The healthcare provider gives a pregnant woman a prescription for one prenatal vitamin with iron daily and tells her to increase iron-rich foods in her diet because her hemoglobin is 8.2 g/dL or (5.09 mmol/L).

When a list of iron-rich foods is given to the client, she tells the practical nurse (PN) that she is vegetarian and does not eat anything that "bleeds." Which instruction should the PN provide? (Select all that apply.)

Choice A rationale:

Notifying the healthcare provider that the client is having difficulty using the spirometer may be necessary if the client is unable to use the device correctly despite encouragement and education. However, the initial action should be to encourage the client and provide support.

Choice B rationale:

Encouraging the client to continue inhaling slowly into the spirometer until the goal is met is the correct action. Incentive spirometry is used to improve lung function, and it is essential for the client to use it correctly and meet their goals to achieve the desired outcomes.

Choice C rationale:

Offering to demonstrate the correct use of the incentive spirometer to the client may be helpful if the client is struggling to use it properly. However, the initial response should be to encourage the client and provide guidance.

Choice D rationale:

Reminding the client to cough after each use of the spirometer to help clear the lungs is not the most appropriate action in this situation. While coughing may be beneficial, the primary focus should be on achieving the goals of the incentive spirometry.

The correct answer is Choice D.

Choice A rationale: Depression assessment is important in bariatric care, but postoperative priorities focus on physiologic risks—venous thromboembolism, pulmonary complications, bleeding, and leaks—heightened by obesity, diabetes, hypertension, and immobility; psychosocial screening is longitudinal.

Choice B rationale: Urinary incontinence is not a typical complication of gastroplasty. Immediate risks include venous thromboembolism, pulmonary issues, hemorrhage, anastomotic leak, and infection; prioritizing VTE prophylaxis and respiratory support offers morbidity reduction.

Choice C rationale: Early post-gastroplasty nutrition requires staged progression: clear liquids to pureed, tiny portions, high-protein focus, vitamin-mineral supplementation. Offering meal variety risks overeating, nausea, vomiting, dumping syndrome, and staple-line stress or disruption.

Choice D rationale: Sequential compression devices augment venous return, reduce stasis, and lower deep vein thrombosis and pulmonary embolism risk in obese, diabetic, hypertensive surgical patients with limited mobility; evidence-based venous thromboembolism prophylaxis.