A client with type 2 diabetes mellitus managed on insulin is admitted for an acute Asthma exacerbation. The healthcare provider prescribes oral prednisone. What is the priority nursing intervention?

Rationale:

A. Secondary progressive MS initially begins as relapsing-remitting, with periods of symptom flare-ups followed by partial recovery. Over time, the disease may transition into a phase of steady progression, but this is after an initial relapsing course, not from disease onset.

B. Progressive-relapsing MS is characterized by steady neurological decline from onset, with occasional superimposed relapses. However, it is a rare subtype. Although it has continuous worsening, the hallmark is the presence of distinct relapses, unlike primary progressive MS, which is purely progressive without relapses.

C. Relapsing-remitting MS is the most common form and is characterized by episodes of new or worsening neurological symptoms (relapses) followed by partial or complete recovery (remissions). Neurological function does not worsen continuously, making this inconsistent with the scenario.

D. Primary progressive MS involves gradual, continuous neurological deterioration from the onset of symptoms, without distinct relapses or remissions. Patients experience steady accumulation of disability, often involving spinal cord symptoms such as weakness and spasticity. This subtype represents 10–15% of MS cases and typically does not respond as well to disease-modifying therapies compared with relapsing forms.

Rationale:

A. While padding bed rails can reduce injury if a fall occurs, it does not actively prevent the patient from attempting to get out of bed or losing balance. It is a passive safety measure, not a primary fall-prevention strategy.

B. Physical restraints are not recommended for fall prevention due to the risk of injury, immobility, and psychological harm. Restraints may actually increase fall risk if patients struggle against them, and their use is regulated and reserved for emergency situations only.

C. Bed or chair alarms alert staff immediately when a high fall-risk patient attempts to get up unassisted, allowing timely intervention to prevent falls. This is an active safety measure that is evidence-based for patients with impaired mobility, weakness, or poor coordination, as often seen in MS exacerbations. Alarms support early recognition of risk behaviors while promoting patient independence.

D. Prolonged bed rest is not recommended because it can lead to deconditioning, muscle weakness, and further mobility deficits, which may increase fall risk over time. MS patients benefit from supervised mobility and activity as tolerated, combined with safety measures.