A nurse plans care for a client who has an external fixator on the lower leg. Which intervention would the nurse include in the plan of care to decrease the client’s risk for infection?

Choice A reason: Guiding a child to the floor during a seizure is unsafe, as it risks injury to both the child and nurse due to uncontrolled movements. Leaving to get help abandons the child, increasing injury risk during the seizure’s tonic-clonic phase.
Choice B reason: Moving objects away from a child during a tonic-clonic seizure prevents injury from striking hard surfaces. Generalized seizures cause uncontrolled muscle contractions, increasing the risk of trauma. Ensuring a safe environment is a priority to minimize harm during the seizure event.
Choice C reason: Inserting a tongue blade, even padded, risks dental injury or airway obstruction, as jaw clenching is common in tonic-clonic seizures. Current guidelines advise against placing objects in the mouth, as it does not prevent tongue biting and may cause harm.
Choice D reason: Restraining a child during a seizure can cause fractures or soft tissue injury due to forceful muscle contractions. It also increases stress and hypoxia risk. Allowing the seizure to occur while ensuring safety is the recommended approach to minimize complications.

Choice A reason: Bisphosphonates are generally safe for clients with diabetes and normal renal function (serum creatinine 0.8 mg/dL is within normal range, indicating adequate kidney function). These drugs inhibit osteoclast activity, reducing bone resorption, and are not contraindicated in diabetes unless renal impairment is present, which is not the case here.
Choice B reason: Vertebral compression fractures are a common complication of osteoporosis. Bisphosphonates are often prescribed to strengthen bones and prevent further fractures by inhibiting bone resorption. Recent fractures do not contraindicate their use; in fact, they are indicated to improve bone density and reduce future fracture risk.
Choice C reason: Calcium channel blockers, used for hypertension, do not interact significantly with bisphosphonates. These drugs work on different systems—bisphosphonates on bone metabolism and calcium channel blockers on vascular smooth muscle. There is no evidence suggesting this combination poses a risk, making bisphosphonates appropriate for this client.
Choice D reason: Bisphosphonates, especially oral ones, require patients to sit upright for 30–60 minutes post-dose to prevent esophageal irritation and ensure proper absorption. A client with a spinal cord injury unable to tolerate sitting up cannot comply with this requirement, increasing the risk of esophageal damage, making bisphosphonates a poor choice.