A nurse is teaching a client who has heart failure about self-management techniques. Which of the following statements by the client indicates an understanding of the teaching?

"I will take ibuprofen for mild pain."

"I will weigh myself every other day."

"I will keep an exercise diary."

"I will expect swelling in my feet and ankles."

Answer and Explanation

The Correct Answer is C

A. "I will take ibuprofen for mild pain": NSAIDs like ibuprofen can lead to sodium and fluid retention, which can exacerbate heart failure by increasing preload and worsening edema. They can also reduce the effectiveness of diuretics and ACE inhibitors, both of which are commonly used in heart failure management. Acetaminophen is generally preferred for pain relief as it does not contribute to fluid retention.

B. "I will weigh myself every other day": Daily weight monitoring is essential for detecting fluid retention early, as a sudden increase of 2–3 pounds in 24 hours or 5 pounds in a week can indicate worsening heart failure. Weighing every other day may delay the recognition of fluid overload, increasing the risk of complications such as pulmonary congestion and hospitalization.

C. "I will keep an exercise diary": Regularly tracking physical activity helps assess functional status and detect any decline in exercise tolerance, which could indicate worsening heart failure. An exercise diary allows the healthcare team to adjust activity levels appropriately, ensuring that the client remains active without overexertion. This approach also promotes adherence to a safe and structured exercise regimen, improving overall cardiovascular health.

D. "I will expect swelling in my feet and ankles": While mild peripheral edema can occur, it should never be considered normal in heart failure management. Swelling in the lower extremities suggests worsening fluid retention and should be promptly reported to the healthcare provider. Early intervention, such as medication adjustments or dietary modifications, can help prevent further decompensation and reduce the risk of hospitalization.

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Correct Answer is B

Explanation

A. A client who has aspiration pneumonia: Pneumonia leads to hypoventilation and carbon dioxide retention, which causes respiratory acidosis. It does not typically result in metabolic alkalosis since it affects gas exchange rather than acid-base balance at the metabolic level.

B. A client who is receiving continuous gastric suctioning: Prolonged removal of gastric secretions depletes hydrochloric acid, leading to an excess of bicarbonate in the blood and resulting in metabolic alkalosis. This is a common cause of alkalosis, along with excessive vomiting or diuretic use.

C. A client who is experiencing an opioid overdose: Opioids depress the respiratory system, reducing ventilation and causing carbon dioxide buildup, leading to respiratory acidosis. This does not cause metabolic alkalosis, as the issue originates in the lungs, not metabolism.

D. A client who has uncontrolled diabetes mellitus: Diabetic ketoacidosis results in excessive production of acidic ketone bodies, which lower blood pH and cause metabolic acidosis. The acid-base disturbance in diabetes is typically acidosis, not alkalosis.

A. Palpate the dorsalis pedis pulse. B. Maintain the affected extremity in a dependent position. C. Wrap sterile gauze on the sharp point of the pins. D. Adjust the clamps on the fixator frame.

Correct Answer is A

Explanation

A. Palpate the dorsalis pedis pulse: Assessing distal pulses ensures adequate circulation to the affected extremity. Impaired blood flow can indicate compartment syndrome or vascular compromise, which are serious complications following fracture stabilization. The nurse should also monitor capillary refill, skin temperature, and sensation.

B. Maintain the affected extremity in a dependent position: Keeping the extremity in a dependent position can increase swelling and venous congestion, leading to complications such as compartment syndrome. Elevation is recommended to minimize edema and promote venous return.

C. Wrap sterile gauze on the sharp point of the pins: The pin sites should be left uncovered to allow for proper monitoring of signs of infection or loosening. Instead, pin site care should be performed per facility protocol to reduce infection risk.

D. Adjust the clamps on the fixator frame: Adjusting the external fixator clamps is outside the nurse's scope of practice. Any modifications to the device should be performed by the orthopedic provider to prevent improper alignment and complications.

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A nurse is teaching a client who has heart failure about self-management techniques. Which of the following statements by the client indicates an understanding of the teaching?

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