SCI & MS NCLEX Style Practice Questions

The nurse sees a client walking in the hallway who begins to have a seizure. The nurse should do which of the following in priority order? 1. Maintain patent airway 2.record the seizure activity observed 3.ease the client to the floor 4. Obtain vital signs

3,1,4,2

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.

While caring for the patient with spinal cord injury (SCI), the nurse elevates the head of the bed, removes compression stockings, and continues to assess vital signs every two to three minutes while searching for the cause in order to prevent loss of consciousness or death. By practicing these interventions, the nurse is avoiding the most dangerous complication of autonomic dysreflexia, which is which of the following? 1. hypoxia 2. bradycardia 3. elevated blood pressure 4. tachycardia

Correct Answer: 3 Rationale: Autonomic dysreflexia is an emergency that requires immediate assessment and intervention to prevent complications of extremely high blood pressure. Additional nursing assistance will be needed and a colleague needs to reach the physician stat.

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.

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.

Which patient is at highest risk for a spinal cord injury? 1. 18-year-old male with a prior arrest for driving while intoxicated (DWI) 2. 20-year-old female with a history of substance abuse 3. 50-year-old female with osteoporosis 4. 35-year-old male who coaches a soccer team

Correct Answer: 1 Rationale: The three major risk factors for spinal cord injuries (SCI) are age (young adults), gender (higher incidence in males), and alcohol or drug abuse. Females tend to engage in less risk-taking behavior than young men.

A patient with a spinal cord injury is recovering from spinal shock. The nurse realizes that the patient should not develop a full bladder because what emergency condition can occur if it is not corrected quickly? 1. autonomic dysreflexia 2. autonomic crisis 3. autonomic shutdown 4. autonomic failure

Correct Answer: 1 Rationale: Be attuned to the prevention of a distended bladder when caring for spinal cord injury (SCI) patients in order to prevent this chain of events that lead to autonomic dysreflexia. Track urinary output carefully. Routine use of bladder scanning can help prevent the occurrence. Other causes of autonomic dysreflexia are impacted stool and skin pressure. Autonomic crisis, autonomic shutdown, and autonomic failure are not terms used to describe common complications of spinal injury associated with bladder distension.

An unconscious patient receiving emergency care following an automobile crash accident has a possible spinal cord injury. What guidelines for emergency care will be followed? Select all that apply. 1. Immobilize the neck using rolled towels or a cervical collar. 2. The patient will be placed in a supine position 3. The patient will be placed on a ventilator. 4. The head of the bed will be elevated. 5. The patient's head will be secured with a belt or tape secured to the stretcher.

Correct Answer: 1,2,5 Rationale: In the emergency setting, all patients who have sustained a trauma to the head or spine, or are unconscious should be treated as though they have a spinal cord injury. Immobilizing the neck, maintaining a supine position and securing the patient's head to prevent movement are all basic guidelines of emergency care. Placement on the ventilator and raising the head of the bed will be considered after admittance to the hospital.

A post-stroke patient is going home on oral Coumadin (warfarin). During discharge teaching, which statement by the patient reflects an understanding of the effects of this medication? 1. "I will stop taking this medicine if I notice any bruising." 2. "I will not eat spinach while I'm taking this medicine." 3. "It will be OK for me to eat anything, as long as it is low fat." 4. "I'll check my blood pressure frequently while taking this medication."

Correct Answer: 2 Rationale: Warfarin is a vitamin K antagonist. Green, leafy vegetables contain vitamin K, and will therefore interfere with the therapeutic effects of the drug. Bruising is a common side effect, and the drug should not be stopped unless by prescriber order. Low-fat foods do not interfere with warfarin therapy, which is not prescribed to affect the blood pressure.

A patient with a spinal cord injury was given IV Decadron (dexamethasone) after arriving in the emergency department. The patient also has a history of hypoglycemia. During the hospital stay, the nurse would expect to see which of the following? 1. increased episodes of hypoglycemia 2. possible episodes of hyperglycemia 3. no change in the patient's glycemic parameters 4. both hyper- and hypoglycemic episodes

Correct Answer: 2 Rationale: A common side effect of corticosteroids is hyperglycemia. Stress as well as the medication could cause this person to have periods of elevated blood sugars.

The nurse is educating a patient and the family about different types of stabilization devices. Which statement by the patient indicates that the patient understands the benefit of using a halo fixation device instead of Gardner-Wells tongs? 1. "I will have less pain if I use the halo device." 2. "The halo device will allow me to get out of bed." 3. "I am less likely to get an infection with the halo device." 4. "The halo device does not have to stay in place as long."

Correct Answer: 2 Rationale: A halo device will allow the patient to be mobile since it does not require weights like the Gardner-Wells tongs. The patient's pain level is not dependant on the type of stabilization device used. The patient does not have a great risk of infection with the Garnder-Wells tongs; both devices require pins to be inserted into the skull. The time required for stabilization is not dependant on the type of stabilization device used.

