A nurse is teaching a client about foods and beverages that can cause diarrhea. Which of the following should the nurse include in the teaching?

Choice A reason: Utilize supine positioning to maximize chest expansion is not an important intervention for clients with a BMI greater than or equal to 30. Supine positioning is when the client lies flat on their back. This position can actually impair chest expansion and breathing for clients with a high BMI, as the weight of the abdomen and chest can compress the lungs and diaphragm. A semi-Fowler's position, where the head of the bed is elevated at 30 to 45 degrees, is preferred for these clients, as it reduces the pressure on the chest and improves ventilation.

Choice B reason: Use an appropriately sized blood pressure cuff is an important intervention for clients with a BMI greater than or equal to 30. A blood pressure cuff that is too small or too tight can cause inaccurate readings and increase the risk of injury to the client. A blood pressure cuff that is too large or too loose can also cause inaccurate readings and compromise the quality of care. A blood pressure cuff that fits the client's arm circumference and width is essential for obtaining accurate and reliable measurements and preventing complications.

Choice C reason: Consult a nutritionist because the client is malnourished/underweight is not an important intervention for clients with a BMI greater than or equal to 30. A BMI greater than or equal to 30 indicates that the client is obese, not malnourished or underweight. Obesity is a condition where the client has excess body fat that can affect their health and well-being. Malnutrition is a condition where the client has inadequate or imbalanced intake of nutrients that can affect their growth and development. Underweight is a condition where the client has a low body weight that can affect their immunity and energy. A nutritionist can help clients with any of these conditions, but the statement is incorrect for clients with a high BMI.

Choice D reason: Place the client on fall precautions because of increased risk for falls due to frail bones is not an important intervention for clients with a BMI greater than or equal to 30. Frail bones are not a common consequence of obesity, but rather of osteoporosis, a condition where the bones become weak and brittle. Obesity can actually increase the bone density and strength, as the bones have to support more weight. However, obesity can increase the risk for falls due to other factors, such as impaired mobility, balance, or coordination. Fall precautions are important for any client who is at risk for falls, but the statement is inaccurate for clients with a high BMI.

Choice A reason: The client will be able to return to work is not a SMART goal. SMART stands for Specific, Measurable, Achievable, Relevant, and Time-bound. This goal is not specific, as it does not state what kind of work the client will do, or how the client's back pain will affect their work performance. It is also not measurable, as it does not state how the client's work ability will be assessed. It may not be achievable, as the client's work-related injury may prevent them from returning to their previous occupation. It may not be relevant, as the client may have other priorities or preferences than work. It is also not time-bound, as it does not state when the client will return to work.

Choice B reason: The client will verbalize diminished pain at the conclusion of physical therapy is not a SMART goal. This goal is not specific, as it does not state how much pain the client will experience, or what level of pain is acceptable for the client. It is also not measurable, as it relies on the client's subjective report of pain, which may vary depending on the client's mood, expectations, or coping skills. It may not be achievable, as the client's chronic back pain may not be fully resolved by physical therapy. It may not be relevant, as the client may have other outcomes or indicators of improvement than pain. It is also not time-bound, as it does not state how long the physical therapy will last, or when the client will verbalize their pain level.

Choice C reason: The client will be able to perform self-care is not a SMART goal. This goal is not specific, as it does not state what aspects of self-care the client will perform, or how the client's back pain will affect their self-care abilities. It is also not measurable, as it does not state how the client's self-care performance will be evaluated. It may not be achievable, as the client's chronic back pain may limit their range of motion, strength, or endurance for self-care tasks. It may not be relevant, as the client may have other goals or needs than self-care. It is also not time-bound, as it does not state when the client will achieve this goal.

Choice D reason: The client will engage in desired activities without the pain level increasing above a pain scale level of 3 out of 10 within one month is a SMART goal. This goal is specific, as it states what activities the client wants to do, and how the client's pain level will be monitored. It is measurable, as it uses a numeric pain scale that can be easily recorded and compared. It is achievable, as it sets a realistic and attainable pain threshold that allows the client to enjoy their activities. It is relevant, as it reflects the client's personal interests and values, and enhances their quality of life. It is time-bound, as it states a clear and reasonable deadline for achieving this goal.