A nurse is caring for a client who was injured by a blast of high-order explosives. Medics report secondary injuries from the explosion. The nurse anticipates what type of injuries?

Choice A reason:

Going automatically into the client’s bedroom without permission is inappropriate and can be seen as an invasion of privacy. The nurse should always seek consent and respect the client’s personal space. Building trust and maintaining professional boundaries are crucial in home care settings.

Choice B reason:

While it is courteous to thank the client for arranging a home visit, it is not a critical action that directly impacts the care provided. The focus should be on assessing the client’s needs and establishing a care plan.

Choice C reason:

Arranging mutual future visits is an appropriate action. It helps to establish a consistent care schedule, ensuring that the client receives ongoing support and monitoring. This is particularly important for managing chronic conditions like diabetes, where regular follow-up is essential for effective management.

Choice D reason:

Asking how the client is managing at home is a crucial part of the initial assessment. It provides the nurse with valuable information about the client’s current health status, challenges, and needs. This information is essential for developing a personalized care plan that addresses the client’s specific circumstances.

Choice E reason:

Sitting down and discussing with the client and family members is an important step in the initial home care visit. It helps to build rapport, understand the client’s support system, and involve family members in the care process. This collaborative approach ensures that everyone is informed and can contribute to the client’s care and well-being.

Choice A reason:

Recommending high-impact, vigorous exercises is not appropriate for clients with MS. These exercises can increase the risk of injury and exacerbate symptoms. Instead, low-impact exercises such as swimming, yoga, and stretching are more suitable for improving muscle strength and overall fitness without causing undue stress on the body.

Choice B reason:

Teaching the client stress management techniques such as deep breathing and meditation is an important intervention for managing MS. Stress can exacerbate MS symptoms, so learning effective stress management strategies can help the client maintain better control over their condition and improve their quality of life.

Choice C reason:

Advising the client to avoid social interactions to minimize stress is not a healthy recommendation. Social support is crucial for mental and emotional well-being. Instead of avoiding social interactions, the client should be encouraged to engage in supportive and positive social activities that do not cause stress.

Choice D reason:

Encouraging the client to void every hour is not a standard intervention for MS unless the client has specific bladder control issues. Bladder training and scheduled voiding may be recommended for clients with urinary symptoms, but this should be tailored to the individual’s needs and not applied universally.