nur 116 - Davis Advantage / Edge - Multiple Sclerosis

Sharon is prescribed a corticosteroid while in the hospital. She tells the nurse, "I hate that medication. It makes me feel like I'm crazy. Why is it needed?" What rationale should the nurse provide? "It suppresses your adrenal gland so it doesn't have to work as hard." "It decreases the inflammatory and immunologic factors involved in the exacerbation." "It provides an increased glucose level so you won't become hypoglycemic." "We can give you something if you feel crazy."

"It decreases the inflammatory and immunologic factors involved in the exacerbation." CORRECT. Strategies used to treat attacks include corticosteroids and plasma exchange (plasmapheresis) to decrease the inflammatory and immunologic factors involved in the exacerbation.

Which statements reflect accurate information related to multiple sclerosis? Select all that apply. -Acute disorder of the peripheral nervous system -Chronic, progressive autoimmune disorder -Equal presentation in males and females -Increased prevalence seen in colder climates -Seen more in Caucasians as compared with Hispanic-Americans

-Chronic, progressive autoimmune disorder. -Increased prevalence seen in colder climates -Seen more in Caucasians as compared with Hispanic-Americans

The nurse is caring for a patient diagnosed with autonomic dysreflexia (AD). Which action performed by the nurse indicates a need for correction? Placing an indwelling urinary catheter in the patient Applying antiembolism stockings on the patient Monitoring the patient's blood pressure every 5 minutes Checking the patient's body for the presence of pressure ulcers

Applying antiembolism stockings on the patient Rationale: Applying antiembolism stockings should help prevent pooling of blood in the patient's lower extremities and reduce blood pressure, which may be the source of an episode of AD. Test Taking Tips: Look for the incorrect answer.

Which complication may be associated with multiple sclerosis syndrome? Ascending paralysis leading to respiratory failure Bladder dysfunction Superficial thrombophlebitis Contact dermatitis

Bladder dysfunction

The nurse is observing a patient with a history of multiple sclerosis. Which of the following findings would the nurse note as being associated with the disease process? -Hypertension -Ankle clonus -Steady gait -Blurred vision

Blurred vision

What is the goal of medication therapy, such as beta interferon, when used in the treatment of multiple sclerosis? Modify the course of disease progression Prevent the development of blood clots Treat clinical symptoms of spasticity Help to maintain core temperature

Modify the course of disease progression

A client with multiple sclerosis is most likely to benefit from what type of therapy in the treatment of muscle spasticity symptoms? Muscle relaxants Increased fluid intake Corticosteroids Analgesics

Muscle relaxants

When performing laboratory testing, which test would be ordered to rule out the possibility of other infectious or inflammatory disorders in the differential diagnosis of multiple sclerosis? -Angiotensin-converting enzyme to detect the presence of Lyme disease -Antinuclear antibodies to confirm the presence of sarcoidosis -Erythrocyte sedimentation rate to detect vitamin B12 deficiency -Rapid plasma reagin to detect neurosyphilis

Rapid plasma reagin to detect neurosyphilis

Which finding leads the nurse to believe that additional education on managing the disease is required for this client? Use of cane assistive device to support ambulation Taking a hot bath at bedtime to relax Working out in a gym once a week with a personal trainer Increasing intake of fresh fruits and vegetables

Taking a hot bath at bedtime to relax CORRECT. Decreased sensation secondary to demyelination makes the patient at risk of burn injuries if the water is too hot. They may also be heat-sensitive and feel that heat makes them feel limp and more fatigued.

The nurse is working with a client who has recently been diagnosed with multiple sclerosis and is now being discharged from the hospital setting. What advice would you provide to the client to prevent possible flare-ups of the disease process? "Make sure to get adequate rest." "Keep your home warm and humid." "Power through stressful situations and life events." "Diet does not affect your disorder."

"Make sure to get adequate rest."

Sharon, a 58-year-old female client, presents to the hospital with an exacerbation of multiple sclerosis (MS) symptoms. She was diagnosed with the disease 4 years ago after noticing some unusual muscle movement and weakness. She continues to work full-time so that she can maintain her health insurance coverage for herself and her two sons in college. In performing the health admission assessment, the nurse identifies several abnormalities. Which clinical symptoms are associated with MS? Select all that apply. Migraine headache Bladder infection Hypertension Numbness in legs Increased thirst

Bladder infection Numbness in legs CORRECT. Clients with MS are likely to experience alterations in bladder function that can lead to an infection. The disease's demyelination process can cause sensory deficits, including numbness in the extremities. The other choices are not usually associated directly with MS.

