An unlicensed assistive personnel (UAP) obtains a urine specimen and places the labeled specimen cup in a sealed plastic bag. Which instruction should the practical nurse (PN) provide the UAP?

Rationale:
A. This option is correct because the prongs of the nasal cannula are inserted into the nostrils. Continuous contact and friction can cause irritation, redness, or even minor skin breakdown. Inspecting around the nostrils ensures early identification of pressure-related injury and allows the PN to implement interventions such as repositioning or padding.

B. This option is correct because the tubing of the cannula rests on the bridge of the nose. Pressure in this area can lead to redness, skin breakdown, or ulceration, especially in clients requiring long-term oxygen therapy. Regular assessment and use of protective barriers (like foam pads) can prevent injury.

C. This option is correct because the cannula tubing loops over the tops of the ears. Prolonged pressure can cause discomfort, redness, or skin breakdown, particularly in clients with thin or sensitive skin. Checking this area allows the PN to reposition the tubing, provide padding, or use alternative securing devices.

D. This option is correct because the cannula tubing rests along the cheeks and can rub against the skin, causing pressure or irritation. Assessment of the cheeks helps prevent skin breakdown and ensures proper cannula placement for effective oxygen delivery.

E. This option is incorrect because the nasal cannula does not contact the forehead. Pressure injuries or irritation in this area would be unrelated to nasal cannula use. Focusing on areas of direct contact (nostrils, bridge of the nose, ears, and cheeks) is essential for preventing device-related skin injury.

Rationale for correct choices:
• decrease caloric intake: The client’s estimated energy requirement (EER) is calculated as REE × physical activity coefficient = 1,335 × 1.12 ≈ 1,495 kcal/day. Her average caloric intake from the dietary history is higher than this, ranging from 1,510 to 1,880 kcal/day, which exceeds her energy needs. Reducing caloric intake will help create a caloric deficit to support weight loss.

• increase the intensity of exercise: Increasing exercise intensity will raise total energy expenditure, contributing to a negative energy balance necessary for weight loss while maintaining lean body mass. Combining dietary changes with increased activity is more effective than diet alone.

Rationale for incorrect choices:
• start weight training: While beneficial for muscle mass, this alone does not address energy balance sufficiently for weight loss.
• eliminate carbohydrates: Completely removing carbohydrates is not necessary and can lead to nutrient deficiencies; moderate intake is preferred.
• eat more frequent meals: Frequency of meals does not directly reduce total caloric intake; the focus should be on total calories consumed versus expended.
• decrease the frequency of exercise: This would reduce energy expenditure, counterproductive to weight loss goals.