The nurse is caring for a client with multiple sclerosis. What actions does the nurse implement to increase venous return, prevent stiffness, and maintain muscle strength and endurance?
Administer corticosteroids
Turn and reposition every 2 hours
Administer interferon
Encourage range-of-motion exercises
The Correct Answer is D
Choice A reason: Administering corticosteroids is not an action that the nurse implements to increase venous return, prevent stiffness, and maintain muscle strength and endurance because it is a medication that reduces inflammation and relieves acute exacerbations of multiple sclerosis, but does not affect the client's physical function or mobility.
Choice B reason: Turning and repositioning every 2 hours is not an action that the nurse implements to increase venous return, prevent stiffness, and maintain muscle strength and endurance because it is a nursing intervention that prevents pressure ulcers and promotes skin integrity, but does not enhance the client's circulation or muscle activity.
Choice C reason: Administering interferon is not an action that the nurse implements to increase venous return, prevent stiffness, and maintain muscle strength and endurance because it is a medication that modifies the immune system and delays the progression of multiple sclerosis, but does not improve the client's physical function or mobility.
Choice D reason: Encouraging range-of-motion exercises is an action that the nurse implements to increase venous return, prevent stiffness, and maintain muscle strength and endurance because it is a physical activity that improves the client's blood flow, flexibility, and muscle tone, as well as prevents contractures and spasticity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C"]
Explanation
Choice A reason: "I may experience urinary incontinencE." This statement does not indicate the need for additional teaching because it is truE. Urinary incontinence is a common symptom of MS due to nerve damage affecting the bladder control.
Choice B reason: "I should not exercise because this may trigger an exacerbation." This statement indicates the need for additional teaching because it is falsE. Exercise is beneficial for people with MS as it can improve strength, balance, mobility, fatigue, mood, and quality of lifE. Exercise does not cause or worsen MS relapses.
Choice C reason: "I should alternate the eye patch every other day to help with the double vision." This statement indicates the need for additional teaching because it is not recommendeD. Eye patching is not an effective treatment for double vision caused by MS, as it can impair depth perception, increase eye fatigue, and delay recovery. Eye patching should only be used temporarily and under medical supervision.
Choice D reason: "I may experience visual disturbances." This statement does not indicate the need for additional teaching because it is truE. Visual disturbances are common in MS due to inflammation or damage of the optic nerve or other parts of the visual pathway. Visual disturbances can include blurred vision, reduced color vision, pain in the eye, and loss of vision.
Choice E reason: "I need to check the water temperature before I take a batH." This statement does not indicate the need for additional teaching because it is truE. People with MS may have impaired sensation and temperature regulation, which can increase the risk of burns or hypothermia when exposed to hot or cold water. Checking the water temperature before bathing can prevent injury and discomfort.
Correct Answer is D
Explanation
Choice A reason: Natural history of disease is not an approach that explains the factors that allow the reproduction and spread of infectious disease, but rather a description of how a disease progresses over time from exposure to outcome in the absence of intervention.
Choice B reason: Health promotion is not an approach that explains the factors that allow the reproduction and spread of infectious disease, but rather a process of enabling people to increase control over and improve their health through education, empowerment, and policy changE.
Choice C reason: Levels of prevention are not an approach that explains the factors that allow the reproduction and spread of infectious disease, but rather a classification of interventions based on their timing and purpose in relation to disease occurrencE.
Choice D reason: Epidemiologic triangle is an approach that explains the factors that allow the reproduction and spread of infectious disease, by identifying and analyzing three elements: agent (the cause of disease), host (the person who gets sick), and environment (the conditions that affect transmission).
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