A patient with a spinal cord injury at the T1 level complains of a severe headache and an "anxious feeling." Which is the most appropriate initial reaction by the nurse? 1. Try to calm the patient and make the environment soothing. 2. Assess for a full bladder. 3. Notify the healthcare provider. 4. Prepare the patient for diagnostic radiography.

Correct Answer: 2 Rationale: Autonomic dysreflexia occurs in patients with injury at level T6 or higher, and is a life-threatening situation that will require immediate intervention or the patient will die. The most common cause is an overextended bladder or bowel. Symptoms include hypertension, headache, diaphoresis, bradycardia, visual changes, anxiety, and nausea. A calm, soothing environment is fine, though not what the patient needs in this case. The nurse should recognize this as an emergency and proceed accordingly. Once the assessment has been completed, the findings will need to be communicated to the healthcare provider.

The patient is admitted with injuries that were sustained in a fall. During the nurse's first assessment upon admission, the findings are: blood pressure 90/60 (as compared to 136/66 in the emergency department), flaccid paralysis on the right, absent bowel sounds, zero urine output, and palpation of a distended bladder. These signs are consistent with which of the following? 1. paralysis 2. spinal shock 3. high cervical injury 4. temporary hypovolemia

Correct Answer: 2 Rationale: Spinal shock is common in acute spinal cord injuries. In addition to the signs and symptoms mentioned, the additional sign of absence of the cremasteric reflex is associated with spinal shock. Lack of respiratory effort is generally associated with high cervical injury. The findings describe paralysis that would be associated with spinal shock in an spinal injured patient. The likely cause of these findings is not hypovolemia, but rather spinal shock.

Which of the following is the priority nursing diagnosis for the patient who has undergone surgery for a spinal fusion? 1. Acute Pain 2. Impaired Mobility 3. Risk for Infection 4. Risk for Injury

Correct Answer: 2 Rationale: The priority nursing diagnosis for a patient who has undergone a spinal fusion is Impaired Mobility, due to the assessment of the ABCs (airway, circulation, breathing). Impaired mobility can affect the patient's circulation, therefore affecting tissue perfusion and causing a risk for skin breakdown. Acute Pain is the next priority since it is an active diagnosis. Diagnoses with "risk for" do not take priority over active diagnoses.

The nurse understands that when the spinal cord is injured, ischemia results and edema occurs. How should the nurse explain to the patient the reason that the extent of injury cannot be determined for several days to a week? 1. "Tissue repair does not begin for 72 hours." 2. "The edema extends the level of injury for two cord segments above and below the affected level." 3. "Neurons need time to regenerate so stating the injury early is not predictive of how the patient progresses." 4. "Necrosis of gray and white matter does not occur until days after the injury."

Correct Answer: 2 Rationale: Within 24 hours necrosis of both gray and white matter begins if ischemia has been prolonged and the function of nerves passing through the injured area is lost. Because the edema extends above and below the area affected, the extent of injury cannot be determined until after the edema is controlled. Neurons do not regenerate, and the edema is the factor that limits the ability to predict extent of injury.

A patient with a spinal cord injury (SCI) is admitted to the unit and placed in traction. Which of the following actions is the nurse responsible for when caring for this patient? Select all that apply. 1. modifying the traction weights as needed 2. assessing the patient's skin integrity 3. applying the traction upon admission 4. administering pain medication 5. providing passive range of motion

Correct Answer: 2,4,5 Rationale: The healthcare provider is responsible for initial applying of the traction device. The weights on the traction device must not be changed without the order of a healthcare provider. When caring for a patient in traction, the nurse is responsible for assessment and care of the skin due to the increased risk of skin breakdown. The patient in traction is likely to experience pain and the nurse is responsible for assessing this pain and administering the appropriate analgesic as ordered. Passive range of motion helps prevent contractures; this is often performed by a physical therapist or a nurse.

A patient has manifestations of autonomic dysreflexia. Which of these assessments would indicate a possible cause for this condition? Select all that apply. 1. hypertension 2. kinked catheter tubing 3. respiratory wheezes and stridor 4. diarrhea 5. fecal impaction

Correct Answer: 2,5 Rationale: Autonomic dysreflexia can be caused by kinked catheter tubing allowing the bladder to become full, triggering massive vasoconstriction below the injury site, producing the manifestations of this process. Acute symptoms of autonomic dysreflexia, including a sustained elevated blood pressure, may indicate fecal impaction. The other answers will not cause autonomic dysreflexia.

