The nurse is addressing exercise and physical activity during discharge education with a client diagnosed with heart failure. What should the nurse teach this client about exercise?

Choice A reason: Increased sleep may occur with sertraline due to its sedative effects, but it is not the priority assessment. Early in treatment, SSRIs can increase energy before mood improvement, heightening suicide risk, making suicidal ideation a more urgent concern.

Choice B reason: Sertraline, an SSRI, can initially increase energy in severe depression before fully improving mood, potentially increasing suicide risk. Assessing suicidal ideation is the priority to ensure safety, as this risk is highest early in treatment, requiring immediate intervention if present.

Choice C reason: Emotional changes are expected with sertraline as it improves mood over weeks. However, this is less urgent than assessing suicidal ideation, which poses an immediate safety risk, especially in severe depression during the early phase of SSRI treatment.

Choice D reason: Increased socialization may indicate improved depressive symptoms but is a secondary outcome. The priority is assessing suicidal ideation, as SSRIs can paradoxically increase suicide risk early in treatment due to improved energy without full mood stabilization, requiring vigilant monitoring.

Choice A reason: Drawing blood for lab studies, such as BNP or electrolytes, is important in heart failure to assess severity and guide treatment. However, 2+ pitting edema and left ventricular enlargement suggest acute pulmonary congestion, making respiratory assessment the priority to detect life-threatening complications like pulmonary edema.

Choice B reason: Weighing the client monitors fluid status in heart failure, as weight gain indicates fluid retention. While important, it is secondary to assessing respiratory status, as edema and ventricular enlargement suggest possible pulmonary edema, which poses an immediate threat to oxygenation.

Choice C reason: Left ventricular enlargement and 2+ pitting edema indicate left-sided heart failure, which can lead to pulmonary edema, causing dyspnea and hypoxia. Assessing respiratory status first ensures detection of crackles or respiratory distress, enabling prompt intervention to prevent respiratory failure or worsening heart failure.

Choice D reason: Inserting a Foley catheter monitors urine output in heart failure but is not the first action. Respiratory distress from pulmonary edema, suggested by edema and ventricular enlargement, is a more immediate concern, requiring assessment of breathing to ensure adequate oxygenation and safety.