Multiple Sclerosis
A patient with multiple sclerosis will begin therapy with fingolimod. Which instruction does the nurse give the patient about this drug? A. Monitor pulse daily. B. Report symptoms of vertigo. C. Report symptoms of flushing. D. Monitor daily fingerstick blood sugar.
ANS: A The patient should be taught to monitor the pulse daily as the medication can cause bradycardia, especially within the first 6 hours of taking it. The drug does not cause elevated blood sugar, so monitoring of blood sugar is not required. The drug does not cause vertigo or flushing.
What chemotherapy drug has been shown to effectively reduce neurologic disability in patients with multiple sclerosis? A. Fingolimod B. Cyclosporine C. Mitoxantrone D. Methotrexate
ANS: C Mitoxantrone is a chemotherapy drug that has been shown to be effective in reducing neurologic disability. Fingolimod was the first oral immunomodulator. Cyclosporine and methotrexate are immunosuppressants.
14. A nurse cares for a client who presents with an acute exacerbation of multiple sclerosis (MS). Which prescribed medication should the nurse prepare to administer? a. Baclofen (Lioresal) b. Interferon beta-1b (Betaseron) c. Dantrolene sodium (Dantrium) d. Methylprednisolone (Medrol)
ANS: D Methylprednisolone is the drug of choice for acute exacerbations of the disease. The other drugs are not used to treat acute exacerbations of MS. Interferon beta-1b is used to treat and control MS, decrease specific symptoms, and slow the progression of the disease. Baclofen and dantrolene sodium are prescribed to lessen muscle spasticity associated with MS.
The nurse assesses a 30-year-old patient diagnosed with multiple sclerosis (MS). Which symptom does the nurse expect to find? A. Vision changes B. Flaccid muscles C. Tremors at rest D. Absent deep tendon reflexes
ANS: A Vision changes, such as diplopia, nystagmus, and blurred vision, are symptoms of MS. Affected muscles are spastic, not flaccid. Tremors at rest are not characteristic of MS. Deep tendon reflexes may be hyperactive, not absent.
What medication may be used in a patient with multiple sclerosis who is experiencing erectile dysfunction? A. Sildenafil B. Methotrexate C. Magnesium oxide D. Methylprednisone
ANS: A Sildenafil is a prostaglandin-5 inhibitor used for patients with sexual dysfunction. Methotrexate, methylprednisone, and magnesium oxide are not indicated for erectile dysfunction.
A patient diagnosed with multiple sclerosis has an abnormal speech pattern with long pauses between words and syllables. What is this disorder called? A. Scanning B. Dysmetria C. Dysarthria D. Scotomas
ANS: A Scanning is presence of abnormal speech patterns with long pauses between words and syllables. Dysmetria is the inability to direct or limit movement. Dysarthria is slurred speech. Scotomas is changes in peripheral vision.
The nurse provides care for a patient admitted with multiple sclerosis (MS). Which symptoms does the nurse expect to find when assessing the patient? Select all that apply. A. Vision loss B. Difficulty walking C. Long-term memory loss D. Numbness in extremities E. Urinary bladder dysfunction
ANS: A,B,D,E Symptoms of MS depend on which nerves are affected. Loss of visual acuity and visual fields can occur with MS. Difficulty walking can occur if the motor nerves to muscles are affected. Numbness occurs when the nerves that carry sensations are affected. Bladder dysfunction occurs due to spinal cord involvement. Memory loss is not usually reported with MS.
The nurse assessing a patient with multiple sclerosis (MS) is aware that although patients with this condition can expect a normal lifespan, they can develop a variety of complications. For which complications should the nurse evaluate the patient? Select all that apply. A. Epilepsy B. Cyanosis in extremities C. Muscle stiffness or spasms D. Paralysis, typically in the legs E. Problems with bladder, bowel, or sexual functioning
ANS: A,C,D,E Epilepsy; muscle stiffness or spasms; paralysis, typically in the legs; and bladder, bowel, or sexual dysfunction are all known complications of MS. Cyanosis in the extremities is not typical of MS.
What does the nurse prioritize when caring for a patient diagnosed with multiple sclerosis who is experiencing hypalgesia? A. Pain B. Injury risk C. Lack of tolerance for activity D. Reduced capacity for self-care
ANS: B A patient with multiple sclerosis who has hypalgesia has decreased sensitivity to pain, which increases the risk of injury. Pain is not as high a priority as injury risk. Reduced capacity for self-care is important but not priority. Likewise, lack of tolerance for activity is important but not priority.
