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The nurse is preparing a client with multiple sclerosis (MS) for discharge from the hospital to home. The nurse should tell the client:
- A. You will need to accept the necessity for a quiet and inactive lifestyle.
- B. Keep active, use stress reduction strategies, and avoid fatigue.
- C. Follow good health habits to change the course of the disease.
- D. Practice using the mechanical aids that you will need when future disabilities arise.
Correct Answer: B
Rationale: Encouraging activity, stress reduction, and fatigue management is essential for maintaining quality of life in MS. A completely inactive lifestyle is not recommended.
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Which assessment finding may indicate a stroke?
- A. Sudden weakness on one side of the body, difficulty speaking, or confusion.
- B. Steady gait and normal muscle strength.
- C. Clear, intact sensation in all extremities.
- D. Symmetrical deep tendon reflexes.
Correct Answer: A
Rationale: Sudden weakness, difficulty speaking, or confusion are hallmark signs of a stroke. Steady gait, intact sensation, and symmetrical reflexes are normal findings.
Which of the following would describe the discomfort experienced by a client with a tension headache?
- A. A heavy feeling over the frontal region
- B. and sensitivity to light
- C. Pressure or steady constriction on both sides of the head
- D. Headache and temporary unilateral paralysis
Correct Answer: B
Rationale: Tension headaches often feel like a tight band around the head.
Mrs. Aster occasionally has pain and stiffness in her hand and fingers. Which of the following nursing measures would most effectively ease her discomfort?
- A. Wrapping her hands in a heating pad
- B. Placing a hot water bottle on top of her hands
- C. Immersing her hands in comfortably hot water
- D. Extending her hands over a heat source, e.g., register or stove
Correct Answer: C
Rationale: Immersion in warm water provides even heat distribution, reducing stiffness and pain.
Mrs. Moore is a client with Parkinson disease. The nurse can anticipate that Mrs. Moore's major nursing needs will be
- A. monitoring for seizures
- B. decreasing pain tolerance
- C. assisting with activities of daily living
- D. preventing diarrhea
Correct Answer: C
Rationale: Parkinson's disease affects motor skills, requiring assistance with daily activities.
With regard to myotomal nerve supply
- A. opponens pollicis is C8
- B. shoulder abduction is C5, 6
- C. ankle plantar flexion is L4, 5
- D. elbow extension is C7, 8
Correct Answer: B
Rationale: Shoulder abduction is primarily controlled by the C5 and C6 nerve roots, which innervate the deltoid and supraspinatus muscles.