A nurse is assisting with planning care for a client who has a new diagnosis of multiple sclerosis. Which of the interventions should the nurse recommend?
Recommend frequent hot baths.
Encourage the client to restrict performing range-of-motion exercises.
Monitor the client's ability to perform ADLS.
Initiate contact precautions.
The Correct Answer is C
A. Recommend frequent hot baths: Hot baths can exacerbate symptoms in clients with multiple sclerosis by increasing fatigue and worsening muscle weakness due to a rise in core body temperature. Clients are usually advised to avoid overheating and use cooling strategies instead to manage their symptoms.
B. Encourage the client to restrict performing range-of-motion exercises: Range-of-motion exercises are important in maintaining joint flexibility, muscle strength, and overall mobility. Restricting these exercises could lead to increased stiffness, weakness, and decreased functional ability in clients with multiple sclerosis.
C. Monitor the client's ability to perform ADLs: Monitoring the client's ability to perform activities of daily living is essential because multiple sclerosis often leads to progressive physical limitations. Regular assessment helps in planning appropriate interventions, promoting independence, and adjusting care as the disease progresses.
D. Initiate contact precautions: Contact precautions are not necessary for clients with multiple sclerosis because it is not an infectious disease. Multiple sclerosis is an autoimmune, neurodegenerative condition that requires supportive care rather than infection control measures.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Reviewing the results of the client's chlamydia screening with their parents, without the client's consent: Sexual health information, including STI screenings, is protected by confidentiality laws even for minors in many regions. Disclosing such sensitive information without the client's consent breaches confidentiality and can undermine trust between the adolescent and healthcare providers.
B. Reviewing the results of the client's celiac screening with their parents, without the client's consent: Celiac screening relates to general medical conditions and nutritional health, which are typically shared with parents of minors unless otherwise restricted. This does not generally breach confidentiality because it is not considered sensitive under adolescent health privacy laws.
C. Reviewing the results of the client's complete blood count (CBC) with their parents, without the client's consent: A CBC is a routine diagnostic test that checks general health indicators such as anemia or infection. Discussing these results with parents, especially for minors, is standard practice and does not usually violate confidentiality.
D. Reviewing the results of the client's urinalysis with their parents, without the client's consent: Urinalysis results typically assess general health or identify infections, which are standard to share with parents in the care of minors. This action would not be considered as a breach of confidentiality unless it revealed sensitive information like substance use without consent.
Correct Answer is D
Explanation
A. Promote bonding by encouraging the guardians to formula feed their newborn: Bonding occurs through close physical contact, responsiveness, and nurturing care, regardless of the feeding method. Bonding is important regardless of feeding method, but feeding choice should be based on the guardians’ preference, not directed solely by the nurse. Formula feeding is not necessary for promoting bonding.
B. Encourage guardians to allow relatives to provide the majority of the care for their newborn: Guardians should be encouraged to provide the majority of the newborn's care themselves to strengthen attachment and build confidence in their parenting abilities.
C. Ensure guardians know that criticism of newborn care is acceptable: Criticism can undermine the guardians' confidence and create stress. Support and positive reinforcement are important for helping new parents feel secure in their roles.
D. Inform guardians how to respond to their newborn's cues: Teaching guardians how to recognize and respond to their newborn's cues, such as hunger, discomfort, or need for interaction, promotes bonding, supports emotional development, and strengthens the parent-newborn relationship.
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