The nurse is caring for a patient admitted with an exacerbation of multiple sclerosis (MS). The patient reports urinary incontinence. Which primary urinary bladder alteration related to MS is most likely the cause? A. Flaccid bladder B. Spastic bladder C. Interstitial cystitis D. Vesicoureteral reflux
ANS: B A spastic bladder caused by MS can result in a small capacity for urine and the incontinence the patient is experiencing. A flaccid bladder has a large capacity for urine and no sensation to urinate. Interstitial cystitis is often related to a defect in the protective lining of the bladder, not MS. Vesicoureteral reflux is a condition in which urine flows retrograde, or backward, from the bladder into the ureters/kidneys and is not one of the primary urinary bladder issues experienced by MS patients.
What teaching is priority for a patient taking dalfampridine? A. Monitoring pulse B. Observing for seizure activity C. Observing for signs of bleeding D. Reporting of visual disturbances
ANS: B Dalfampridine has been shown to improve the ability of patients with multiple sclerosis to walk; however, it has a high incidence of seizures. There's no indication to check the pulse while on this medication. It does not carry the risk of bleeding. Dalfampridine does not increase the risk of visual disturbances.
Which drug type does the nurse expect to administer as part of the treatment plan for a patient with relapsing multiple sclerosis (MS)? A. Antispasmodic B. Immunomodulator C. Calcium channel blocker D. Penicillin-based antibiotic
ANS: B Immunomodulators such as interferon-beta, synthetic proteins like glatiramer acetate, and monoclonal antibodies such as natalizumab are among the current drug therapies recommended for early and continuous treatment of relapsing types of MS. Penicillin-based antibiotics are used in the treatment of bacterial infections. Calcium channel blockers are commonly used in patients with hypertension and other cardiovascular issues. Antispasmodics are used to suppress muscle spasms.
The nurse is teaching a patient newly diagnosed with multiple sclerosis (MS). Which statement by the patient indicates a correct understanding of the pathophysiology of the disease? A. "I will die early." B. "Parts of my nervous system have plaques." C. "I will have gradual deterioration with no healthy times." D. "This was caused by getting too many x-rays as a child."
ANS: B MS is characterized by an inflammatory response that results in diffuse random or patchy areas of plaque in the white matter of the central nervous system. The patient with MS has no decrease in life expectancy. Frequent times of remission are common in patients with MS. There is no known cause for MS.
Which type of multiple sclerosis (MS) involves steady and gradual neurological deterioration without temporary diminution of the symptoms? A. Relapsing-remitting multiple sclerosis (RRMS) B. Primary progressive multiple sclerosis (PPMS) C. Progressive relapsing multiple sclerosis (PRMS) D. Secondary progressive multiple sclerosis (SPMS)
ANS: B Primary progressive multiple sclerosis involves steady and gradual neurological dysfunction without the remittance of the symptoms. Relapsing-remitting multiple sclerosis involves the development and resolution of symptoms within the span of a few weeks to a few months. After the resolution of symptoms, the patient returns to the baseline. Progressive relapsing multiple sclerosis involves frequent relapses with partial recovery without the patient returning to the baseline. Secondary progressive multiple sclerosis begins with a relapsing remitting course that later becomes steadily progressive.
A patient diagnosed with multiple sclerosis is having difficulty managing her activities of daily living (ADLs) due to weakness, fatigue, and loss of balance. What is recommended for this patient? A. Allow others to do ADLs. B. Perform regular exercise. C. Perform ADLs independently. D. Use assistive devices when weak or fatigued.
ANS: B Regular exercise will help the patient with multiple sclerosis gain mobility if she is having difficulty managing ADLs. The patient should have some independence and not allow others to perform ADLs. It is not recommended that the patient does all ADLs independently. The patient should use assistive devices to avoid weakness and fatigue.
16. A nurse is teaching a client with multiple sclerosis who is prescribed cyclophosphamide (Cytoxan) and methylprednisolone (Medrol). Which statement should the nurse include in this client's discharge teaching? a. "Take warm baths to promote muscle relaxation." b. "Avoid crowds and people with colds." c. "Relying on a walker will weaken your gait." d. "Take prescribed medications when symptoms occur."
ANS: B The client should be taught to avoid people with any type of upper respiratory illness because these medications are immunosuppressive. Warm baths will exacerbate the client's symptoms. Assistive devices may be required for safe ambulation. Medication should be taken at all times and should not be stopped.
The nurse has provided teaching to a patient diagnosed with multiple sclerosis about interventions to decrease constipation. What statement by the patient indicates a need for further teaching? A. "I should increase my physical activity." B. "I will increase my fluid intake to 1 L a day." C. "I'm going to try to eat 30 g of dietary fiber a day." D. "I will take magnesium oxide to decrease my constipation."
ANS: B The patient should drink more than 1 liter of fluid a day; 1.5 to 2 L is recommended. The patient should increase his or her physical activity. The patient should be eating 25 to 35 g of dietary fiber a day. The patient should use magnesium oxide to decrease constipation.