A school nurse is called after a student falls down a flight of stairs. The student is breathing, but unconsciousness. After calling the ambulance, which is the most appropriate action by the nurse? 1. Protect the patient's neck and head from any movement. 2. Place the patient on his side to prevent aspiration. 3. Immobilize the neck,,securing the head. 4. Try to rouse the patient by gently shaking his shoulders.

Correct Answer: 3 Rationale: Guidelines for emergency care are avoiding flexing, extending, or rotating the neck; immobilizing the neck; securing the head; maintaining the patient in the supine position; and transferring from the stretcher with backboard in place to the hospital bed. This patient is unconscious, and the nurse must protect the neck from any (or any further) damage. If the patient vomits, the nurse should utilize the log-roll technique to turn the patient while keeping the head, neck, and spine in alignment. Rousing the patient by shaking could cause damage to the spinal cord.

Which of the following is the priority nursing diagnosis for a patient diagnosed with a spinal cord injury? 1. Fluid Volume Deficit 2. Impaired Physical Mobility 3. Ineffective Airway Clearance 4. Altered Tissue Perfusion

Correct Answer: 3 Rationale: Ineffective Airway Clearance is the priority nursing diagnosis for this patient. The nurse utilizes the ABCs (airway, breathing, circulation) to determine priority. With Ineffective Airway Clearance, the patient is at risk for aspiration and therefore, impaired gas exchange. Fluid Volume Deficit is the nurse's next priority (circulation), and then Altered Tissue Perfusion. If the patient does not have enough volume to circulate, then tissue perfusion cannot be adequately addressed. The last priority for this patient is Impaired Physical Mobility.

Of the following, which groups are the most at risk for bacterial meningitis? Select all that apply. 1. older adults 2. pregnant women 3. military recruits 4. college students 5. low-income

Correct Answer: 3,4 Rationale: Military personnel living on a base and young adults living in close proximity (such as college students living in a dormitory) are at a greater risk of contracting bacterial meningitis. The other populations are at lower risk.

Which of the following nursing actions is appropriate for preventing skin breakdown in a patient who has recently undergone a laminectomy? 1. Provide the patient with an air mattress. 2. Place pillows under patient to help patient turn. 3. Teach the patient to grasp the side rail to turn. 4. Use the log roll to turn the patient to the side.

Correct Answer: 4 Rationale: A patient who has undergone a laminectomy needs to be turned by log rolling to prevent pressure on the area of surgery. An air mattress will help prevent skin breakdown but the patient still needs to be turned frequently. Placing pillows under the patient can help take pressure off of one side but the patient still needs to change positions often. Teaching the patient to grasp the side rail will cause the spine to twist, which needs to be avoided.

A patient with a spinal cord injury (SCI) has complete paralysis of the upper extremities and complete paralysis of the lower part of the body. The nurse should use which medical term to adequately describe this in documentation? 1. hemiplegia 2. paresthesia 3. paraplegia 4. quadriplegia

Correct Answer: 4 Rationale: Quadriplegia describes complete paralysis of the upper extremities and complete paralysis of the lower part of the body. Hemiplegia describes paralysis on one side of the body. Paresthesia does not indicate paralysis. Paraplegia is paralysis of the lower body.

A hospitalized patient with a C7 cord injury begins to yell "I can't feel my legs anymore." Which is the most appropriate action by the nurse? 1. Remind the patient of her injury and try to comfort her. 2. Call the healthcare provider and get an order for radiologic evaluation. 3. Prepare the patient for surgery, as her condition is worsening. 4. Explain to the patient that this could be a common, temporary problem.

Correct Answer: 4 Rationale: Spinal shock is a condition almost half the people with acute spinal injury experience. It is characterized by a temporary loss of reflex function below level of injury, and includes the following symptomatology: flaccid paralysis of skeletal muscles, loss of sensation below the injury, and possibly bowel and bladder dysfunction and loss of ability to perspire below the injury level. In this case, the nurse should explain to the patient what is happening.

A patient with a history of a T2 spinal cord tells the nurse, "I feel awful today. My head is throbbing, and I feel sick to my stomach." Which action should the nurse take first? a. Notify the patient's health care provider. b. Check the blood pressure (BP). c. Give the ordered antiemetic. d. Assess for a fecal impaction.

Correct Answer: B Rationale: The BP should be assessed immediately in a patient with an injury at the T6 level or higher who complains of a headache to determine whether autonomic dysreflexia is causing the symptoms, including hypertension. Notification of the patient's health care provider is appropriate after the BP is obtained. Administration of an antiemetic is indicated after autonomic dysreflexia is ruled out as the cause of the nausea. The nurse may assess for a fecal impaction, but this should be done after checking the BP and lidocaine jelly should be used to prevent further increases in the BP.

