A nurse is assessing a client who has a cast in place for a fractured tibia. Which of the following actions should the nurse take first?

A. Use Echinacea to manage joint pain:
Echinacea is a natural supplement, but its effectiveness in managing joint pain related to osteoarthritis is not well-established. It's important for individuals to consult their healthcare provider before using any supplements, as they may interact with medications or have other adverse effects.

B. Maintain a recommended body weight.
Maintaining a healthy body weight is an important recommendation for managing osteoarthritis. Excess weight puts additional stress on weight-bearing joints, such as knees and hips, which can worsen osteoarthritis symptoms. Losing weight, if necessary, or maintaining a healthy weight can help reduce joint pain and improve mobility in individuals with osteoarthritis.

C. Apply ice to the joint before exercising:
Applying ice can help reduce inflammation and provide pain relief, but it's typically used after exercising or during acute flare-ups, not necessarily before exercising. Heat is often recommended before exercise to warm up the joint and improve flexibility.

D. Reduce the amount of purine in the diet:
This recommendation is more relevant for managing gout, a different type of arthritis caused by the buildup of uric acid crystals in the joints. Purine-rich foods can trigger gout attacks but are not directly related to osteoarthritis. Osteoarthritis is primarily related to wear and tear of the joints over time.

A. McBurney's point on the abdomen: McBurney's point is a location in the right lower quadrant of the abdomen that is significant in the assessment for appendicitis. It is not relevant to the assessment of pyelonephritis, which is a kidney infection.

B. Psoas sign at the knee: The psoas sign is a test for appendicitis, not pyelonephritis. It involves the patient lying on their back and lifting their right leg against resistance. If this movement causes pain in the lower right abdomen, it could indicate irritation of the psoas muscle due to an inflamed appendix.

C. Rovsing's Sign on the abdomen: Rovsing's sign is also a test for appendicitis. It involves palpating the left lower quadrant of the abdomen and observing if it causes pain in the right lower quadrant. The presence of pain in the right lower quadrant during palpation of the left lower quadrant can indicate appendicitis. This sign is not specific to pyelonephritis.

D. Costovertebral angle (CVA) on the back: The CVA is located on the back at the angle formed by the 12th rib and the spine. Percussion of the CVA is a common technique used to assess for kidney tenderness. In the case of acute pyelonephritis, infection and inflammation of the kidneys can cause tenderness and pain in the CVA area. Therefore, this area is assessed for pain related to kidney infections like pyelonephritis.