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

Rationale:
A. The client exhibits a flat affect: A flat affect reflects blunted emotional expression and is typically a symptom of depression. Its persistence suggests the condition has not yet improved.

B. The client can express angry feelings: The ability to identify and express emotions, including anger, indicates improved emotional responsiveness and progress in managing depressive symptoms. This reflects increased insight and healthier coping.

C. The client experiences self-doubt when making decisions: Persistent self-doubt is a common feature of depression and suggests that the client still struggles with confidence and decision-making.

D. The client looks down when speaking to others: Avoiding eye contact and looking down are associated with low self-esteem and social withdrawal, which are characteristic of depression and indicate the condition is not yet improving.

Rationale

A. Perform a vaginal examination every 12 hr: Vaginal examinations should be avoided in a client with severe preeclampsia unless delivery is imminent, as they can stimulate uterine activity and increase the risk of placental abruption. Continuous monitoring and noninvasive assessments are prioritized instead.

B. Administer betamethasone: Betamethasone promotes fetal lung maturity by stimulating surfactant production when preterm delivery before 34 weeks is anticipated. This reduces the risk of neonatal respiratory distress syndrome and intraventricular hemorrhage.

C. Provide a low-stimulation environment: A quiet, dimly lit environment helps minimize CNS stimulation, reducing the risk of seizure activity in clients with severe preeclampsia. Environmental stressors such as bright lights and loud noises should be avoided.

D. Maintain bed rest: Bed rest, particularly in the left lateral position, improves uteroplacental perfusion and reduces blood pressure by minimizing pressure on the vena cava. It also helps limit activity that could elevate BP further.

E. Obtain a 24-hr urine specimen: Collecting a 24-hour urine specimen allows accurate assessment of total protein excretion, which confirms the severity of preeclampsia. Proteinuria greater than 300 mg/24 hr indicates significant renal involvement.

F. Give antihypertensive medication: Antihypertensives such as labetalol or hydralazine help prevent maternal complications like stroke or heart failure from sustained severe hypertension while avoiding excessive BP reduction that could impair uteroplacental blood flow.

G. Monitor intake and output hourly: Close monitoring of intake and output detects early signs of renal compromise or fluid overload, which are common in preeclampsia. Accurate measurement helps guide safe fluid management and prevent pulmonary edema.