeutic communication or informed decision-making.

B. “I have never heard of any holistic treatment that is effective”: This statement invalidates the client’s preference and can damage trust. It focuses on the nurse’s opinion rather than understanding the client’s beliefs, limiting collaborative care and shared decision-making.

C. "Tell me what you know about chemotherapy.": This response encourages the client to share their knowledge and concerns, allowing the nurse to clarify misconceptions and provide education. It fosters an open, therapeutic dialogue and helps the client make an informed choice about treatment options.

D. "You should ask your provider about your plan.": While consulting the provider is important, this response shifts responsibility away from the nurse and does not address the client’s concerns directly. It misses the opportunity to assess understanding and provide immediate support or education.