Exhibits

The nurse has provided discharge teaching to the client to manage his chest pain at home. Which 2 statements from the client should the nurse recognize as a need for further education?

A. Increase intake of insoluble fiber: In diverticulosis, the presence of small outpouchings in the colon wall is often linked to low-fiber diets. Increasing insoluble fiber promotes regular bowel movements, reduces intraluminal pressure, and prevents stool from stagnating in diverticula, thereby decreasing the risk of inflammation or diverticulitis.

B. Eliminate caffeine and chocolate: These substances are more commonly associated with exacerbating symptoms of irritable bowel syndrome (IBS) or gastroesophageal reflux disease (GERD), not typically diverticulosis.

C. Decrease foods high in fat or trans fats: Although limiting unhealthy fats is good for overall health, it is not the primary dietary focus in managing diverticulosis. Fiber intake plays a much more direct role in supporting colon health and preventing complications in these clients.

D. Augment intake of dairy products: Dairy is not contraindicated in diverticulosis, but it is also not specifically beneficial unless addressing a separate nutritional need such as calcium deficiency. Increasing dairy does not impact colonic transit or diverticular disease directly.

• A. I will wear a medication alert bracelet to indicate my history of heart problems: This is an appropriate safety measure. Medical alert bracelets provide critical information in emergencies, ensuring first responders and healthcare providers are aware of the client’s cardiac history if he is unable to communicate.
• B. I will lie down or sit if I start to feel any chest discomfort: Sitting or lying down conserves energy and reduces myocardial oxygen demand during episodes of chest pain. This position also reduces fall risk if the client experiences hypotension after taking nitroglycerin.
• C. I will take the nitroglycerin 1 or 2 more times 10 minutes apart if pain does not get better: The correct guideline is to take nitroglycerin at 5-minute intervals, up to three doses total. Waiting 10 minutes between doses delays treatment and may worsen outcomes during acute coronary syndrome.
• D. I will call 911 if there is no improvement in my chest pain after taking nitroglycerin: This is correct. If chest pain persists after the first dose of nitroglycerin, emergency services should be contacted immediately to prevent delays in treating a possible myocardial infarction.
• E. I will chew my nitroglycerin tabs as soon as pain begins: Sublingual nitroglycerin tablets should not be chewed or swallowed, as this bypasses the intended absorption route under the tongue. Chewing reduces efficacy and delays relief during angina episodes.
• F. I will keep my nitroglycerin tablets with me all the time: Carrying nitroglycerin at all times is essential for clients with angina or cardiac risk. Immediate access allows for early treatment at the onset of symptoms, reducing the risk of progression to infarction.
• G. I will wait 5 minutes after taking my nitroglycerin to see if the pain improves: This statement aligns with current recommendations. Clients should assess for symptom relief within 5 minutes of taking the first dose before deciding to take additional doses or call emergency services.