Multiple Sclerosis (MS)

The nurse is teaching a client diagnosed with MS about the factors that may precipitate a relapse. Which factor should the nurse include? SATA A) Increases in body temperature B) Constipation C) Stress D) Acetaminophen use E) Fatigue

A, C, E 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.

The nurse is performing a health history of a client diagnosed with MS. Which data should the nurse gather? SATA A) Reflex assessment B) Exposure to environmental hazards C) Onset of symptoms D) Cranial nerve assessment E) Factors that affect symptoms

B, C, E Rationale: When performing a health history on a client with multiple​ sclerosis, the nurse needs to obtain information about factors that affect​ symptoms, onset of​ symptoms, and exposure to environmental hazards. Cranial nerve and reflex assessment are part of the physical examination.

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 MS will be ordered? A) The client reports episodes of rapid heart rate during periods of weakness in the lower extremities. B) The client reports increasing manifestation over the past week. C) The client reports previous episodes, each lasting 1 day, and then no problems for at least 1 month. D) The client reports pain in the lower back for the past few days.

C) 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

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

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

B) "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.

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

B) 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 MS to a client newly diagnosed with the disease. Which manifestation should the nurse include in this teaching? A) Hypertension B) Difficulty chewing C) Fever D) Frequent dry cough

B) Difficulty chewing Rationale: A common manifestation of MS is difficulty chewing; it should be included in client teaching. Frequent dry cough, fever, and hypertension are not manifestation of MS.

The nurse formulates the plan of care for a client diagnosed with 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? A) Eliminating the post-lunch nap. B) Turning down the shower's temperature C) Keeping night hours D) Turning the bedroom heat off and opening the windows

B) 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.

The nurse is caring for a client admitted with an exacerbation of MS. The client is demonstrating frustration with eating because he is experiencing hand and arm spasms that prevent the proper use of utensils. Which intervention should the nurse implement to best assist this client? A) Consult with the occupational therapist regarding assistive devices for meals B) Counsel the client to select finger foods for meals C) Plan time to feed the client D) consult the the physical therapist regarding hand and arm exercises

A) Consult with the occupational therapist regarding assistive devices for meals Rationale: Because the ability to feed oneself is essential to positive self-concept and self-esteem, the nurse should consult with the occupational therapist regarding devices the client can use to maintain independence at mealtimes. The nurse should not counsel the client to select finger foods for meals, nor should the nurse feed the client. Neither of these actions would support the client's self-concept and self-esteem needs. The nurse might consult the physical therapist regarding hand splints, but hand and arm exercises might not be beneficial for this client.

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

A) 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.

A client with relapsing-remitting MS tells the nurse that even though her primary symptoms of exacerbation are leg spasms and blurred vision, her greatest struggle is getting through the day because she is always tired. Which diagnosis should the nurse identify as a priority for this client? A) Fatigue B) Disturbed sensory perception C) Impaired physical mobility D) Self-care defecit

A) Fatigue Rationale: The client states that the worst part of her disease exacerbations is being tired, even though leg spasms and blurred vision are present. Therefore, the nurse should identify the diagnosis of Fatigue as a priority for this client. The diagnoses of Impaired Physical Mobility because of the leg spasms and Disturbed Sensory Perception because of the blurred vision are additional nursing diagnoses applicable for this client, but they are not the priority based on the client's statement. The client may or may not have a Self-Care Deficit.

A client with MS is prescribed diazepam (Valium). What assessment finding indicates that this medication is effective for the client? A) Muscle spasticity is reduced B) Blood glucose is within normal limits C) The client states that muscles are weak D) Ophthalmologic examination shows no evidence of cataracts

A) Muscle spasticity is reduced Rationale: Diazepam (Valium) is a muscle relaxant commonly used for clients with multiple sclerosis. It 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

Which of the following would be classified as a secondary symptom of MS? A) Pressure sores B) Urinary retention C) Depression D) Unsteady gait

A) Pressure sores Rationale: Secondary symptoms of MS result from chronic primary symptoms of the disease. Because pressure sores result from primary symptoms such as muscle weakness and inability to ambulate, they would be considered a secondary symptom. In comparison, both urinary retention and unsteady gait are primary symptoms of MS, whereas depression is a tertiary symptom (because it involves a psychosocial problem).

