A nurse is teaching a client who has a new prescription for a transdermal nitroglycerin patch. Which of the following instructions should the nurse include?

Choice A reason: Stopping smoking is beneficial for lung health but does not directly address immediate fatigue from ineffective breathing during sleep. Elevating the head improves airway patency overnight, providing faster relief for sleep-related breathing issues, making this less effective.

Choice B reason: Running 30 minutes daily is inappropriate for an obese patient with fatigue and ineffective breathing, as it may exacerbate respiratory strain. Elevating the head during sleep directly improves oxygenation, making exercise a long-term rather than immediate solution for sleep promotion.

Choice C reason: Limiting diet to 1500 calories addresses obesity but not acute fatigue from ineffective breathing during sleep. Sleeping with pillows elevates the head, reducing airway obstruction and improving rest, making dietary changes a secondary intervention for this specific issue.

Choice D reason: Sleeping on two to three pillows is the most appropriate intervention, as it elevates the head, reducing airway collapse in obese patients with ineffective breathing. This promotes better oxygenation during sleep, alleviating fatigue, making it the most effective immediate strategy.

Choice A reason: Oxygen saturation is the priority assessment for obstructive sleep apnea, as airway obstruction causes intermittent hypoxemia during apneic episodes. Pulse oximetry provides immediate data on respiratory compromise, guiding interventions to prevent hypoxia-related complications (e.g., arrhythmias), making it the most urgent assessment in this condition.

Choice B reason: Blood pressure is relevant, as sleep apnea contributes to hypertension, but it is not the immediate priority. Oxygen saturation directly reflects acute airway obstruction’s impact on oxygenation, posing a greater immediate risk, making blood pressure a secondary assessment for long-term management.

Choice C reason: Body mass index (BMI) is a risk factor for sleep apnea due to obesity but is not an acute assessment priority. Oxygen saturation addresses immediate respiratory threats from apneic events, while BMI informs chronic management, making this less critical during active assessment.

Choice D reason: Neck circumference correlates with airway narrowing in sleep apnea but is not the priority during assessment. Oxygen saturation directly measures the physiological impact of apnea, guiding urgent interventions. Neck circumference is relevant for risk stratification, not immediate respiratory status, making it less urgent.