Answer to Question 1
Answer: A
Diazepam (Valium) is a muscle relaxant commonly used for clients with multiple sclerosis. Diazepam (Valium) does not cause muscle weakness. Evidence of medication effectiveness would be an observed reduction in muscle spasticity. Glucose intolerance would be assessed if the client were prescribed an adrenal corticosteroid. Cataract development is also a side effect of adrenal corticosteroids.
Answer to Question 2
Answer: A
The nurse observed the client independently transfer from the bed to a motorized wheelchair, apply splints, and enter the bathroom to perform morning self-care. This is evidence that the client uses assistive devices to optimize autonomy. The statement Client is reliant upon assistive devices for independence indicates that the client is not autonomous. The statement Client is dependent upon assistive devices also indicates the client is not autonomous. The statement Client needs instruction to conduct morning care before applying splints to lower extremities does not take into consideration the client's preference, which might be to apply the splints before doing self-care.
Finding an unknown side of a triangle
Areas of sclerosis (see arrows) in the white matter of a patient with MS.
Example of simplified note for one-time client.
Client and therapist positioning for foot reflexology.
Inspection of client
Approaching the client for the ophthalmoscopic exam