A nurse on a medical-surgical unit is receiving reports for four clients. Which of the following clients should the nurse assess first?

Rationale:
A. Encourage the client to eat a large meal in the evening: Clients with myasthenia gravis experience progressive muscle weakness, especially later in the day. Eating large evening meals increases the risk of fatigue and aspiration because muscle strength is reduced after activity.

B. Recommend the client eat within 45 min of taking cholinesterase-inhibitor medication: Cholinesterase inhibitors, such as pyridostigmine, enhance neuromuscular transmission and improve muscle strength. Eating within 45 minutes of taking the medication ensures optimal swallowing ability and reduces the risk of aspiration by aligning mealtime with peak effect.

C. Recommend the client extend their neck to facilitate swallowing: Extending the neck actually increases the risk of aspiration by opening the airway. Clients should be instructed to flex the neck slightly forward while swallowing to close the airway and promote safe swallowing mechanics.

D. Encourage the client to contact an occupational therapist to learn techniques of avoiding aspiration: While an occupational therapist can provide helpful adaptive techniques, primary aspiration prevention teaching should come directly from the nurse and speech-language pathologist.

Rationale for Correct Choices

• Pain medication: Fractures cause pain due to bone and soft tissue injury. Administering analgesics helps manage discomfort, improves cooperation with care, and facilitates movement and participation in activities as tolerated. Pain control also reduces stress responses that can interfere with healing.

• Limb immobilization: Nondisplaced midshaft fractures of the radius and ulna require immobilization using a cast or splint to maintain proper alignment, prevent further injury, and promote bone healing. Immobilization also supports neurovascular protection and decreases the risk of displacement.

Rationale for Incorrect Choices

• Skin traction: Skin traction is typically used for femur or lower limb fractures, not isolated forearm fractures, and is unnecessary for nondisplaced radius and ulna fractures.

• Antibiotics: The fracture is closed and nondisplaced, with no open wound or infection, so prophylactic antibiotics are not indicated.

• Surgical consultation: Surgery is usually reserved for displaced, unstable, or complex fractures. This nondisplaced fracture can be managed conservatively with immobilization.

• Bed rest: While rest is important, strict bed rest is unnecessary for upper extremity fractures. The child can perform limited activities while the arm is immobilized.