The nurse is caring for a client with a history of multiple sclerosis. Which intervention should the nurse prioritize?

Assist with mobility and safety measures

Encourage high-sodium diet

Restrict physical therapy

Promote bed rest

Answer and Explanation

The Correct Answer is A

Choice A reason: Assisting with mobility and safety is critical in multiple sclerosis, as muscle weakness and spasticity increase fall risk. Physical therapy and assistive devices enhance safety, reducing injury risk, making it the priority intervention to maintain independence and prevent complications like fractures.

Choice B reason: A high-sodium diet is inappropriate, as it may exacerbate fluid retention, unrelated to multiple sclerosis. Mobility assistance is the priority, as falls are a significant risk due to neurological deficits, making dietary sodium irrelevant to primary symptom management.

Choice C reason: Restricting physical therapy worsens mobility and spasticity in multiple sclerosis. Assisting with mobility and safety is critical, as it prevents falls and maintains function, making therapy restriction counterproductive, as exercise supports neurological health and independence.

Choice D reason: Promoting bed rest increases muscle atrophy and spasticity in multiple sclerosis. Mobility and safety measures are essential, as they reduce fall risk and maintain function, making bed rest detrimental to managing neurological symptoms and overall patient well-being.

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Correct Answer is D

Explanation

Choice A reason: Chronic constipation and serum gastrin levels are not directly relevant to acute pancreatitis. Constipation may indicate gastrointestinal issues, but gastrin primarily relates to gastric acid secretion. These do not confirm pancreatitis or guide acute management, unlike amylase levels, which are diagnostic for pancreatic inflammation.

Choice B reason: Helicobacter pylori antibodies indicate gastric infection, unrelated to pancreatitis, which involves pancreatic inflammation. Urine output is a general vital sign but not specific to pancreatitis diagnosis. Amylase and symptom severity are more critical for confirming and managing acute pancreatitis, making this less valuable.

Choice C reason: Bowel sounds and abdominal pain degree provide general information but are nonspecific. Pain is expected in pancreatitis, and bowel sounds may vary. Serum amylase and nausea/vomiting severity are more diagnostic, directly reflecting pancreatic inflammation and its systemic effects, making them more critical to report.

Choice D reason: Serum amylase levels are a key diagnostic marker for acute pancreatitis, as pancreatic inflammation releases amylase into the blood. Severity of nausea and vomiting reflects disease impact and fluid loss, guiding treatment. These are the most valuable data for reporting, as they confirm diagnosis and inform management.

A. Monitor heart rate and rhythm B. Encourage high-calorie snacks C. Administer supplemental oxygen D. Restrict fluid intake

Correct Answer is A

Explanation

Choice A reason: Hyperthyroidism increases metabolic rate, causing tachycardia and potential arrhythmias due to elevated thyroid hormone levels stimulating cardiac beta-receptors. Monitoring heart rate and rhythm is critical to detect cardiovascular complications, guiding urgent treatment to prevent heart failure or atrial fibrillation.

Choice B reason: High-calorie snacks address weight loss in hyperthyroidism but are secondary to cardiovascular risks. Tachycardia and arrhythmias pose immediate threats, making heart rate monitoring the priority, as uncontrolled hyperthyroidism can lead to life-threatening cardiac events before nutritional needs are addressed.

Choice C reason: Supplemental oxygen is not routinely needed in hyperthyroidism unless respiratory distress occurs, which is rare. Elevated heart rate and arrhythmias are more immediate concerns, as hyperthyroidism’s cardiac effects are primary, making heart monitoring critical to prevent acute cardiovascular complications.

Choice D reason: Restricting fluid intake is inappropriate, as hyperthyroidism increases metabolism, risking dehydration. Heart rate monitoring is prioritized, as tachycardia and arrhythmias are direct, life-threatening effects of excess thyroid hormone, requiring immediate assessment to guide antithyroid therapy and prevent cardiac crises.

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The nurse is caring for a client with a history of multiple sclerosis. Which intervention should the nurse prioritize?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client presents to the emergency department with acute abdominal pain and a provisional diagnosis of pancreatitis. The client reports nausea and vomiting from laboratory studies. Which information is most valuable in reporting the client’s status to the healthcare provider?

Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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