Multiple Sclerosis In Class Assignment

A Nurse is caring for a client who is experiencing trouble with coordination and balance, spastic muscles and tingling in the extremities. This client is most likely suffering From... A) Multiple Sclerosis B) Myasthenia Gravis C) Guillain Barre Syndrome D) Fibromyalgia

Answer: A) Multiple sclerosis ¡Rationale: Multiple sclerosis is caused by a deterioration of the myelin sheath and is characterized by fatigue, tremors, weakness, bowel and bladder dysfunction and muscle spasticity.

A client has MS of the relapsing-remitting type. What clinical course of the disease should the nurse expect in this client? ¡A) An absence of periods of remission ¡B) Attacks become increasingly frequent. ¡C) Absence of active disease manifestations. ¡D) Gradual neurologic symptoms without remission.

Answer: B ¡Rationale: The classic picture of relapsing-remitting MS is characterized by increasingly frequent attacks.

Which clinical manifestations would serve to alert the nurse to early onset of MS? ¡A) Hyperresponsive reflexes ¡B) Excessive somnolence ¡C) Nystagmus and ataxia ¡D) Heat intolerance

Answer: C ¡Rationale: Early signs and symptoms of MS include changes in motor skills, vision and sensation.

A client with MS has been treat for 6 months with Mitoxantrone (Novantrone). What clinical manifestation would alert the nurse to an adverse effect of this medication A) Periorbital edema B) Black, tarry stools C) Crackles in the lungs D) Nausea and vomiting after meals

Answer: C Crackles in the LUngs Rationale: Atineoplastic agent that can cause cardiotoxicity when used for long periods. Adverse effects are CHF and dysrhythmias.

The nurse is caring for a client who is newly diagnosed with multiple sclerosis. Which of the following is appropriate teaching for this client? ¡A) "If you are compliant with your treatment regimen, there is a chance this will resolve completely." ¡B) "You may notice you start to walk by shuffling, or move your hands like you're rolling a pill. That is normal. " ¡C) "Make sure you are getting good fluid intake, around 2 L per day." ¡D) "Here is a list of foods containing rye, barley, and oats. You must not consume these if you want to avoid flare ups."

Answer: C) "Make sure you are getting good fluid intake, around 2L/Day." ¡Rationale: Multiple sclerosis can cause incontinence, and this is difficult to cope with. Many clients with MS will drink less to avoid episodes of incontinence, but this leads to dehydration and constipation. The client with MS must be taught to continue adequate fluid intake.

Which statement concerning the pathophysiology of multiple sclerosis is true? ¡A) Poor cellular repair mechanisms support the proliferation of dysfunctional neurons. ¡B) The autoimmune response causes damage to unmyelinated nerve fibers. ¡C) Degeneration of axonal bodies interferes with signal transmission. ¡D) Damage to the myelin sheath causes an inflammatory response.

Answer: D) Damage to the myelin sheath causes an inflammatory response. ¡Rationale: In MS, the myelin sheath is damaged leading to an inflammatory response.

A client diagnosed with multiple sclerosis​ (MS) tells the nurse about exploring complementary health practices to help deal with the MS. Which health practice should concern the nurse​ most? Acupuncture ​Low-dose naltrexone Bee venom therapy Therapeutic horseback riding

Correct! Bee venom therapy Rationale: Bee venom therapy carries more risk​ (due to anaphylactic​ shock) to the client than​ benefit, so it is the therapy that most concerns the nurse. Therapeutic horseback riding and acupuncture have low risk and may be beneficial for some clients and for some symptoms.​ Low-dose naltrexone has been shown to improve quality of​ life, but has no impact on physical symptoms. It should not concern the nurse.

The nurse is preparing to teach about the manifestations of multiple sclerosis to a client newly diagnosed with the disease. Which manifestation should the nurse include in this​ teaching? Fever Frequent dry cough Difficulty chewing Hypertension

Correct! Difficulty chewing ​Rationale: A common manifestation of multiple sclerosis is difficulty​ chewing; it should be included in client teaching. Frequent dry​ cough, fever, and hypertension are not manifestations of multiple sclerosis.

The nurse caring for a client diagnosed with multiple sclerosis​ (MS) identifies a goal of promoting​ self-care. Which intervention should the nurse​ include? Encourage the client to wear arm or wrist braces. Teach the client to perform​ self-care activities at the end of the day. Teach the client to limit fluid intake. Encourage the client to take responsibility for all food preparation duties.

Correct! Encourage the client to wear arm or wrist braces. ​Rationale: Maintaining independence with​ self-care is important for the client with MS because it promotes a positive​ self-image and encourages participation in social activities. Encouraging the client to wear or use assistive devices as necessary promotes independence. Wearing arm or wrist braces provides stability during​ self-care activities.​ Self-care activities should be performed when energy levels are​ high, not at the end of the day when the client is fatigued. Receiving assistance with food preparation can promote independence with other activities of daily living​ (ADLs). Clients should consume adequate fluid​ intake, not limit fluids.

