A nurse is reviewing home care with a client who has multiple sclerosis. Which of the following precautions should the nurse recommend to promote client safety?

Choice A reason: Encouraging ambulation only after 48 hours delays recovery, as early ambulation (within 12-24 hours) promotes circulation, prevents thromboembolism, and aids bowel function post-abdominal surgery. This instruction is incorrect, as it contradicts evidence-based protocols for early mobilization to enhance recovery.
Choice B reason: Instructing clients to avoid coughing is inappropriate, as coughing and deep breathing prevent pulmonary complications like atelectasis post-abdominal surgery. Splinting the incision during coughing reduces discomfort and dehiscence risk, making this instruction incorrect as it increases respiratory complications.
Choice C reason: Monitoring for signs of infection, such as fever or redness, is critical post-abdominal surgery to detect complications early. Infections can delay healing and lead to sepsis. Regular assessment ensures timely intervention, aligning with evidence-based postoperative care, making this the correct information to include.
Choice D reason: Removing surgical dressings within 12 hours is not standard, as dressings typically remain for 24-48 hours or per surgeon orders to protect the wound and reduce infection risk. Premature removal increases contamination risk, making this instruction incorrect for postoperative care.

Choice A reason: High-osmolarity formulas may cause diarrhea but are not directly linked to aspiration risk. Aspiration results from improper positioning or reflux, not formula osmolarity, so this factor is less relevant, making it incorrect for identifying aspiration risk in enteral feedings.
Choice B reason: Sitting in high-Fowler’s position (60-90 degrees) reduces aspiration risk by promoting gastric emptying and preventing reflux during enteral feedings. This is a protective measure, not a risk factor, making it incorrect for this scenario.
Choice C reason: A residual of 65 mL 1 hour postprandial is within acceptable limits (<100-200 mL, per facility protocol) and does not indicate high aspiration risk. Elevated residuals may suggest delayed emptying, but this value is normal, making it incorrect.
Choice D reason: A history of gastroesophageal reflux disease increases aspiration risk, as reflux can allow gastric contents to enter the airway during enteral feedings. This condition compromises esophageal sphincter function, making it a significant risk factor and the correct choice.