This nurse is caring for a patient with this stabilization device. What is the nurse's priority action to prevent complications? Administer pain medications. Clean pins to prevent infection. Confirm that weights are hanging freely. Monitor for bleeding at pin sites.

Clean pins to prevent infection. Rationale: Pin site infections occur in approximately 20% of patients with a halo vest. The sites must be frequently assessed for signs of infection and site care provided. Test Taking Tips: An invasive device has a risk for infection.

A patient is diagnosed with amyotrophic lateral sclerosis (ALS) characterized by flaccidity. Which complication is associated with this? Dementia Dysphagia Lower back pain Slurred speech

Lower back pain Rationale: Lower back pain in patients diagnosed with ALS is caused by damage to lower motor neurons, which is characterized by flaccidity. Test Taking Tips: Consider symptoms of amyotrophic lateral sclerosis (ALS).

Which spinal cord disorder is characterized by the buildup of scar tissue or plaques? Multiple sclerosis (MS) Spinal cord tumors Herniated nucleus pulposus Amyotrophic lateral sclerosis (ALS)

Multiple sclerosis (MS) Rationale: MS is a chronic neurological disorder in which the nerves of the central nervous system degenerate. It is characterized by the buildup of scar tissue (sclerosis) or plaques that are formed during the process of demyelination. Test Taking Tips: Differentiate spinal conditions.

Sharon is now experiencing increased muscle spasticity. Which medication can be added to the treatment plan to help alleviate this clinical symptom? Corticosteroids Bronchodilators Muscle relaxants Pain analgesics

Muscle relaxants CORRECT. Muscle relaxants are typically used to treat muscle spasms for MS clients. Corticosteroids are used for treatment of inflammatory effects. Bronchodilators are not indicated in the treatment plan for MS. Pain analgesics provide pain relief but do not alleviate muscle spasticity.

Which client presentation is indicative of a clinical diagnosis of multiple sclerosis? Hearing loss Numbness or weakness in at least one limb Nasal congestion Petechiae

Numbness or weakness in at least one limb

Sharon returns to the provider a month later and reports the diplopia is getting worse. What intervention can the nurse suggest? Stand slowly with eyes closed. Place a patch over one eye or the other each day. Ask the provider for steroid eye drops. Ask eye doctor for a contact lens adjustment.

Place a patch over one eye or the other each day. CORRECT. For the person experiencing diplopia, using a patch on each eye daily as can decrease the symptoms. The client should alternate the patching of each eye several times per day, which can improve balance and vision

Which type of multiple sclerosis (MS) is characterized by the gradual progression of symptoms without remissions? Relapsing remitting Primary progressive Progressive relapsing Secondary progressive The life span of RBCs in the patient is 15 to 20 days.

Primary progressive The life span of RBCs in the patient is 15 to 20 days. Rationale: The primary progressive type of MS is characterized by gradual progression of symptoms with no remissions; however, there may be temporary plateaus. Rationale: The normal life span of an RBC is 120 days, whereas in an individual with SCD, the normal life span is only 15 to 20 days. Test Taking Tips: Differentiate types of multiple sclerosis (MS).

The nurse is teaching about monitoring for clinical manifestations when assessing spinal shock in a patient. Which statement indicates effective teaching? Select all that apply. "The patient would have low urine output." "The patient would have improper digestion." "The patient would have low blood pressure." "The patient would have a decreased heart rate." "The patient would not show reflexes if tapped on the knee."

"The patient would have low urine output." "The patient would have improper digestion." "The patient would not show reflexes if tapped on the knee." Rationale: In spinal shock, the patient will manifest hypotension as a result of vasodilation. Rationale: A patient who has spinal shock would manifest symptoms such as paralytic ileus, which impairs movement through the intestines. Rationale: In spinal shock, the patient would not respond reflexively. Test Taking Tips: Look for the correct responses.

