An older aphasic client has severe osteoarthritis, bilateral contractures of the lower extremities, and a stage IV pressure ulcer. The nurse practitioner prescribes analgesic medications to be administered around-the-clock, with as-needed doses to be administered as appropriate. What observation by the nurse would indicate that the pain regimen is effective? (Select all that apply.)

Choice A reason: A licensed practical nurse is qualified to care for the feet of a client with diabetes is false because foot care for people with diabetes requires specialized training and skills that are beyond the scope of practice of a licensed practical nurse. A registered nurse or a podiatrist should provide foot care for people with diabetes, as they can assess, treat, and prevent foot problems such as ulcers, infections, or nerve damage.

Choice B reason: Onychomycosis is quickly eradicated with antifungal creams or powders is false because onychomycosis, or fungal nail infection, is a stubborn and persistent condition that can take months or years to clear. Antifungal creams or powders are usually not effective for onychomycosis, as they cannot penetrate the nail plate. Oral antifungal medication or laser therapy may be needed to treat onychomycosis.

Choice C reason: Maintaining oral hydration may reduce the incidence of xerosis is true because xerosis, or dry skin, is a common problem for older adults, as their skin produces less oil and moisture. Drinking enough fluids can help hydrate the skin and prevent dryness, itching, cracking, or infection. The recommended fluid intake for older adults is 2400 mL/day, according to the National Council on Aging.

Choice D reason: Ram’s-horn nail should be cut to give a smooth, rounded edge is false because ram’s-horn nail, or onychogryphosis, is a condition where the nail becomes thickened, curved, and distorted. Cutting the nail can be difficult and painful, and may cause bleeding or infection. A podiatrist should trim and file the nail, and treat any underlying causes of the condition.

Choice A reason: Risk for injury is a potential nursing diagnosis for a client who recently experienced a stroke, but it is not the priority. Risk for injury is related to the possible complications of stroke, such as hemiparesis, hemiplegia, dysphagia, or sensory deficits, that may increase the risk of falls, aspiration, or pressure ulcers. However, these complications are secondary to the primary problem of altered cerebral perfusion, which is the cause of stroke.

Choice B reason: Altered cerebral perfusion is the priority nursing diagnosis for a client who recently experienced a stroke, because it is the most urgent and life-threatening problem. Altered cerebral perfusion is defined as a decrease in blood flow to the brain, which can result in ischemia, infarction, or hemorrhage of the brain tissue. This can lead to irreversible neurological damage, disability, or death. Therefore, the nurse should focus on restoring and maintaining adequate cerebral perfusion as the first priority.