The public health nurse is assigned to the population of clients in an inner city community. The nurse identifies which of the following as a priority intervention.

Choice A reason: Giving the patient extra time to perform activities is an appropriate action by the nurse. Bradykinesia is a symptom of Parkinson's disease that causes slow and reduced movement, making it difficult for the patient to initiate and complete tasks. The nurse should respect the patient's autonomy and dignity, and allow them to do as much as they can by themselves, without rushing or interfering.

Choice B reason: Teaching the client to walk more quickly when ambulating is not an appropriate action by the nurse. Bradykinesia can affect the patient's gait and balance, making them prone to falls and injuries. The nurse should not encourage the patient to walk faster than their ability, but rather provide them with assistive devices, such as a cane or walker, and ensure a safe environment.

Choice C reason: Placing the client on a low-protein, low-calorie diet is not an appropriate action by the nurse. Bradykinesia does not require any specific dietary modifications, unless the patient has other comorbidities, such as diabetes or hypertension. The nurse should ensure that the patient has adequate nutrition and hydration, and avoid foods that may interfere with their medication absorption, such as high-fiber or high-fat foods.

Choice D reason: Completing passive range-of-motion exercises daily is not an appropriate action by the nurse. Bradykinesia can cause muscle stiffness and rigidity, which can limit the patient's range of motion and flexibility. The nurse should encourage the patient to do active range-of-motion exercises, which involve moving their own joints to their full extent, rather than passive ones, which involve someone else moving their joints for them. Active exercises can help maintain muscle strength and joint mobility and prevent contractures and deformities.

Choice A reason: Providing total assistance with all ADLs is not an intervention that should be included in the client's plan. ADLs are activities of daily living, such as bathing, dressing, eating, and toileting. Providing total assistance with all ADLs can reduce the client's independence and self-esteem, and increase their dependence and learned helplessness. The nurse should encourage and assist the client to perform as much as they can by themselves and provide partial or intermittent assistance only when needed.

Choice B reason: Ordering a low-residue diet is not an intervention that should be included in the client's plan. A low-residue diet is a type of diet that limits foods that are high in fiber or indigestible material, such as whole grains, nuts, seeds, fruits, and vegetables. A low-residue diet may be recommended for clients who have inflammatory bowel disease (IBD), diverticulitis, or bowel obstruction, as it can reduce bowel frequency and irritation. However, it is not indicated for clients who have MS, unless they have other comorbidities that require it. A balanced diet that includes adequate fiber, fluids, and nutrients is more beneficial for clients who have MS.

Choice C reason: Encouraging the client to void every hour is not an intervention that should be included in the client's plan. Voiding every hour can be inconvenient and impractical for the client, and may not address their bladder problems effectively. MS can cause bladder dysfunction, such as urinary urgency, frequency, incontinence, or retention, due to nerve damage that affects bladder control. The nurse should assess the type and severity of the bladder dysfunction, and provide appropriate interventions, such as medication, catheterization, pelvic floor exercises, or bladder training.

Choice D reason: Instructing the client on daily muscle stretching is an intervention that should be included in the client's plan. Muscle stretching is a type of exercise that involves extending or elongating a muscle or group of muscles to their full length. Muscle stretching can help prevent or relieve muscle spasticity, stiffness, pain, or contractures that may occur in clients who have MS. The nurse should teach the client how to perform muscle stretching safely and correctly, and encourage them to do it daily or as prescribed.