A nurse is caring for a client who had a stroke and has dysphagia. The nurse should monitor the client for which of the following complications?

Choice A reason: Genetics play a significant role in the development of multiple sclerosis (MS). While MS is not directly inherited, certain genetic markers can increase susceptibility. Studies have shown that individuals with a first-degree relative with MS have a higher risk compared to the general population.

Choice B reason: Environmental factors, such as low vitamin D levels, smoking, and possibly viral infections, are believed to contribute to the risk of developing MS. Geographic location, particularly living further from the equator, has also been associated with a higher incidence of MS, which may be related to sun exposure and vitamin D synthesis.

Choice C reason: While upper respiratory infections can trigger exacerbations in individuals with existing MS, they are not identified as a direct contributing factor to the development of the disease itself.

Choice D reason: MS is considered an autoimmune disorder where the immune system mistakenly attacks the central nervous system. This immune-mediated process targets the myelin sheath, leading to inflammation and characteristic lesions.

Choice E reason: Urinary tract infections are a common complication in individuals with MS due to bladder dysfunction, but they are not a contributing factor to the development of MS.

Choice A reason: While having at least one stool per day is a sign that lactulose is working, it does not directly indicate its effectiveness in reducing ammonia levels and improving mental status.

Choice B reason: Denial of nausea and vomiting is positive but is not a direct indicator of lactulose's effectiveness in treating hepatic encephalopathy.

Choice C reason: A decrease in bilirubin levels may be a positive sign, but it is not a direct indicator of lactulose's effectiveness in treating hepatic encephalopathy.

Choice D reason: The client being alert and oriented is a direct indicator that lactulose is effectively reducing ammonia levels and improving mental status, which is a key goal in treating hepatic encephalopathy associated with liver cirrhosis.