Which outcome would the nurse include in the care plan for a patient with multiple sclerosis (MS)? Select all that apply.

Make decisions about health and lifestyle modifications to manage MS

Cure the disease

Maintain or improve muscle strength and mobility

Maintain urinary continence

Maintain independence in performing ADLs

Answer and Explanation

Correct Answer : A,C,D,E

Choice A reason: The nurse would include making decisions about health and lifestyle modifications to manage MS because this helps the patient to make informed choices that can alleviate symptoms and improve their quality of life. Modifying aspects such as diet, exercise, and stress management can play a significant role in managing the disease and preventing relapses.

Choice B reason: Curing the disease is not currently a feasible outcome for multiple sclerosis, as there is no known cure. The focus of the care plan is typically on managing symptoms, slowing the progression of the disease, and improving the patient's quality of life rather than curing the disease.

Choice C reason: Maintaining or improving muscle strength and mobility is crucial for patients with MS, as the disease often affects muscle control and strength. Including this outcome in the care plan helps to reduce the risk of falls, improve the patient's ability to perform daily tasks, and enhance overall physical function.

Choice D reason: Maintaining urinary continence is an important aspect of care for MS patients, as the disease can affect bladder control. Including this outcome helps to ensure the patient's comfort and dignity, prevent urinary tract infections, and improve their quality of life.

Choice E reason: Maintaining independence in performing activities of daily living (ADLs) is essential for patients with MS to ensure they can continue to perform tasks such as bathing, dressing, and eating. This outcome supports the patient's self-esteem and promotes a sense of autonomy.

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Correct Answer is ["B","C","D","E"]

Explanation

Choice A reason: Dementia is not a typical complication directly related to the post-operative period of a total hip replacement. While elderly patients may have underlying cognitive issues, dementia is not considered a direct post-op complication.

Choice B reason: Venous thromboembolism (VTE) is a common post-operative complication, particularly in orthopedic surgeries like total hip replacement. Due to immobility and surgical stress, patients are at higher risk for blood clots forming in the veins, which can be life-threatening if they travel to the lungs.

Choice C reason: Fluid overload can occur due to the administration of intravenous fluids during surgery. Monitoring for signs of fluid overload, such as swelling, shortness of breath, and increased blood pressure, is crucial to ensure proper fluid balance and prevent complications like heart failure.

Choice D reason: Infection is a significant risk after surgery, especially in procedures like total hip replacement. Monitoring for signs of infection, such as fever, increased pain, redness, swelling, and drainage from the surgical site, is essential to detect and treat infections early.

Choice E reason: Unrelieved pain is a critical aspect to monitor post-operatively. Effective pain management is crucial for patient comfort, mobility, and recovery. Uncontrolled pain can impede rehabilitation and recovery, increasing the risk of complications.

A. "I should eat foods high in potassium because diuretics cause potassium loss." B. "I need to limit my fluid intake to no more than 1 quart of liquids a day." C. "I need to shop for foods low in sodium and avoid adding salt to food." D. "I should weigh myself daily and report sudden weight loss or gain."

Correct Answer is C

Explanation

Choice A reason: Eating foods high in potassium can be important for patients taking diuretics, as diuretics can cause potassium loss. However, for SIADH patients, this is not a primary focus unless they are on diuretics that specifically lead to potassium loss.

Choice B reason: Limiting fluid intake is crucial for patients with SIADH to prevent fluid overload and hyponatremia. This statement aligns with proper management of the condition.

Choice C reason: Patients with SIADH need to carefully manage their sodium intake. Rather than reducing sodium, they often need to maintain or increase their sodium intake to help counteract the effects of SIADH, which causes dilutional hyponatremia (low blood sodium levels). Therefore, this statement indicates a need for additional instruction.

Choice D reason: Weighing oneself daily is an important practice for SIADH patients to monitor for sudden weight changes, which can indicate fluid imbalances. This statement is appropriate and does not require additional instruction.

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Which outcome would the nurse include in the care plan for a patient with multiple sclerosis (MS)? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is ["B","C","D","E"]

Explanation

Which patient statement indicates to the nurse that additional instruction is needed for a patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH)?

Correct Answer is C

Explanation

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