What laboratory findings are consistent with a diagnosis of multiple sclerosis? Select all that apply. A.Positive protein in the urine B. Elevated protein in the cerebrospinal fluid C. Immunoglobulins in the cerebrospinal fluid D. Elevated albumin levels in the peripheral blood sample E. Decreased white blood cell count in peripheral blood sample
ANS: B,C A collection of findings such as elevated proteins and immunoglobulins in the cerebrospinal fluid are consistent with a diagnosis of multiple sclerosis. Positive protein in the urine is not significant for multiple sclerosis. An elevated albumin level or a decreased white blood cell count in the peripheral blood sample are not indicative of multiple sclerosis.
The nurse provides care for a patient admitted with multiple sclerosis (MS). Which medications does the nurse expect will be ordered for the patient? Select all that apply. A. Antibiotics B. Cholinergics C. Stool softeners D. Muscle relaxants E. Glucocorticoids
ANS: B,C,D,E Cholinergics are used to treat bladder dysfunction for MS patients. Stool softeners are commonly used to treat bowel dysfunction that accompanies MS. Muscle relaxants reduce stiffness and spasms for MS patients. Glucocorticoids are steroids used to treat relapses of MS. Antibiotics are not routinely used to treat MS symptoms.
The nurse teaches a patient who is newly diagnosed with multiple sclerosis (MS) about the disease. The nurse tells the patient about which characteristics of MS? Select all that apply. A. Drooping eyelids B. Problems chewing C. Exacerbation and remissions D. Demineralization of the neurons E. Breakdown in communication between nerves and muscles F. Chronic degenerative disease of the central nervous system
ANS: B,C,D,F MS may cause problems chewing. It is characterized by exacerbation and remissions and demineralization of the neurons. MS is a degenerative disease of the central nervous system. Drooping eyelids and the breakdown in communication between nerves and muscles are characteristic of myasthenia gravis, not MS.
Which risk factors would the nurse educate a patient about in regards to risk for multiple sclerosis (MS)? Select all that apply. A. Male gender B. Family history C. Age 20 to 50 years D. Asian and African descent E. History of Epstein-Barr virus
ANS: B,C,E If a parent or sibling has had MS, the patient is at higher risk of developing the disease. MS can occur at any age, but most commonly affects people between the ages of 20 to 50 years. A variety of viruses, including Epstein-Barr, have been linked to MS. Women are about twice as likely as men to develop MS. White people, particularly those of Northern European descent, are at the highest risk of developing MS. People of Asian, African, or Native American descent have the lowest risk.
18. A nurse cares for several clients on a neurologic unit. Which prescription for a client should direct the nurse to ensure that an informed consent has been obtained before the test or procedure? a. Sensation measurement via the pinprick method b. Computed tomography of the cranial vault c. Lumbar puncture for cerebrospinal fluid sampling d. Venipuncture for autoantibody analysis
ANS: C A lumbar puncture is an invasive procedure with many potentially serious complications. The other assessments or tests are considered noninvasive and do not require an informed consent.
What treatment can be used to relieve diplopia in a patient diagnosed with multiple sclerosis? A.Use corrective lenses as prescribed. B. Ensure adequate sleep and rest periods. C. Alternate an eyepatch from eye to eye every few hours. D. Use scanning techniques by moving the head side to side.
ANS: C Alternating an eyepatch from eye to eye every few hours can relieve diplopia. Corrective lenses help with visual acuity. Rest does not affect diplopia. Scanning techniques are used for issues with preferable vision.
13. A nurse assesses a client with early-onset multiple sclerosis (MS). Which clinical manifestation should the nurse expect to find?a. Hyperresponsive reflexes b. Excessive somnolence c. Nystagmus d. Heat intolerance
ANS: C Early signs and symptoms of MS include changes in motor skills, vision, and sensation. Hyperresponsive reflexes, excessive somnolence, and heat intolerance are later manifestations of MS.
The nurse teaches a patient with multiple sclerosis (MS) how to reduce fatigue. Which recommendation does the nurse provide? A. Take a hot bath. B. Avoid naps during the day. C. Rest in an air-conditioned room. D. Increase the dose of muscle relaxants.
ANS: C Fatigue is a common symptom in patients with MS. Lowering the body temperature by resting in an air-conditioned room may relieve fatigue, though extreme cold should be avoided. A hot bath or shower can increase body temperature, producing fatigue. Planning for frequent rest periods and naps can relieve fatigue. Muscle relaxants, prescribed to reduce spasticity, can cause drowsiness and fatigue and should only be taken as prescribed.
15. A nurse assesses a client with multiple sclerosis after administering prescribed fingolimod (Gilenya). For which adverse effect should the nurse monitor? a. Peripheral edema b. Black tarry stools c. Bradycardia d. Nausea and vomiting
ANS: C Fingolimod (Gilenya) is an antineoplastic agent that can cause bradycardia, especially within the first 6 hours after administration. Peripheral edema, black and tarry stools, and nausea and vomiting are not adverse effects of fingolimod.
