A nurse is planning care for a client who has left-sided hemiplegia. Which of the following actions should the nurse include in the plan?

Initiate frequent, short periods of exercise throughout the day.

Decrease the amount of range of motion performed if tightness occurs.

Perform range-of-motion exercises to the affected side once per day.

Avoid repetitive movements during exercise.

Answer and Explanation

The Correct Answer is A

A) Initiate frequent, short periods of exercise throughout the day: Frequent, short periods of exercise are beneficial for a client with left-sided hemiplegia. Regular movement helps maintain joint flexibility, muscle strength, and overall functional ability. This approach can prevent complications such as contractures and muscle atrophy.

B) Decrease the amount of range of motion performed if tightness occurs: If tightness occurs, rather than decreasing range of motion, it is important to address it through appropriate stretching and adjustments in exercise technique. Reducing range of motion could lead to further loss of mobility and function.

C) Perform range-of-motion exercises to the affected side once per day: Performing range-of-motion exercises only once per day is generally insufficient. To maintain or improve mobility and prevent contractures, range-of-motion exercises should be performed multiple times throughout the day, as directed by the care plan.

D) Avoid repetitive movements during exercise: Repetitive movements are not necessarily harmful and can be beneficial for improving motor function and muscle coordination. However, it is important to balance repetitive exercises with variety and adjust based on the client’s condition and tolerance.

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Correct Answer is D

Explanation

A) "Limit fluids that contain electrolytes":
For a client with gastroenteritis, it is crucial to maintain hydration due to the risk of dehydration from diarrhea and vomiting. However, fluids containing electrolytes can help replenish lost electrolytes and are beneficial. The instruction to "limit" these fluids might be misunderstood as a need to avoid them, which is not appropriate. The aim should be to encourage adequate hydration with fluids that contain electrolytes.

B) "Eliminate sources of probiotics from the diet":
Probiotics can help restore the balance of gut bacteria and may be beneficial in managing gastroenteritis. Eliminating probiotics from the diet is not typically recommended and may not support the recovery process.

C) "Take docusate sodium twice daily":
Docusate sodium is a stool softener, generally used to relieve constipation. In the context of gastroenteritis, which typically involves diarrhea, this medication is not appropriate and could worsen the condition.

D) "Avoid foods high in simple sugars":
Foods high in simple sugars can exacerbate diarrhea by increasing osmotic load in the intestines, leading to more water being drawn into the gut. Avoiding these foods can help manage and reduce symptoms of gastroenteritis.

A. Provide detailed directions for the client's expected behavioral changes. B. Request the client write down an evaluation of personal strengths. C. List alternative interpretations of the client's illogical thinking. D. Encourage the client to participate in group recreational activities to help concentration.

Correct Answer is B

Explanation

A) Provide detailed directions for the client's expected behavioral changes
Giving detailed directions may overwhelm the client, increasing anxiety. It's more effective to offer support and simple, clear guidance to reduce stress.

B) Request the client write down an evaluation of personal strengths
Encouraging the client to focus on personal strengths can boost self-esteem and resilience, helping them cope with anxiety by promoting a positive self-image and reinforcing their ability to manage stress.

C) List alternative interpretations of the client's illogical thinking
While reframing thoughts can be helpful, this approach might be too confrontational initially. It's important to build trust and allow the client to explore thoughts at their own pace.

D) Encourage the client to participate in group recreational activities to help concentration
While recreational activities can be beneficial, they may not directly address anxiety management. Individual reflection on strengths can be a more immediate way to enhance coping skills.

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A nurse is planning care for a client who has left-sided hemiplegia. Which of the following actions should the nurse include in the plan?

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