A nurse is teaching a client who has multiple sclerosis. Which of the following instructions should the nurse include in the teaching?

Rationale:
A. "Perform Kegel exercises several times daily.": Kegel exercises strengthen pelvic floor muscles, improving bladder control and reducing stress incontinence episodes. Regular practice is essential for effectiveness.

B. "Take prescribed diuretics no later than 2000.": Limiting evening diuretic use helps reduce nighttime incontinence but does not address stress incontinence, which is triggered by increased intra-abdominal pressure, not fluid timing.

C. "Maintain a daily fluid intake of 1,000 to 1,200 mL/day.": Restricting fluids excessively can lead to concentrated urine and urinary tract irritation. Adequate hydration is important; fluid restriction is not recommended for stress incontinence.

D. "Attempt to void every 2 hours.": Scheduled voiding helps prevent bladder overfilling, reducing leakage episodes and improving bladder control. This is an effective behavioral strategy.

E. "Maintain optimal body weight for height.": Excess weight increases intra-abdominal pressure, which can worsen stress incontinence. Maintaining a healthy weight helps reduce strain on pelvic floor muscles.

Rationale for Correct Choices

• Pain medication: Fractures cause pain due to bone and soft tissue injury. Administering analgesics helps manage discomfort, improves cooperation with care, and facilitates movement and participation in activities as tolerated. Pain control also reduces stress responses that can interfere with healing.

• Limb immobilization: Nondisplaced midshaft fractures of the radius and ulna require immobilization using a cast or splint to maintain proper alignment, prevent further injury, and promote bone healing. Immobilization also supports neurovascular protection and decreases the risk of displacement.

Rationale for Incorrect Choices

• Skin traction: Skin traction is typically used for femur or lower limb fractures, not isolated forearm fractures, and is unnecessary for nondisplaced radius and ulna fractures.

• Antibiotics: The fracture is closed and nondisplaced, with no open wound or infection, so prophylactic antibiotics are not indicated.

• Surgical consultation: Surgery is usually reserved for displaced, unstable, or complex fractures. This nondisplaced fracture can be managed conservatively with immobilization.

• Bed rest: While rest is important, strict bed rest is unnecessary for upper extremity fractures. The child can perform limited activities while the arm is immobilized.