The nurse is creating a plan of care for a client who has a recent diagnosis of multiple sclerosis. Which of the following should the nurse include in the client’s care plan?

Choice B rationale
Patients who experience severe cluster headaches should be instructed to take medications as soon as they sense the onset of symptoms. Cluster headaches are characterized by severe, debilitating pain that reaches peak intensity within a short period of time, often within 15 minutes. Therefore, early intervention is crucial to manage the pain effectively.
Choice A rationale

Waiting twenty to thirty minutes after the onset of symptoms to take medications may not be effective for cluster headaches. The pain of a cluster headache often reaches peak intensity within 15 minutes, so delaying medication could result in unnecessary suffering.
Choice C rationale
Waiting until the patient’s pain becomes unbearable is not recommended for managing cluster headaches. The goal of treatment is to prevent or reduce pain, not to wait until it becomes unbearable.
Choice D rationale
Taking medications when the patient senses their symptoms are peaking is not the most effective strategy for managing cluster headaches. Given the rapid onset and severe pain associated with cluster headaches, medications should be taken as soon as the patient senses the onset of symptoms.

Choice A rationale
Postoperative delirium is a common condition that can occur in older patients after surgery, especially major procedures like hip arthroplasty. It is characterized by a sudden onset of confusion and altered consciousness. This type of delirium is indeed treatable and most patients’ cognition will return to its previous levels. The treatment often involves addressing the underlying causes, such as pain, medication effects, or metabolic imbalances, and providing supportive care. It’s important for the family to understand that this is a temporary condition and does not indicate a permanent change in their loved one’s mental status.
Choice B rationale
While anesthetics can contribute to postoperative delirium, the condition is usually multifactorial and not solely due to the anesthetic used in surgery. Therefore, administering antidotes to the anesthetic is not typically how postoperative delirium is managed. Instead, the focus is on treating the underlying causes and providing supportive care.
Choice C rationale

Delirium does involve a disturbance in cognition, including memory impairment, but it does not involve a progressive decline in memory loss and overall cognitive function. That description is more characteristic of dementia, a different condition. Delirium is typically a temporary condition that improves once the underlying cause is addressed.
Choice D rationale
While postoperative delirium is often self-limiting, meaning it resolves on its own over time, it is not accurate to say there is nothing to worry about. Postoperative delirium can be distressing for the patient and their family, and in some cases, it can be associated with longer hospital stays and increased morbidity. Therefore, it is a condition that should be taken seriously and managed appropriately.