When caring for a patient who had a C8 spinal cord injury 10 days ago and has a weak cough effort, bibasilar crackles, and decreased breath sounds, the initial intervention by the nurse should be to a. administer oxygen at 7 to 9 L/min with a face mask. b. place the hands on the epigastric area and push upward when the patient coughs. c. encourage the patient to use an incentive spirometer every 2 hours during the day. d. suction the patient's oral and pharyngeal airway.

Correct Answer: B Rationale: The nurse has identified that the cough effort is poor, so the initial action should be to use assisted coughing techniques to improve the ability to mobilize secretions. Administration of oxygen will improve oxygenation, but the data do not indicate hypoxemia, and oxygen will not help expel respiratory secretions. The use of the spirometer may improve respiratory status, but the patient's ability to take deep breaths is limited by the loss of intercostal muscle function. Suctioning may be needed if the patient is unable to expel secretions by coughing but should not be the nurse's first action.

The health care provider orders administration of IV methylprednisolone (Solu-Medrol) for the first 24 hours to a patient who experienced a spinal cord injury at the T10 level 3 hours ago. When evaluating the effectiveness of the medication the nurse will assess a. blood pressure and heart rate. b. respiratory effort and O2 saturation. c. motor and sensory function of the legs. d. bowel sounds and abdominal distension.

Correct Answer: C Rationale: The purpose of methylprednisolone administration is to help preserve neurologic function; therefore, the nurse will assess this patient for lower-extremity function. Sympathetic nervous system dysfunction occurs with injuries at or above T6, so monitoring of BP and heart rate will not be useful in determining the effectiveness of the medication. Respiratory and GI function will not be impaired by a T10 injury, so assessments of these systems will not provide information about whether the medication is effective.

In which order will the nurse perform the following actions when caring for a patient with possible cervical spinal cord trauma who is admitted to the emergency department? a. Administer O2 using a non-rebreathing mask. b. Monitor cardiac rhythm and blood pressure. c. Immobilize the patient's head, neck, and spine. d. Transfer the patient to radiology for spinal CT.

Correct Answer: C, A, B, D Rationale: The first action should be to prevent further injury by stabilizing the patient's spinal cord. Maintenance of oxygenation by administration of 100% O2 is the second priority. Because neurogenic shock is a possible complication, continuous monitoring of heart rhythm and BP is indicated. CT scan to determine the extent and level of injury is needed once initial assessment and stabilization is accomplished.

A patient with a neck fracture at the C5 level is admitted to the intensive care unit (ICU) following initial treatment in the emergency room. During initial assessment of the patient, the nurse recognizes the presence of spinal shock on finding a. hypotension, bradycardia, and warm extremities. b. involuntary, spastic movements of the arms and legs. c. the presence of hyperactive reflex activity below the level of the injury. d. flaccid paralysis and lack of sensation below the level of the injury.

Correct Answer: D Rationale: Clinical manifestations of spinal shock include decreased reflexes, loss of sensation, and flaccid paralysis below the area of injury. Hypotension, bradycardia, and warm extremities are evidence of neurogenic shock. Involuntary spastic movements and hyperactive reflexes are not seen in the patient at this stage of spinal cord injury.

A 26-year-old patient with a C8 spinal cord injury tells the nurse, "My wife and I have always had a very active sex life, and I am worried that she may leave me if I cannot function sexually." The most appropriate response by the nurse to the patient's comment is to a. advise the patient to talk to his wife to determine how she feels about his sexual function. b. tell the patient that sildenafil (Viagra) helps to decrease erectile dysfunction in patients with spinal cord injury. c. inform the patient that most patients with upper motor neuron injuries have reflex erections. d. suggest that the patient and his wife work with a nurse specially trained in sexual counseling.

Correct Answer: D Rationale: Maintenance of sexuality is an important aspect of rehabilitation after spinal cord injury and should be handled by someone with expertise in sexual counseling. Although the patient should discuss these issues with his wife, open communication about this issue may be difficult without the assistance of a counselor. Sildenafil does assist with erectile dysfunction after spinal cord injury, but the patient's sexuality is not determined solely by the ability to have an erection. Reflex erections are common after upper motor neuron injury, but these erections are uncontrolled and cannot be maintained during coitus.

Subjective data from a patient diagnosed with multiple sclerosis (MS) includes facial muscle spasms accompanied by stabbing pain. The patient states, "It gets worse during meals when I'm chewing food." The healthcare provider determines that these symptoms are most likely due to a lesion on which cranial nerve? A. VIII B. VI C. VII D. V

D The lesion will be on the cranial nerve that provides sensory conduction to the face and sensory and motor conduction to the muscles of mastication (chewing). The patient is experiencing a problem called trigeminal neuralgia. The trigeminal nerve is the fifth cranial nerve. Damage to this nerve can cause facial muscle spasms and pain, which can be initiated by touch, drinking hot or cold beverages, chewing, brushing teeth, or even when talking.

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.