A client with a history of relapsing-remitting MS is expecting her first child. Which of the following nursing interventions would be indicated for this client? A) Suggest the client seek reproductive counseling. B) Tell the client to expect a period of remission after delivery C) Instruct the client to expect an exacerbation of symptoms while pregnant D) Discuss the client's options for pain control during labor, as her contractions will be especially severe

A) Suggest the client seek reproductive counseling Rationale: A definite genetic cause of MS has not been established; however, studies suggest that genetic factors make some individuals more susceptible to the disorder than others. Also, some medications used in the treatment of MS can be harmful to a fetus. Thus, reproductive counseling would be recommended for this client. Pregnancy often brings about remission (not exacerbation) of MS, and there is a slightly increased relapse rate postpartum. The strength of uterine contractions in a client with MS is not severe, and because clients often have lessened sensation, labor may be almost painless

A client with MS is observed transferring from the bed to a motorized wheelchair and applying splints to the lower extremities before entering the bathroom to perform morning self-care. What could the nurse conclude regarding this observation? A) The client uses assistive devices to optimize autonomy B) The client should be instructed to conduct morning care before applying splints to the lower extremities C) The client is dependent on assistive devices D) The client should be advised to avoid use of a motorized wheelchair when possible

A) The client uses assistive devices to optimize autonomy Rationale: 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 nurse should not conclude that the client is dependent on assistive devices, because this conclusion suggests that the client is not autonomous. Similarly, the nurse should not conclude that the client requires instruction regarding wheelchair avoidance or when to apply splints, because this conclusion does not take the client's preferences into consideration.

The nurse is planning care for a client diagnosed iwth MS. Which collaborative service should be consulted to help maintain or improve the functional status of this client? SATA A) Occupational therapy B) Vocational rehab C) Cognitive therapy D) Physical therapy E) Pastoral care

A, B, C, D Rationale: Vocational rehabilitation should be consulted because this service trains the client to use assistive devices. Physical therapy should be consulted because this service will help to maintain mobility and optimal functioning. Occupational therapy should be consulted because this service will enhance​ independence, productivity,​ safety, and retention of skills. Cognitive therapy should be consulted because this service will help to improve the​ client's ability to​ think, reason,​ concentrate, and remember. A pastoral care consultation will not help to improve the​ client's functional status

Which problem should the nurse include in the plan of care for a client with MS? SATA A) Altered urinary elimination pattern B) Risk of fatigue C) Acute pain D) Risk of hopelessness E) Impaired physical mobility

A, B, D, E Rationale: When planning care for a client diagnosed with​ MS, the nurse needs to address the following​ problems: impaired physical​ mobility, risk of​ fatigue, altered urinary elimination​ patterns, and risk of hopelessness. Acute pain is not a problem that needs to be addressed when planning care for a client with MS.

The nurse conducts discharge planning for a client diagnosed with MS. Which intervention should the nurse include? SATA A) Teaching of good body mechanics B) Assessment of home safety C) Instruction for a low fat, low salt diet D) Arrangement for pastoral care consultation E) Teaching of a bladder control program

A, B, E 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. Next Question

The nurse evaluates the care of a client diagnosed with MS. Which assessment should the nurse perform? SATA A) Presence of complications B) Bowel sounds C) Emotional stability of the client D) The progression from relapsing-remitting MS to primary-progressive MS E) Need for assistive devices

A, C, E Rationale: MS is an​ ever-changing disease that requires constant evaluation. The evaluation process should include the presence of complications such as infection because complications may lead to an exacerbation. The nurse should also evaluate the need for assistive devices and the emotional stability of the client because depression is common in clients with MS. Bowel sounds are not affected by MS.​ Relapsing-remitting MS may progress to​ secondary-progressive MS, not​ primary-progressive MS.

