SCI & MS NCLEX Style Practice Questions

When analyzing the cerebrospinal fluid of a patient diagnosed with multiple sclerosis (MS), which of the following results would the healthcare provider anticipate? A. Clear with decreased white blood cells B. Clear with increased proteins C. Cloudy with increased turbidity D. Pinkish with increased red blood cells

B Normally, CSF is clear, colorless, with very small amounts of protein, glucose, and white blood cells. MS breaks down the blood brain/blood-CSF barrier. For the most part, proteins are excluded from the CSF by the blood-CSF barrier. The cerebrospinal fluid of a patient diagnosed with MS will be clear but will contain an increased amount of proteins (immunoglobulins). WBC count in the CSF is normal in most patients, and no blood will be present.

A patient diagnosed with multiple sclerosis (MS) is prescribed baclofen (Gablofen). Which question will the healthcare provider ask when evaluating the effectiveness of the medication? A. "Are you feeling stronger and less fatigued today?" B. "Has the stiffness in your muscles decreased?" C. "Did you have a bowel movement this morning?" D. "Have you been able to urinate without difficulty?"

B Think about some of the major indications for medication therapy for patients with MS. Baclofen is a skeletal muscle relaxant. How will the medication help the patient, and what adverse effects may be experienced? Skeletal muscle relaxants such as baclofen relieve muscle spasticity and muscle spasms in patients diagnosed with MS. Adverse effects of baclofen include urinary retention and constipation.

The healthcare provider is teaching a group of patients diagnosed with multiple sclerosis (MS) about common bladder problems. Which of the following will the healthcare provider include? A. "You should not attempt to urinate until you feel that your bladder is full." B. "Patients with MS are at increased risk of developing urinary tract infections." C. "Drinking lots of citrus juices will decrease the amount of bacteria in your urinary tract." D. "Drink 1.5 - 2 liters of water each day so your urine isn't too concentrated." E. "Drinking caffeinated beverages can help you empty your bladder completely." F. "MS may cause the bladder to contract and empty more often than usual."

B, D, F MS can cause a variety of urinary problems including detrusor overactivity. Caffeinated beverages and alcohol are bladder irritants and should be limited or avoided. Although citrus juices are acidic, they make urine more alkaline, which increases the risk of a urinary tract infection. Drinking at least 1.5 - 2 liters of water each day will keep urine dilute. This will decrease bladder irritation. MS heightens a patient's risk of urinary tract infections. Patients should plan to void on a regular basis. Voiding at least every 2 hours will decrease urine stasis.

Which of these assessment findings should the healthcare provider expect to identify as an early clinical characteristic of multiple sclerosis (MS)? A. Vision loss B. Dementia C. Muscle atrophy D. Clonus

A MS is an inflammatory demyelinating disease of the central nervous system. Demyelination will cause slowed conduction and eventually loss of function. Vision loss and eye pain (optic neuritis) are early symptoms of MS. Dementia is uncommon and found only in severely affected patients. Clonus (rhythmic contractions when a muscle is stretched) is a sign of nerve damage which may be seen as MS progresses. Muscle atrophy is also a later sign of MS which is caused by disuse of a muscle group.

A patient diagnosed with multiple sclerosis (MS) is admitted to the medical unit. When assessing the patient, which of the following will the HCP expect to identify? A. Scanning speech B. Flaccid paralysis C. Nystagmus D. Resting tremors E. Seizures

A, C MS is an autoimmune inflammatory demyelinating disease of the brain and spinal cord. The tremor will be characterized by rhythmic shaking in the hands and/or arms during purposeful movement. Common findings can be remembered as the Charcot triad: nystagmus (and/or double vision), scanning speech (slow, hesitant pronunciation of words as syllables), and intention tremor.

A patient is prescribed high-dose methylprednisolone for an acute exacerbation of multiple sclerosis (MS). Which of these findings, if identified in the patient, would indicate the patient is experiencing an adverse effect of the medication? A. Hypokalemia B. Angioedema C. Hyperglycemia D. Candida infection E. Epigastric pain F. Paralytic ileus

A, C, D, E Methylprednisolone is a corticosteroid. Corticosteroids suppress the inflammatory response. Corticosteroids are also referred to as glucocorticoids. By suppressing the inflammatory response, methylprednisolone inhibits the actions of leukocytes, thereby increasing the risk of opportunistic infections (e.g. Candida). Suppressing the inflammatory response also involves inhibition of COX-1, thereby increasing the patient's risk of gastric ulcers (which may be manifested by epigastric pain). Glucocorticoids such as methylprednisolone increases blood glucose levels and decreases serum potassium levels.

A student is assisting the healthcare provider with the care of a patient diagnosed with multiple sclerosis (MS). The student correctly identifies which of the following as part of the pathophysiological process of MS? A. Axonal loss in the central nervous system B. Deficiency of acetylcholine at the neuromuscular junction C. Scarring and plaque development D. Hypoxic damage to cerebral tissue E. Myelin regeneration and remission of symptoms F. Autoimmune damage to myelin sheath

A, C, E, F Hint #1 Recall the structure and function of a nerve cell. Clinical manifestations of MS are because of slowed or blocked conduction of neural impulses secondary to neuronal damage. The damage is initiated by an autoimmune process and T-cell activation. Sometimes the damaged nerves regenerate, causing in temporary remission. MS is characterized by inflammation, formation of demyelinating plaques, and axonal loss in the CNS.

A patient diagnosed with multiple sclerosis is prescribed bethanechol (Urecholine). Which of these findings would indicate that the patient is experiencing an adverse effect of the medication? A. Constipation B. Urinary retention C. Hypotension D. Dry mouth

C Bethanechol is prescribed for neurogenic bladder secondary to MS. Bethanechol is a cholinergic agonist. Cholinergic agonists will stimulate actions of the parasympathetic nervous system, so bladder tone will be increased (facilitating urination) and peristalsis will be enhanced.

Which of the following statements made by a patient diagnosed with multiple sclerosis (MS) would alert the healthcare provider that the patient requires additional instruction about the disease? A. "Use of stress reduction strategies can decrease the severity of my symptoms." B. "Regular exercise can help reduce fatigue and help improve my sense of balance." C. "I will avoid foods that are high in fiber to prevent problems with my bowels." D. "It's important for me to inspect my skin daily make sure there aren't any injuries." E. "A hot bath in the evenings will help relax my muscles and relieve pain."

C, E Principles of patient self-care are guided by an understanding of how MS affects the nervous system, the symptoms the patient experiences, and what can exacerbate the patient's symptoms. Impaired peripheral sensation can make the patient more prone to undetected injury. Exercise can help ease the symptoms of MS, so patients should confer with their healthcare provider to determine the right type of exercise for them. Decreased mobility and upper and lower motor neuron impairment can increase the risk of constipation. The patient should be taught about factors that can exacerbate symptoms, such as heat and stress. In addition, the patient is at risk for burns due to impaired peripheral sensation, so bathing temperatures should be carefully monitored.

When assessing a patient diagnosed with multiple sclerosis (MS), which of the following would require immediate action by the healthcare provider? A. Fatigue and depression B. Paresthesia and tremor C. Nystagmus and diplopia D. Dysphagia and congested cough

D These are all signs and symptoms of MS, but some can be more serious than others. Select the clinical manifestations of MS that may result in a serious secondary problem for the patient. Dysphagia puts the patient at risk for aspiration pneumonia, and the congested cough is an indication that aspiration has already occurred.