A nurse is providing teaching to a client who has gastritis. Which of the following instructions should the nurse include in the teaching?

A. Crackles in the lungs: Pulmonary edema causes fluid accumulation in the alveoli, leading to crackles or rales heard during auscultation of the lungs.
B. Jugular vein distension: Increased pressure in the pulmonary circulation can lead to right-sided heart strain, resulting in visible jugular venous distension.
C. Persistent, dry cough: Cough in pulmonary edema is typically productive, often associated with pink, frothy sputum due to fluid leakage into the alveoli.
D. Frothy, blood-tinged sputum: A hallmark sign of pulmonary edema, this occurs as fluid mixed with blood leaks into the alveoli and airways due to high pulmonary capillary pressure.
E. Bradycardia: Pulmonary edema is typically associated with tachycardia as a compensatory response to hypoxia and impaired cardiac output, not bradycardia.

• Minimize environmental stimuli for the client: This is appropriate because clients experiencing acute mania are highly distractible and overstimulated. A low-stimulation environment helps reduce agitation and promotes safety.
• Weigh the client each day: Daily weights are necessary as manic clients often exhibit decreased nutritional intake and increased physical activity, placing them at risk for weight loss and dehydration.
• Provide the client with high-calorie fluids every hour: Frequent intake of calorie-dense fluids supports the client’s nutritional needs without requiring prolonged focus or interruption of hyperactive behavior.

• Encourage the client to avoid napping during the day: This is contraindicated because rest is crucial during manic episodes. Encouraging naps supports mood stabilization and prevents exacerbation of manic symptoms due to sleep deprivation.