What statement by the patient diagnosed with multiple sclerosis indicates a need for further teaching? A. "I will try to use stress relief techniques." B. "I will stay away from people who have infections." C. "If my muscles are feeling tired I will take a hot bath." D. "I will alternate an eyepatch from side to side when I have diplopia."
ANS: C Taking a hot bath is contraindicated in patients with multiple sclerosis; extreme heat will exacerbate the multiple sclerosis. Use of stress relief techniques is indicated. The patient should avoid people with infections. If the patient has diplopia, alternating an eyepatch from side to side is appropriate.
21. A nurse cares for a client with amyotrophic lateral sclerosis (ALS). The client states, "I do not want to be placed on a mechanical ventilator." How should the nurse respond? a. "You should discuss this with your family and health care provider." b. "Why are you afraid of being placed on a breathing machine?" c. "Using the incentive spirometer each hour will delay the need for a ventilator." d. "What would you like to be done if you begin to have difficulty breathing?"
ANS: D ALS is an adult-onset upper and lower motor neuron disease characterized by progressive weakness, muscle wasting, and spasticity, eventually leading to paralysis. Once muscles of breathing are involved, the client must indicate in the advance directive what is to be done when breathing is no longer possible without intervention. The other statements do not address the client's needs.
The family member of a patient diagnosed with multiple sclerosis expresses concern over the patient's inappropriate behavior. What statement by the nurse is most appropriate? A. "It may be important to avoid social situations." B. "We can talk to the doctor about medication to help with the behavior." C. "Unfortunately this is part of the disease process and will likely get worse." D. "It is a good idea to develop a cue to let them know they're being inappropriate."
ANS: D Developing a cue to let the patient know she is behaving inappropriately is indicated. Avoiding social situations is not indicated. This behavior may be a permanent part of the disease; however, telling the family that this will likely get worse is not supporting the family. There are no medications to improve the behavioral changes related to MS.
17. A nurse assesses a client with a neurologic disorder. Which assessment finding should the nurse identify as a late manifestation of amyotrophic lateral sclerosis (ALS)? a. Dysarthria b. Dysphagia c. Muscle weakness d. Impairment of respiratory muscles
ANS: D In ALS, progressive muscle atrophy occurs until a flaccid quadriplegia develops. Eventually, the respiratory muscles are involved, which leads to respiratory compromise. Dysarthria, dysphagia, and muscle weakness are early clinical manifestations of ALS.
Which statement about multiple sclerosis (MS) is correct? A. MS affects more men than women. B. It usually occurs in people older than 50 years. C. MS is seen more often in the warmer climates. D. It occurs more frequently among whites than other races.
ANS: D MS affects people of all races but does tend to occur more frequently among whites. Women are affected twice as often as men. Though MS may occur in people over 50 years, it usually affects people between 20 and 40 years of age. There is a higher incidence in the colder climates of the Northeastern states, the Great Lakes, and Pacific Northwestern states, as well as Canada.
When providing teaching to a patient newly diagnosed with multiple sclerosis, the nurse informs the patient that the confirmation of the diagnosis is based on what finding? A. Recent bloodwork B. Physical assessment C. Abnormal cerebrospinal fluid D. Magnetic resonance imaging (MRI)
ANS: D Magnetic resonance imaging (MRI) is the primary confirmative diagnostic tool in diagnosing multiple sclerosis. Blood work is not diagnostic for MS. Physical assessment and cerebrospinal fluid findings will rule out other causes and point toward a diagnosis of multiple sclerosis.
19. A nurse prepares a client for prescribed magnetic resonance imaging (MRI). Which action should the nurse implement prior to the test? a. Implement nothing by mouth (NPO) status for 8 hours. b. Withhold all daily medications until after the examination. c. Administer morphine sulfate to prevent claustrophobia during the test. d. Place the client in a gown that has cloth ties instead of metal snaps.
ANS: D Metal objects are a hazard because of the magnetic field used in the MRI procedure. Morphine sulfate is not administered to prevent claustrophobia; lorazepam (Ativan) or diazepam (Valium) may be used instead. The client does not need to be NPO, and daily medications do not need to be withheld prior to MRI.
What symptoms should a patient taking teriflunomide be assessed for? Select all that apply. A. Diplopia B. Dysarthria C. Tachycardia D. Facial flushing E. Gastrointestinal (GI) disturbances
ANS: D,E Facial flushing and GI disturbances are major side effects of teriflunomide. Diplopia and dysarthria are symptoms of multiple sclerosis. Bradycardia, not tachycardia, is another common finding in patients taking teriflunomide.