The nurse is teaching a client diagnosed with multiple sclerosis​ (MS) about the factors that may precipitate a relapse. Which factor should the nurse​ include? (Select all that​ apply.) Constipation Increases in body temperature Fatigue Stress Acetaminophen use

Correct! Increases in body temperature Correct! Fatigue Correct! Stress ​Rationale: While there are no common triggers for relapses in​ MS, several factors such as​ stress, fatigue, and increases in body temperature may influence a relapse. MS may cause​ constipation; it is not a cause of a relapse. Acetaminophen may be used to reduce body temperature to prevent a​ relapse; however, it does not cause a relapse in symptoms.

A client with multiple sclerosis reports difficulty walking. Which collaborative therapy should the nurse​ request? Physical therapy Cognitive therapy Speech therapy Occupational therapy

Correct! Physical therapy ​Rationale: Physical therapy helps clients with​ walking, strength, and balance issues. Occupational therapy enhances independence and activities dealing with activities of daily living​ (ADLs). Speech therapy is used for speech or swallowing problems. Cognitive therapy treats changes in the ability to​ think, reason,​ concentrate, and remember.

The nurse conducts discharge planning for a client diagnosed with multiple sclerosis​ (MS). Which intervention should the nurse​ include? (Select all that​ apply). Teaching of good body mechanics Assessment of home safety Arrangement for pastoral care consultation Teaching of a bladder training program Instruction for a low​ fat, low salt diet

Correct! Teaching of good body mechanics Correct! Assessment of home safety Correct! Teaching of a bladder training program ​Rationale: Before discharging a client diagnosed with​ MS, the nurse should conduct a home safety assessment to determine the​ client's ability to function safely at home and to evaluate the need for any assistance at home. The nurse should also teach the client the basics of good body mechanics to prevent injuries and a​ bladder-training program to help the client remain continent. Arranging for a pastoral care consult and instruction for a low​ fat, low salt diet are not appropriate interventions for a client diagnosed with MS.

A client presents with double vision and increasing weakness in the lower extremities. Which additional information should lead the nurse to expect that diagnostic testing for multiple sclerosis​ (MS) will be​ ordered? The client reports previous​ episodes, each lasting​ 1-day, and then no problems for at least 1 month. The client reports episodes of rapid heart rate during periods of weakness in the lower extremities. The client reports increasing manifestations over the past week. The client reports pain in the lower back for the past few days.

Correct! The client reports previous​ episodes, each lasting​ 1-day, and then no problems for at least 1 month. ​Rationale: MS can cause episodes lasting for more than 24​ hours, and the episodes occur more than 1 month apart.​ 1-week duration is too short to suspect multiple​ sclerosis; MS is diagnosed from manifestations that last over a period of​ months; the client reports are not necessarily consistent with multiple sclerosis. MS does not cause a rapid heart rate. The client could be describing a cardiac disorder that is causing weakness from decreased cardiac output. Back pain for a few days is more consistent with a back injury. The weakness in the legs could be from MS or from a back injury.

The nurse formulates the plan of care for a client diagnosed with multiple sclerosis​ (MS). The client stays up late at​ night, takes long hot​ showers, sleeps in a cool​ bedroom, loves fresh air all year​ round, and naps after lunch. Which lifestyle changes should the nurse suggest for the​ client? Keeping night hours Eliminating the​ post-lunch nap Turning the bedroom heat off and opening the windows Turning down the​ shower's temperature

Correct! Turning down the​ shower's temperature ​Rationale: Temperature extremes should be avoided by the client with​ MS, so the client should have a​ warm, not​ hot, shower. A heated bedroom with closed windows might help with MS symptoms. Rest is essential to fight​ fatigue, so the client should keep the​ post-lunch nap. Rather than continuing to keep night​ hours, the client might find that getting things done in the morning hours is easier.

A client has been diagnosed with​ relapsing-remitting multiple sclerosis​ (MS). Which statement by the nurse most accurately explains to the client the onset of symptoms with this type of​ MS? ​"Symptoms will not develop for at least several years after​ diagnosis." ​"Symptoms will become progressively worse with periods of​ flare-ups." ​"Symptoms will develop​ slowly, but continuously with no periods of​ remission." ​"Symptoms will flare up at​ times, with periods of partial or complete​ remission."

Correct! ​"Symptoms will flare up at​ times, with periods of partial or complete​ remission." ​Rationale: A client with​ relapsing-remitting MS will experience periods of​ flare-ups followed by periods of partial or complete remission. Clients experience slow but continuous worsening of disease with no remissions with​ primary-progressive MS. Clients experience progressive worsening of the disease with periods of​ flare-ups with​ progressive-relapsing MS. Symptoms of MS typically develop​ immediately, not several years after diagnosis.

A young woman with multiple sclerosis is planning to get pregnant. She asks the​ nurse, "What are the​ risks?" Which response by the nurse is​ correct? ​"You should plan to have difficulty getting​ pregnant." ​"Pregnancy may cause your disease to progress​ faster." ​"The drug treatment you are on may be harmful to the​ fetus." ​"You may have exacerbations during your last​ trimester."

Correct! ​"The drug treatment you are on may be harmful to the​ fetus." Rationale: Pharmacologic treatment of MS involves drugs that may be harmful to a fetus. Evidence suggests that pregnancy does not influence the overall course of​ disease, and MS does not affect a​ woman's ability to become pregnant. Pregnant women are usually protected from exacerbations during the second and third​ trimester, but they have a 20-​40% risk of developing a​ flare-up in the first 6 months postpartum.