The nurse is assessing a client suspected of having multiple sclerosis. Which manifestation should the nurse expect to observe in the client? SATA A) Spastic movements B) Tachycardia C) Lack of coordination D) Decreased level of consciousness E) Double Vision

A, C, E Rationale: Double vision is consistent with multiple​ sclerosis; multiple sclerosis​ (MS) causes demyelination and plaque formation in the central nervous​ system, including damage to the optic nerve. Spastic movements are consistent with MS because it is an upper motor neuron​ disorder; these disorders involve the central nervous system and cause spasticity. Lack of coordination is consistent with multiple​ sclerosis; coordination and balance are controlled in the​ cerebellum, and damage to nerve transmission in the cerebellum can cause loss of coordination and poor balance. Decreased level of consciousness is not a manifestation that is directly related to multiple sclerosis.​ Tachycardia, or rapid heart​ rate, is not a manifestation of multiple sclerosis.

The nurse admits a client suspected of having MS. Which diagnostic test should the nurse expect to be ordered? SATA A) Lumbar puncture B) ECG C) Colonoscopy D) Cystoscopy E) MRI

A, E Rationale: MRI and lumbar puncture are diagnostic tests that are useful in diagnosing MS. An MRI is used to detect the presence of lesions in the central nervous system​ (CNS) that indicate demyelination. A lumbar puncture is used to obtain cerebrospinal fluid​ (CSF), which is tested for the presence of substances that indicate the presence of MS.​ Electrocardiography, colonoscopy, and cystoscopy are not used to diagnose MS.

An adult client recently diagnosed with MS reports engaging in vigorous exercise on a regular basis. Which statements contain the correct information to give this client when answering specific questions about lifestyle? SATA A) "Hyperbaric oxygen treatment is recommended prior to vigorous physical activities." B) "You will tolerate exercise better in an air-conditioned room C) "Acupuncture may benefit some of your symptoms." D) "Drinking cold water is recommended during exercise." E) "You will be able to maintain your current exercise schedule."

B, C, D Rationale: Symptoms of MS are exacerbated by increased body temperature. Exercising in a cold room and drinking cold beverages help keep body temperature down. Acupuncture has low risk and may be beneficial for some symptoms of MS. Hyperbaric oxygen therapy carries more risk than benefit. Also, it is unlikely that a newly diagnosed client with MS will be able to tolerate regular vigorous exercise.

The nurse performs an admission assessment on a client diagnosed with MS. Which assessment should the nurse perform as a part of the physical exam? SATA A) The client's breath sounds B) The client's affect C) The client's speech D) The client's balance E) The client's ability to hear

B, C, D Rationale: As part of the physical​ examination, the nurse should assess the​ client's balance,​ affect, and speech because these all may be affected by the disease. Breath sounds and the ability to hear are generally not affected by MS.

Which goal is appropriate for the nurse to set for a client with MS? SATA A) The client will verbalize methods to prevent and treat diarrhea B) The client will receive psychologic counseling as needed. C) The client will participate in an exercise program to maintain independence D) The client will sleep 5 hours per night E) The client will state methods to reduce urinary incontinence

B, C, E Rationale: Appropriate goals for the client with MS include participating in an exercise program to maintain​ independence, stating methods to reduce urinary​ incontinence, and receiving psychologic counseling as needed.​ Constipation, not​ diarrhea, is usually a problem for clients with MS. Because fatigue is also a​ problem, clients should receive at least 8 hours of sleep each night.

A nurse is teaching the parents of a client who was recently diagnosed with MS about what to expect as their child's condition progresses. Which statement by the parents indicates the need for further instruction? A) "My child is at increased risk for seizures because of the MS diagnosis." B) "It's not unusual for kids with MS to have problems with their schoolwork." C) "MS usually progresses faster in children than in adults." D) "Making friends may be more difficult for our child because of the MS."

C) "MS usually progresses faster in children than in adults." Rationale: Children with MS often experience seizures related to their diagnosis, and they may suffer from reduced academic performance and difficulty in family and peer relationships. However, MS usually progresses more slowly in children than in adults. Thus, the parents' statement about the speed of disease progression indicates the need for further instruction.

The nurse is caring for several clients from various cultural backgrounds. Which client would the nurse assess as having the highest risk for MS? A) A Brazilian woman with chronic parasitic infection B) A Hispanic man with colonized MRSA C) A Northern Canadian woman who has smoked for 25 years D) An African man in his 20s who has a Vitamin D deficiency

C) A Northern Canadian woman who has smoked for 25 years Rationale: The Northern Canadian woman who smokes has three risk factors for MS: female gender, living farthest from the equator, and smoking. Factors that lower the risk of MS include living closer to the equator (as is the case for the Brazilian and Hispanic clients), having a lowered immune response (as is the case for the client with chronic parasitic infestation), and being male.

