The client diagnosed with multiple sclerosis (MS) is at risk for fatigue. Which priority intervention would the nurse implement to address this issue?

Schedule activities late in day and in the evening

Provide supplemental oxygen when fatigued

Teach the importance of hot showers to help relax

Have the client prioritize activities for the day

Answer and Explanation

The Correct Answer is D

A. Schedule activities late in the day and in the evening:

Scheduling activities late in the day is not an ideal approach for managing fatigue in clients with MS. Fatigue typically worsens as the day progresses, and clients with MS often experience more energy depletion in the late afternoon and evening. Therefore, the best time to schedule demanding activities is earlier in the day when the client may have more energy. Scheduling strenuous tasks late in the day may exacerbate fatigue and lead to physical and emotional exhaustion.

B. Provide supplemental oxygen when fatigued:

While oxygen therapy is appropriate for clients with respiratory issues or other conditions that affect oxygenation, it is not the most relevant intervention for addressing fatigue in MS. Fatigue in MS is primarily caused by neurological factors, muscle weakness, or impaired mobility, not by a lack of oxygen. The priority for MS-related fatigue is managing energy levels through activity planning and rest, not providing supplemental oxygen unless there is a specific indication of respiratory distress or hypoxia.

C. Teach the importance of hot showers to help relax:

Hot showers may help some individuals relax, but they are not the best intervention for managing fatigue in MS. In fact, heat can sometimes worsen symptoms in clients with MS, a phenomenon known as Uhthoff’s phenomenon, where heat increases neurological symptoms such as muscle weakness, fatigue, or visual disturbances. It is important to educate clients to avoid overheating, which could exacerbate fatigue or other symptoms. Instead, clients should focus on rest, energy conservation, and temperature regulation.

D. Have the client prioritize activities for the day: Fatigue is a common and debilitating symptom in clients with multiple sclerosis (MS), and it can significantly affect their daily functioning. One of the most effective interventions for managing fatigue in MS is to encourage the client to prioritize activities and manage their energy levels throughout the day. By scheduling the most important or demanding tasks earlier in the day when energy levels tend to be higher, clients can conserve energy for essential activities. Additionally, teaching clients to break tasks into smaller, manageable steps and incorporating frequent rest periods can help minimize fatigue and prevent overexertion. Prioritizing activities ensures that the client is not overwhelmed and can still maintain independence while managing their symptoms effectively.

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Correct Answer is B

Explanation

A. Partially compensated metabolic alkalosis:
Metabolic alkalosis is characterized by elevated bicarbonate levels (HCO3), but in this case, the HCO3 is elevated (29 mEq/L), which suggests alkalosis. However, the PaCO2 is elevated at 47 mmHg, which is more consistent with a respiratory problem. A fully or partially compensated metabolic alkalosis would show a normal or low PaCO2 (due to respiratory compensation). Therefore, this option does not fit the ABG results.

B. Partially compensated respiratory acidosis: In this case, the pH is 7.17, which is low and indicates acidosis. The PaCO2 is 47 mmHg, which is elevated (normal range: 35-45 mmHg), indicating that the respiratory system is contributing to the acidosis. The HCO3 is 29 mEq/L, which is elevated (normal range: 22-26 mEq/L), suggesting a compensatory response from the kidneys to retain bicarbonate in an attempt to buffer the acidosis. Since the pH is still below normal and has not yet returned to the normal range (7.35-7.45), this suggests that the compensation is partial and the primary issue is respiratory acidosis.

C. Fully compensated metabolic alkalosis:
This answer is incorrect because metabolic alkalosis is not the primary disturbance here. Also, for a condition to be fully compensated, the pH would need to be within the normal range (7.35-7.45). Since the pH is 7.17, the condition is not fully compensated.

D. Fully compensated respiratory acidosis:
For fully compensated respiratory acidosis, the pH should be within the normal range, as the kidneys would have fully compensated for the elevated PaCO2. Since the pH is 7.17, this is a sign of partial compensation, not full compensation. Therefore, this option is incorrect.

A. Suction the client as needed B. Administer pantoprazole sodium IV C. Apply sequential compression device (SCD) D. Perform oral care with chlorhexidine

Correct Answer is A

Explanation

A. Suction the client as needed: Suctioning is an essential nursing intervention for clients on mechanical ventilation to maintain effective ventilation. Ventilated clients are at risk for accumulating secretions in the airway, which can obstruct the endotracheal tube or tracheostomy, impairing ventilation and oxygenation. Regular or as-needed suctioning helps to clear secretions, ensuring that the airway remains patent and effective ventilation is maintained. This intervention directly supports the goal of maintaining optimal respiratory function and preventing complications such as atelectasis, pneumonia, or hypoxia.

B. Administer pantoprazole sodium IV: Pantoprazole is a proton pump inhibitor used to decrease stomach acid, typically to prevent stress ulcers in critically ill patients. While this is an important aspect of care for preventing gastrointestinal complications in ventilated patients, it does not directly support ventilation. Therefore, administering pantoprazole is not as directly related to ensuring effective ventilation as suctioning or other respiratory interventions.

C. Apply sequential compression device (SCD): While applying an SCD is important for preventing deep vein thrombosis (DVT) and promoting circulation in immobile patients, it does not directly address the client's ventilation or respiratory function. This intervention is more relevant for preventing venous thromboembolism, not for managing ventilation or airway clearance.

D. Perform oral care with chlorhexidine: Oral care with chlorhexidine is an important practice to reduce the risk of ventilator-associated pneumonia (VAP) and promote overall oral hygiene. It helps decrease the colonization of bacteria in the mouth and reduces the risk of infection. However, while oral care is an essential component of care for a ventilated patient, suctioning directly addresses the goal of effective ventilation by maintaining airway patency, making it the most immediate and relevant intervention for supporting ventilation.

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The client diagnosed with multiple sclerosis (MS) is at risk for fatigue. Which priority intervention would the nurse implement to address this issue?

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