The nurse is planning care for a patient with an exacerbation of multiple sclerosis (MS). Which is the correct intervention for the nurse to include in the plan of care for bladder control?

Rationale:

A. While padding bed rails can reduce injury if a fall occurs, it does not actively prevent the patient from attempting to get out of bed or losing balance. It is a passive safety measure, not a primary fall-prevention strategy.

B. Physical restraints are not recommended for fall prevention due to the risk of injury, immobility, and psychological harm. Restraints may actually increase fall risk if patients struggle against them, and their use is regulated and reserved for emergency situations only.

C. Bed or chair alarms alert staff immediately when a high fall-risk patient attempts to get up unassisted, allowing timely intervention to prevent falls. This is an active safety measure that is evidence-based for patients with impaired mobility, weakness, or poor coordination, as often seen in MS exacerbations. Alarms support early recognition of risk behaviors while promoting patient independence.

D. Prolonged bed rest is not recommended because it can lead to deconditioning, muscle weakness, and further mobility deficits, which may increase fall risk over time. MS patients benefit from supervised mobility and activity as tolerated, combined with safety measures.

Rationale:

A. Glargine is a long-acting, basal insulin with a peakless effect. It is not suitable for acute hyperglycemic emergencies, such as diabetic ketoacidosis (DKA), because it does not act quickly enough to reduce dangerously high blood glucose levels.

B. Lispro is a rapid-acting insulin, but intramuscular injection is not standard; it is administered subcutaneously. IM absorption can be unpredictable and may not provide reliable glucose lowering in emergencies.

C. NPH is an intermediate-acting insulin with delayed onset (1–2 hours) and a peak at 4–12 hours. It cannot rapidly lower blood glucose in an acute hyperglycemic crisis, making it inappropriate for emergency management.

D. Regular insulin given IV acts immediately and can be titrated continuously to rapidly reduce blood glucose in emergencies like DKA. IV administration allows close monitoring of glucose and potassium levels and is considered the standard of care for acute hyperglycemic crises in hospitalized patients.