Exhibits

The practical nurse (PN) calls the healthcare provider to notify them that the heart rate is too low to administer the digoxin.

Place the nurse statements in Situation, Background, Assessment, Recommendation (SBAR) format. Each column must have at only one answer selected.

A. Assist the client to perform active range of motion and back exercises: Active exercises can be beneficial in rehabilitation phases but may worsen pain if done too early or without proper pain control. Immediate strategies should focus on comfort and supporting medication effectiveness before promoting activity.
B. Force fluids and progress diet to include milk products: While hydration and nutrition are important for overall health, they do not directly enhance the immediate effectiveness of analgesics. This intervention is unrelated to managing or reducing the client's current low back pain.
C. Reposition the client with proper alignment and massage the lower back: Proper repositioning reduces strain on the spine, improves comfort, and enhances the action of analgesics. Gentle massage promotes circulation and relaxation, helping to amplify pain relief when combined with medication.
D. Encourage the client to take deep breaths and to ambulate frequently: Deep breathing and early ambulation are excellent for preventing complications like pneumonia and deep vein thrombosis especially in clients with decreased mobility due to pain but may not be appropriate as an initial intervention to maximize immediate pain relief from analgesics.

• 1. 21 to 24%: The client’s fat intake for the three days totals approximately 69 grams of fat (24g + 22g + 23g), which, when multiplied by 9 calories per gram, equals about 621 calories from fat. Given the total caloric intake of 3,200–3,310 calories per day, fat constitutes approximately 21% to 24% of the total caloric intake, which is within the recommended range for a balanced diet.
• 2. has an appropriate fat intake for calories: The fat intake of 21% to 24% of total calories aligns with the general dietary recommendation, which is for 20% to 35% of total calories to come from fat. Therefore, the client’s fat intake is appropriate and does not require any adjustments.

• 1. 26 to 28%: This percentage would be too high for the client’s daily fat intake. To reach 26% to 28% of calories from fat, the client would need to consume more grams of fat. Based on the actual fat intake (69g), this range is not appropriate.
• 1. 14 to 19%: A fat intake of 14% to 19% would be considered lower than the recommended range, and would suggest the client is consuming too little fat for a balanced diet. Given the actual fat intake, this percentage is not accurate.
• 2. should increase his fat intake: Given that the client’s fat intake is already within the recommended 20%–35% range, there's no need for the client to increase his fat intake. Therefore, this option is not appropriate.
• 2. should reduce his fat intake: Reducing the client’s fat intake is not necessary, as the fat intake falls within the recommended range. A reduction in fat would lower the total percentage of calories from fat below the suggested 20%–35% range, which could be harmful for overall nutrition.
• 2. should decrease his caloric intake: There’s no indication that the client is consuming an excessive amount of calories based on the information provided. His calorie intake seems appropriate for his needs. Decreasing caloric intake isn't necessary, especially when his fat intake is within the normal range.