Which findings are consistent with the relapsing-remitting type of multiple sclerosis? Select all that apply. -Exacerbations with development of new symptoms -Symptoms that present continuously without remission -Temporary plateaus during exacerbation states -Relapses last days or months -Progression toward general deterioration during exacerbations

-Exacerbations with development of new symptoms -Relapses last days or months

Treatment of multiple sclerosis focuses on which of the following? Select all that apply. -Quickening disease progression -Curing the disease -Improving the speed of recovery -Reducing number of attacks -Improving patient pain threshold

-Improving the speed of recovery -Reducing number of attacks

Sharon has been taking beta interferon to manage the disease. What is the purpose of this medication? Modifies the course of disease progression Provides pain relief Supports immune function to help normalize bowel function Helps normalize glucose levels

Modifies the course of disease progression CORRECT. Beta interferon is used to slow the progression of disease. It does not provide pain relief or normalize glucose levels. This medication has no direct effect on bowel function.

The nurse is teaching about caring for a patient who has undergone surgery for herniated nucleus pulposus. Which statement indicates a need for further education? Select all that apply. "Changes in respiratory rate and effort may indicate a cerebrospinal fluid leak." "I will inspect the surgical site to detect signs of hemorrhage or a cerebrospinal fluid leak." "Monitoring the neurological status of the patient helps to detect early and subtle changes." "I will advise the patient to maintain the body in good alignment since it helps to prevent infection." "Encouraging range of motion exercises in the patients decreases the risk of contracture development."

"Changes in respiratory rate and effort may indicate a cerebrospinal fluid leak." "I will advise the patient to maintain the body in good alignment since it helps to prevent infection." Rationale: Changes in respiratory rate and effort may indicate ventilatory impairment. Rationale: Maintaining the body in good alignment promotes stabilization of the surgical site to optimize function. Test Taking Tips: Look for the incorrect answers.

A patient involved in an auto accident has severe spinal cord injuries. If the patient is having difficulty with diaphragmatic breathing, which level of the spinal cord is injured? C1 to C4 C6 to C7 T1 to T12 Below L1 Obstructive lung disease

C6 to C7 Rationale: The injury at the C6 to C7 level of the spinal cord is associated with functional loss associated with difficulty in diaphragmatic breathing. Test Taking Tips: Consider the level of the diaphragm.

Sharon is being discharged from the hospital and is looking forward to going home. Which health promotion method should be included in her discharge teaching? Return to office for follow up corticosteroid injection therapy to prevent infection. Avoid dairy to prevent excessive mucus formation. Continue walking with assistance to prevent injury. Use a hot tub each day to help reduce inflammation.

Continue walking with assistance to prevent injury. CORRECT. Walking as a form of exercise can help improve endurance and support muscle strength. Because of changes in mobility, sensation, and vision, the patient is at increased risk of falls and injury. There is no need for follow up corticosteroid injection therapy or avoidance of milk products. Avoidance of hot tubs would be beneficial as the warm water could possibly act as a trigger and lead to exacerbation of the disease.

A patient reports numbness, pain, weakness in the lower extremities, and an inability to control motor movement. The primary healthcare provider prescribes gabapentin and tramadol. What should be the outcome of this intervention? Decreased lower back pain Suppression of spinal cord tumors Reduced symptoms of multiple sclerosis Relief from symptoms associated with amyotrophic lateral sclerosis (ALS)

Decreased lower back pain Rationale: Gabapentin (an anticonvulsant) and tramadol (a nonopioid analgesic) often help to relieve nerve damage pain, a major reason for lower back pain. Test Taking Tips: Understand medications.

Which patient is the most appropriate candidate for administration of riluzole? Patient A Patient B Patient C Patient D Antipyretics

Patient D Rationale: Riluzole is an example of the benzothiazole class of medications and is used to treat ALS. Test Taking Tips: Differentiate medications to conditions.

Sharon is also concerned about the burden she is becoming on others, especially her family. What should the nurse suggest? She considers going to a nursing home. She pays someone to care for her. She includes her family in her clinic visits so their concerns can be addressed. She takes out a good nursing home insurance policy.

She includes her family in her clinic visits so their concerns can be addressed. CORRECT. The problems of MS are relatively permanent and lead to an increased need for personal responsibility and the involvement of supportive family and friends in the patient's care. The family should be involved with the client's care and treatment plan.