A. A respiratory therapist focuses on breathing and airway management, which is not the primary concern for a client needing strengthening after a stroke.
B. An occupational therapist helps clients with daily living activities and fine motor skills, but the focus on strengthening the affected side is more specific to physical therapy.
C. A physical therapist specializes in developing and implementing exercise programs to strengthen muscles and improve mobility, making this the most appropriate referral for the client's needs.
D. A social worker assists with emotional and social needs but would not focus on physical rehabilitation after a stroke.

A. Primary progressive multiple sclerosis is characterized by a gradual progression of symptoms without relapses, so this does not match the client's pattern.
B. Relapsing-remitting multiple sclerosis is defined by episodes of exacerbation (active symptoms) followed by periods of remission (no symptoms), which aligns with the client's description.
C. Secondary progressive multiple sclerosis follows an initial relapsing-remitting course but leads to a more continuous decline in function, so it does not match the pattern described.
D. Clinically isolating syndrome refers to a single episode of neurological symptoms but does not indicate the pattern of relapses and remissions typical of relapsing-remitting multiple sclerosis.

Assessment Findings and Rationale

1. Ambulation Pattern

Parkinson's Disease: The slow and shuffling gait is characteristic of Parkinson's disease due to muscle rigidity and bradykinesia (slowness of movement). Patients often exhibit a stooped posture and a shuffling gait.

2. Muscle Movements

Parkinson's Disease: Unilateral resting tremors and generalized muscle stiffness are hallmark signs of Parkinson's disease, which affects motor control due to basal ganglia degeneration. As the disease progresses, bilateral tremors and stiffness develop.

3. Speech

Parkinson's Disease: Slow and slurred speech is common in Parkinson's disease as a result of muscle rigidity affecting speech production.

Stroke: Speech difficulties such as slurred speech may also occur in stroke patients due to dysarthria, which arises from motor control deficits.

Multiple Sclerosis: Speech issues, including slurred speech, can also be seen in multiple sclerosis due to neurological involvement and muscle control issues.

4. Orientation Status

Parkinson's Disease: Disorientation to date and time can be seen in later stages of Parkinson's disease as cognitive decline may accompany the motor symptoms.

Stroke: Cognitive deficits, including disorientation, can result from stroke, especially if it affects the areas of the brain responsible for cognition.

Multiple Sclerosis: Orientation issues may also occur in multiple sclerosis as cognitive impairment can be part of the disease process.

5. Facial Rigidity

Parkinson's Disease: Facial rigidity, often described as a "masked face," is a classic symptom of Parkinson's disease, resulting from decreased facial muscle control.

A. Documenting the findings and continuing the visit does not address the potential seriousness of the weight gain and edema in a patient with heart failure. It is important to act promptly on such findings.

B. Notifying the RN case manager of the change in status is essential because a weight gain of this magnitude, along with generalized edema, may indicate worsening heart failure. This requires a timely assessment and possible adjustment of the treatment plan, including medication and fluid management.

C. While reinforcing the importance of daily weights is beneficial for long-term management, it is not an immediate intervention for the acute change in the patient’s condition.

D. Ensuring the client has been taking their prescribed diuretic is important, but the nurse should first communicate the significant changes to the RN case manager for further evaluation and intervention, as this might require a medication review or adjustment.

A. While age contributes to hypertension risk, being male and 53 years old does not inherently confer the greatest risk when compared to other factors like ethnicity.
B. The client’s younger age and female gender reduce the overall risk for hypertension compared to other groups.
C. Although people of Asian ethnicity can develop hypertension, their overall risk is lower than that of African Americans.
D. African Americans have a significantly higher risk for hypertension due to a combination of genetic, environmental, and socio-economic factors. This group is known to have a higher prevalence of this condition, often developing it at an earlier age.

A. Nicardipine is a calcium channel blocker primarily used to manage blood pressure but does not directly reduce ICP.
B. Phenytoin is an anticonvulsant used to prevent seizures, which may occur after a hemorrhage, but it does not address increased ICP.
C. Dopamine is used to increase blood pressure and cardiac output but does not play a role in reducing ICP.
D. Mannitol is an osmotic diuretic that helps decrease ICP by drawing fluid from brain tissue into the bloodstream, thus relieving pressure within the skull. It is the most appropriate intervention for managing increased ICP.

A. Falls are one of the leading causes of TBIs, especially in older adults and young children.
B. Violence, including assaults or domestic abuse, can result in traumatic brain injuries, often due to blunt trauma to the head.
C. Sports-related injuries, particularly from contact sports like football or boxing, are a well-recognized cause of TBIs.
D. While firefighting can involve physical risks, it is not a direct cause of traumatic brain injuries unless an accident involving the head occurs.
E. Working in a factory, though it may pose various risks, does not typically involve causes directly linked to TBIs unless there is an accidental head injury.

A. A QRS interval of 0.08 second is within the normal range and does not indicate a myocardial infarction.
B. A PR interval of 0.15 second is normal and not indicative of an acute myocardial infarction.
C. ST-segment elevation above the isoelectric line is a key indicator of an acute myocardial infarction (STEMI), signifying myocardial injury.
D. The QT interval being equal to the R to R interval is not a specific indicator of myocardial infarction.

A. Shopping for shoes in the morning is not recommended, as feet tend to swell later in the day, and shoe fitting should account for potential swelling.
B. Incorporating walking into the daily routine helps improve circulation and can aid in managing peripheral vascular disease by promoting blood flow in the legs.
C. Elevating the legs might decrease circulation and is not advised for clients with peripheral vascular disease, as it can reduce blood flow to the extremities.
D. Knee-length stockings can restrict circulation, especially if they are too tight, and should be avoided to promote proper blood flow in clients with this condition.

A. Clients with a basilar skull fracture may experience confusion or memory loss regarding the injury, making them unable to recall how it occurred.
B. Pooling of blood around the eyes, known as "raccoon eyes," is a common sign of a basilar skull fracture.
C. Bruising over the mastoid process (Battle's sign) is another classic sign of a basilar skull fracture, indicating trauma to the base of the skull.
D. Chvostek's sign is associated with hypocalcemia, not basilar skull fractures.