The nurse is planning are for a client with MS. Which intervention would address the nursing diagnosis of fatigue? A) Encourage increased activity B) Schedule physical therapy 3X/day C) Plan activities with sufficient rest periods between them D) Group activities together so care will not be interrupted

C) Plan activities with sufficient rest periods between them Rationale: Interventions to address the diagnosis of Fatigue include assessing the client's level of fatigue, arranging activities to include rest periods between them, and assisting the client in setting priorities regarding activities. Activities should not be grouped together. Increased activity will not help the client with fatigue. Physical therapy three times a day may be too aggressive for this client.

Which category of MS is characterized by a slow but nearly continuous worsening of the disease from the time of onset with no distinct remissions? A) Relapsing-remitting B) Progressive-relapsing C) Primary-progressive D) Secondary-progressive

C) Primary-progressive Rationale: There are four classifications of multiple sclerosis (MS). Relapsing-remitting MS is characterized by clearly defined flare-ups with worsening neurological function followed by periods of partial or complete remission with few or no symptoms. Primary-progressive MS involves slow but nearly continuous worsening of the disease from the time of onset with no distinct remissions. Secondary-progressive MS begins as relapsing-remitting but becomes worse between exacerbations. Progressive-relapsing MS involves a steady worsening of disease with acute relapses.

A client diagnosed with MS has an acute onset of visual changes, fatigue, and leg weakness. The client states that the last time this happened, she recovered in a few weeks. Which classification of MS is the client experiencing? A) Progressive-relapsing B) Secondary-progressive C) Relapsing-remitting D) Primary-progressive

C) Relapsing-remitting Rationale: There are four classifications of multiple sclerosis (MS). This client is affected by relapsing-remitting MS, which is characterized by clearly defined flare-ups with worsening neurological function followed by periods of partial or complete remission with few or no symptoms. In comparison, primary-progressive MS involves slow but nearly continuous worsening of the disease from the time of onset with no distinct remissions; secondary-progressive MS begins as relapsing-remitting but becomes worse between exacerbations; and progressive-relapsing MS involves a steady worsening of disease with acute relapses.

A young adult client complains of blurred vision and muscle spasms that have come and gone over the past several months. The physician suspects that the client has MS. What in the client's history would the nurse recognize as a risk factor for MS? A) The client is male B) The client is of Native American descent C) The client is of European descent D) The client takes a Vitamin D supplement daily

C) The client is of European descent Rationale: Risk factors for MS include being female, having a European ancestry, and being between the ages of 20 and 40. Smoking also increases the risk for MS, but taking a vitamin D supplement may decrease the risk.

A client diagnosed with MS asks the nurse whether woodworking and carving objects can still be done as a hobby. Which response by the nurse is correct? A) Advising the client to increase intricate patterns of work B) Telling client to continue to use all the woodworking tools as before C) Having client remember and describe how all previous projects were assembled D) Assisting the client in identifying modifications that may be needed.

D) Assisting the client in identifying modifications that may be needed. Rationale: Continuing a​ long-standing hobby is possible. The client will need help to assist with some planned modifications. The visual blurring of MS combined with spasticity would make working on intricate patterns difficult.​ Short-term memory loss and difficulty with word finding may make remembering and describing previous projects difficult.

A client with MS reports difficulty walking. Which collaborative therapy should the nurse request? A) Occupational therapy B) Cognitive therapy C) Speech therapy D) Physical therapy

D) 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.

A client diagnosed with MS is being treated with disease-modifying therapy. Which form of MS should the nurse suspect the client has? A) Primary-progressive MS B) Secondary-progressive MS C) Progressive-relapsing MS D) Relapsing-remitting MS

D) Relapsing-remitting MS Rationale: Disease-modifying therapies are not approved or used for the treatment of progressive forms of​ MS; they are only used for the​ relapsing-remitting form. Clients with progressive forms are treated with medications that are specific for their symptoms.