The nurse is performing a functional assessment of an older adult to determine safety in the home. Which musculoskeletal assessment is most important for the nurse to include?

A. Remind the client to keep his appointments to have his cholesterol level checked: Ezetimibe works by reducing absorption of cholesterol in the intestines, which lowers serum lipid levels. The most direct way to evaluate effectiveness is through laboratory testing of cholesterol levels at scheduled follow-up appointments.

B. Assess the elasticity of the client's skin at the next scheduled clinic appointment: Skin elasticity is not affected by cholesterol-lowering therapy and does not provide meaningful information about the effectiveness of ezetimibe.

C. Teach the client to weigh himself weekly and keep a log of the measurements: Weight monitoring is more relevant for managing conditions like heart failure or obesity. Ezetimibe’s primary effect is on lipid levels, not weight change.

D. Encourage the client to keep a diary of his food intake until his next visit to the clinic: While dietary tracking supports lifestyle management, it does not directly measure the pharmacologic effectiveness of ezetimibe. Laboratory results remain the standard for evaluation.

• Temperature 98.1°F (36.7°C): Afebrile status indicates that the body is not mounting a febrile response to pathogens, showing infection is being prevented postoperatively.

• pH 7.40: Normal pH reflects adequate perfusion and circulation after fluid resuscitation, suggesting hypovolemia has been managed effectively.

• Blood pressure 112/77 mm Hg: Stable blood pressure within normal range after fluid bolus demonstrates restoration of circulating volume, consistent with hypovolemia management.

• Capillary refill 2 seconds: Normal refill indicates improved tissue perfusion after fluid therapy, confirming adequate correction of hypovolemia.

• Pain 0 on a scale of 0 to 10: Absence of reported pain while sedated indicates comfort and relief of anxiety, showing pain control is being achieved.

• Surgical dressing dry and intact: A clean, dry surgical site without drainage supports the goal of preventing infection after abdominal trauma surgery.

• PaCO2 42 mm Hg: PaCO 2 of 42mmHg is within the normal range (35−45mmHg) and indicates effective ventilation. This is primarily an ABC or respiratory goal, not directly related to the three listed goals.