The nurse provides education to a client who is newly diagnosed with multiple sclerosis (MS). Which client statements indicate the need for additional teaching? SELECT ALL THAT APPLY
"I may experience urinary incontinence."
"I should not exercise because this may trigger an exacerbation."
"I should alternate the eye patch every other day to help with the double vision."
"I may experience visual disturbances."
"I need to check the water temperature before I take a bath."
Correct Answer : B,C
Choice A reason: "I may experience urinary incontinence." This statement does not indicate the need for additional teaching. It is a correct statement that reflects an understanding of one of the possible symptoms of MS. Urinary incontinence is caused by nerve damage that affects bladder control.
Choice B reason: "I should not exercise because this may trigger an exacerbation." This statement indicates the need for additional teaching. It is an incorrect statement that reflects a misconception about exercise and MS. Exercise does not cause or worsen MS relapses but rather has many benefits for people with MS, such as improving muscle strength, balance, mobility, mood, and quality of life.
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. It is an incorrect statement that reflects a misunderstanding of how to manage double vision, which is another possible symptom of MS. Alternating the eye patch every other day does not help with double vision, but rather may cause eye fatigue or confusion. The correct way to use an eye patch is to wear it on one eye only when needed, such as when reading or driving.
Choice D reason: "I may experience visual disturbances." This statement does not indicate the need for additional teaching. It is a correct statement that reflects an awareness of another possible symptom of MS. Visual disturbances may include blurred vision, loss of color vision, pain in one eye, or partial or complete blindness.
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. It is a correct statement that reflects a precaution that people with MS should take. Checking the water temperature before taking a bath can prevent burns or scalds, as some people with MS may have reduced sensation or numbness in their skin.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","E"]
Explanation
Choice A reason: The integumentary system is a portal of entry for anthrax because the bacteria can enter through cuts or abrasions on the skin. This is called cutaneous anthrax, and it is the most common and least deadly form of anthrax infection.
Choice B reason: The endocrine system is not a portal of entry for anthrax because the bacteria do not affect the glands or hormones of the body. The endocrine system is mainly involved in regulating metabolism, growth, development, and reproduction.
Choice C reason: The central nervous system is a portal of entry for anthrax because the bacteria can spread to the brain and spinal cord from other parts of the body. This is called meningeal anthrax, and it is a rare and fatal complication of anthrax infection.
Choice D reason: The renal system is not a portal of entry for anthrax because the bacteria do not infect the kidneys or urinary tract. The renal system is mainly involved in filtering waste products and excess fluids from the blood.
Choice E reason: The respiratory system is a portal of entry for anthrax because the bacteria can be inhaled into the lungs. This is called inhalation anthrax, and it is the most deadly form of anthrax infection.
Correct Answer is A
Explanation
Choice A reason: "Move objects away from the client." This instruction should be included in the teaching. It is a safety measure that can prevent injury or harm to the client during a seizure. Moving objects away from the client can create more space and avoid contact with sharp, hard, or hot items.
Choice B reason: "Restrain the client." This instruction should not be included in the teaching. It is a harmful action that can worsen or prolong the seizure. Restraining the client can interfere with their natural movements, cause pain or discomfort, or damage their muscles or joints.
Choice C reason: "Place the client on his back." This instruction should not be included in the teaching. It is a dangerous position that can compromise the client's airway and breathing. Placing the client on his back can increase the risk of choking, aspiration, or suffocation.
Choice D reason: "Insert a padded tongue blade into the client's mouth." This instruction should not be included in the teaching. It is an outdated and ineffective practice that can cause more harm than good. Inserting a padded tongue blade into the client's mouth can damage their teeth, gums, tongue, or lips, or block their airway. Contrary to popular belief, it is impossible for a person to swallow their tongue during a seizure.
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