A nurse is providing postoperative teaching to a client who had a coronary artery bypass graft due to arteriosclerosis. Which of the information should the nurse include in the teaching regarding exercise?

"If you experience angina, take a 10-minute rest period, then resume exercise."

"Stop exercising if your heart rate increases by 20 beats per minute from baseline."

"Limit your exercise to an indoor facility to avoid exposure to the sun."

"Begin by walking half a mile two times a day for the first week."

Answer and Explanation

The Correct Answer is D

A) "If you experience angina, take a 10-minute rest period, then resume exercise."
It's important for clients to stop exercising immediately and consult a healthcare provider if they experience angina during exercise. Resting and then resuming exercise can be unsafe without medical advice, as angina indicates insufficient blood flow to the heart.

B) "Stop exercising if your heart rate increases by 20 beats per minute from baseline."
An increase in heart rate during exercise is expected, and stopping at a 20 BPM increase may be overly cautious. Clients should be taught to monitor for excessive fatigue or symptoms like dizziness, but a 20 BPM increase alone isn't necessarily a concern.

C) "Limit your exercise to an indoor facility to avoid exposure to the sun."
While excessive sun exposure can be a concern for some individuals, limiting exercise to indoors is unnecessary unless there are specific contraindications. Clients should be encouraged to exercise in environments they enjoy, with appropriate sun protection if outdoors.

D) "Begin by walking half a mile two times a day for the first week."
This recommendation is a reasonable starting point for postoperative exercise. Walking is a low-impact exercise that can help improve cardiovascular health gradually. Clients should gradually increase their activity level based on their tolerance and healthcare provider's advice.

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Correct Answer is A

Explanation

A) "I'll use pursed-lip breathing when I feel short of breath.": Pursed-lip breathing is a beneficial technique for clients with COPD as it helps keep the airways open longer, reduces the work of breathing, and improves ventilation. This statement indicates the client understands a key management strategy for COPD.

B) "I'll skip my exercises for the week if I feel short of breath.": Regular exercise is important for managing COPD, and while adjustments may be necessary when symptoms are severe, completely skipping exercise can lead to deconditioning and worsening of symptoms. This statement does not reflect appropriate management of COPD.

C) "I will use my inhaler 30 minutes after each meal.": Inhalers should be used as prescribed, usually before activities that might trigger symptoms, such as eating, rather than on a fixed schedule unrelated to symptoms or physician's guidance. This statement indicates a misunderstanding of inhaler use.

D) "I will limit myself to drinking only 1 quart of water each day.": Staying hydrated is important for thinning mucus in COPD. Unless there are specific medical reasons to restrict fluids, such as heart failure, limiting water intake could lead to dehydration and thickened mucus, making breathing more difficult. This statement is not appropriate for managing COPD.

A. Double-bag the client's trash before removing it from the room. B. Place the client in a negative air pressure room with 6 to 12 air exchanges per hour. C. Ensure all air in the client's room is filtered through a HEPA filter. D. Wear a surgical mask when within 1 m (3 ft) of the client.

Correct Answer is D

Explanation

A) Double-bag the client's trash before removing it from the room: Double-bagging trash is typically recommended for patients with highly contagious and severe infectious diseases, such as those requiring contact precautions. Influenza, while contagious, does not necessitate this level of precaution.

B) Place the client in a negative air pressure room with 6 to 12 air exchanges per hour: Negative air pressure rooms are used for airborne diseases like tuberculosis or measles, which can spread through the air over long distances. Influenza primarily spreads through respiratory droplets, so this precaution is not necessary.

C) Ensure all air in the client's room is filtered through a HEPA filter: HEPA filters are used for airborne pathogens to filter out infectious particles. Since influenza spreads via respiratory droplets rather than airborne particles, this level of air filtration is not required.

D) Wear a surgical mask when within 1 m (3 ft) of the client: Influenza spreads through respiratory droplets, which can travel up to about 1 meter (3 feet) when a person coughs or sneezes. Wearing a surgical mask within this distance helps prevent inhalation of these droplets, making it the appropriate precaution for influenza.

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A nurse is providing postoperative teaching to a client who had a coronary artery bypass graft due to arteriosclerosis. Which of the information should the nurse include in the teaching regarding exercise?

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