A nurse is providing teaching to a client who has multiple sclerosis. Which of the following statements should the nurse include in the teaching?
"Avoid exercising in warm places."
"Walk with your feet close together."
"Decrease your daily fluid intake.
"Apply an ice pack to spastic muscles."
The Correct Answer is A
Rationale:
A. "Avoid exercising in warm places.": Heat can temporarily worsen symptoms of multiple sclerosis, such as fatigue, weakness, and spasticity, due to slowed nerve conduction. Clients should exercise in cool environments or use cooling techniques to prevent symptom exacerbation.
B. "Walk with your feet close together.": Walking with feet close together can increase the risk of imbalance and falls in clients with MS, who often have gait disturbances. Maintaining a wider stance or using assistive devices improves stability and safety during ambulation.
C. "Decrease your daily fluid intake.": Fluid restriction is not recommended for MS and can lead to dehydration and urinary tract complications. Adequate hydration helps maintain bladder function and overall health.
D. "Apply an ice pack to spastic muscles.": Cold therapy does not effectively relieve muscle spasticity in MS; instead, heat may temporarily reduce muscle stiffness. Ice packs are more appropriate for acute inflammation or injury rather than chronic spasticity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. Ask an experienced nurse to assist with the procedure: Seeking assistance from an experienced nurse promotes patient safety and supports proper skill development. The newly licensed nurse can observe, perform the procedure under supervision, and ensure that the client receives competent care while staying within professional practice boundaries.
B. Delegate the task to an assistive personnel: Tracheal suctioning is a sterile and invasive procedure that requires nursing judgment and assessment, which are outside the scope of practice for assistive personnel.
C. Identify that the task is in the scope of RN practice and perform the suctioning: Although tracheal suctioning is within an RN’s scope, the nurse should not perform it independently without adequate training or supervision.
D. Refuse to take the assignment: Refusing the assignment entirely is inappropriate because the nurse has a duty to provide care within their level of competence. Instead, the nurse should seek guidance and supervision to safely complete the procedure.
Correct Answer is A
Explanation
Rationale:
A. Gently push the syringe plunger to administer medication: Medications given via NG tube should be administered slowly and gently using a syringe to avoid tube damage, aspiration, or sudden changes in gastric pressure. This technique ensures safe and effective delivery of the medication.
B. Dissolve the medications together: Mixing multiple medications can cause chemical interactions or precipitation, which can block the NG tube or reduce medication efficacy. Each medication should be dissolved and administered separately.
C. Flush the NG tube with 5 mL of cold tap water after administration: Flushing is necessary to maintain tube patency, but 5 mL is insufficient for continuous feedings. Typically, 15–30 mL of warm or room-temperature water is used to prevent tube occlusion.
D. Add medication directly to the enteral feeding: Adding medication to the feeding can alter the composition, affect absorption, and create a risk for tube blockage. Medications should be given separately with flushing before and after administration.
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