A nurse is providing care for clients on a medical-surgical unit.
Which of the following clients should the nurse identify as being at risk for the development of pressure ulcers? (Select all that apply.)

Choice A rationale

Maintaining a recommended body weight is crucial for managing osteoarthritis as excess weight places additional stress on weight-bearing joints like the hips and knees, accelerating cartilage breakdown and increasing pain. Reducing this mechanical stress can slow the progression of the disease and alleviate symptoms. A healthy Body Mass Index (BMI) is generally considered to be between 18.5 and 24.9 kg/m².

Choice B rationale

Applying ice to the joint before exercising is generally not recommended for osteoarthritis. While ice can help reduce inflammation and pain after exercise or during acute flares, applying it before exercise can stiffen the joint and potentially hinder movement, increasing the risk of injury. Heat application is often preferred before exercise to warm up the muscles and tissues around the joint, improving flexibility.

Choice C rationale

Reducing the amount of purine in the diet is a primary recommendation for managing gout, a type of arthritis caused by the buildup of uric acid crystals in the joints. Purines are substances found in certain foods that break down into uric acid. Osteoarthritis, however, is a degenerative joint disease not directly related to purine metabolism or uric acid levels.

Choice D rationale

There is insufficient scientific evidence to support the use of Echinacea for managing joint pain associated with osteoarthritis. Echinacea is an herb primarily known for its potential immune-boosting properties and is often used for colds and flu. Its efficacy in treating the underlying mechanisms or symptoms of osteoarthritis has not been established through rigorous clinical trials.

Choice A rationale

Prednisone, a corticosteroid, can decrease calcium absorption in the gut and increase calcium excretion by the kidneys. Long-term use can lead to bone demineralization and osteoporosis. Vitamin D is essential for calcium absorption, so supplementation helps mitigate these effects and maintain bone health. Normal serum calcium levels range from 8.5 to 10.5 mg/dL.

Choice B rationale

Pantothenic acid (vitamin B5) is involved in various metabolic processes, and vitamin B6 is crucial for protein metabolism and nerve function. While important for overall health, there is no direct established link requiring their supplementation specifically due to prednisone therapy.

Choice C rationale

Biotin (vitamin B7) is involved in carbohydrate and fat metabolism, and vitamin B12 is essential for red blood cell formation and nerve function. There is no strong scientific evidence indicating a specific need for biotin and vitamin B12 supplementation during long-term prednisone treatment.

Choice D rationale

Folic acid (vitamin B9) is important for cell growth and DNA synthesis, and vitamin C (ascorbic acid) is an antioxidant involved in immune function and collagen synthesis. While beneficial for overall health, their supplementation is not specifically indicated to counteract the side effects of long-term prednisone therapy.