Multiple Sclerosis Practice Questions

The client newly diagnosed with multiple sclerosis (MS) states, "I don't understand how I got multiple sclerosis. Is it genetic?" On which statement should the nurse base the response? 1. Genetics may play a role in susceptibility to MS, but the disease may be caused by a virus. 2. There is no evidence suggesting there is any chromosomal involvement in developing MS. 3. Multiple sclerosis is caused by a recessive gene, so both parents had to have the gene for the client to get MS. 4. Multiple sclerosis is caused by an autosomal dominant gene on the Y chromosome,so only fathers can pass it on.

1. The exact cause of MS is not known,but there is a theory stating a slow virus is partially responsible. A failure of apart of the immune system may also beat fault. A genetic predisposition involving chromosomes 2, 3, 7, 11, 17, 19, and X may be involved. 2. There is some evidence supporting a genetic component involved in developing MS. 3. A specific gene has not been identified to know if the gene is recessive or dominant. 4. The X chromosome, not the Y chromosome,may be involved.

A client has had multiple sclerosis (MS) for 15 years and has received various drug therapies. What is the primary reason why the nurse has found it difficult to evaluate the effectiveness of the drugs that the client has used? 1.The client exhibits intolerance to many drugs. 2.The client experiences spontaneous remissions from time to time. 3.The client requires multiple drugs simultaneously. 4.The client endures long periods of exacerbation before the illness responds to a particular drug.

2 Evaluating drug effectiveness is difficult because a high percentage of clients with MS exhibit unpredictable episodes of remission, exacerbation, and steady progress without apparent cause. Clients with MS do not necessarily have increased intolerance to drugs, nor do they endure long periods of exacerbation before the illness responds to a particular drug. Multiple drug use is not what makes evaluation of drug effectiveness difficult.

The nurse is preparing a client with multiple sclerosis (MS) for discharge from the hospital to home. The nurse should tell the client: 1."You will need to accept the necessity for a quiet and inactive lifestyle." 2."Keep active, use stress reduction strategies, and avoid fatigue." 3."Follow good health habits to change the course of the disease." 4."Practice using the mechanical aids that you will need when future disabilities arise.

2 The nurse's most positive approach is to encourage a client with MS to keep active, use stress reduction strategies, and avoid fatigue because it is important to support the immune system while remaining active. A quiet, inactive lifestyle is not necessarily indicated. Good health habits are not likely to alter the course of the disease, although they may help minimize complications. Practicing using aids that will be needed for future disabilities may be helpful but also can be discouraging.

The nurse and a licensed practical nurse (LPN) are caring for a group of clients.Which nursing task should not be assigned to the LPN? 1. Administer a skeletal muscle relaxant to a client diagnosed with low back pain. 2. Discuss bowel regimen medications with the HCP for the client on strict bed rest. 3. Draw morning blood work on the client diagnosed with bacterial meningitis. 4. Teach self-catheterization to the client diagnosed with multiple sclerosis.

4 The nurse should not assign assessing,teaching, or evaluation to the LPN. Evaluating the client's ability to per-form self-catheterization should not be assigned to the LPN

A client with a history of relapsing-remitting multiple sclerosis is expecting her first child. What would be indicated for this client? A) Suggest reproductive counseling, as multiple sclerosis can be genetic. B) Instruct to expect a period of remission after delivery of the baby. C) Instruct to expect an exacerbation of symptoms while pregnant. D) Discuss pain control during labor, as contractions will be severe.

Answer: A Explanation A definite genetic factor has not been established; however, studies suggest that genetic factors make some individuals more susceptible to the disorder than others. Reproductive counseling would be recommended for this client. Pregnancy often brings about remission of multiple sclerosis, but with a slightly increased relapse rate postpartum. The strength of uterine contractions in a client with multiple sclerosis is not severe, and because clients often have lessened sensation, labor may be almost painless.

A client admitted with an exacerbation of multiple sclerosis is demonstrating frustration with eating because hand and arm spasms prevent the proper use of utensils. What should the nurse do to assist this client? A) Consult with Occupational Therapy regarding assistive devices for meals. B) Counsel the client to select finger foods for meals. C) Plan time to feed the client. D) Consult with Physical Therapy regarding hand and arm exercises.

Answer: A Explanation Since the ability to feed oneself is essential to positive self-concept and self-esteem, the nurse should consult with Occupational Therapy for devices that the client can use to maintain independence at meal times. The nurse should not counsel the client to select finger foods for meals, or feed the client. This would not support the client's self-concept and self-esteem needs. Physical Therapy might be consulted for hand splints, but hand and arm exercises might not be beneficial for this client

A client with relapsing-remitting multiple sclerosis tells the nurse that even though the primary symptoms of exacerbation are leg spasms and blurred vision, the hardest part is trying to get through the day because of being so 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 Deficit

Answer: A Explanation: The client states that the worst part of the disease exacerbation is being tired even though leg spasms and blurred vision are present. The nurse should identify the diagnosis of Fatigue as being 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 multiple sclerosis 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 needs instruction to conduct morning care before applying splints to lower extremities. C) The client is dependent upon assistive devices. D) The client is reliant upon assistive devices for independent.

Answer: A Explanation: 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 statement "Client is reliant upon assistive devices for independence" indicates that the client is not autonomous. The statement "Client is dependent upon assistive devices" also indicates the client is not autonomous. The statement "Client needs instruction to conduct morning care before applying splints to lower extremities" does not take into consideration the client's preference, which might be to apply the splints before doing self-care

A 32-year-old client recently diagnosed with multiple sclerosis is a full-time aerobics exercise instructor at a local fitness center. Which statements contain the correct information to give the client when answering her specific questions about lifestyle? Select all that apply. A) "Hyperbaric oxygen treatment is recommended prior to vigorous physical exercise." 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 exercise teaching schedule."

Answer: B, C, D Explanation: Symptoms of MS are exacerbated by increased body temperature. Exercising in a cold room and drinking cold beverages keep body temperature down. Acupuncture has low risk and may be beneficial for some symptoms. Hyperbaric oxygen therapy carries more risk than benefit. It is unlikely that a newly diagnosed client with MS will be able to tolerate a full-time exercise instructor role.

The nurse is planning care for a client with multiple sclerosis. Which intervention would address the nursing diagnosis of Fatigue? A) Encourage increased activity. B) Schedule physical therapy three times a day. C) Plan activities with sufficient rest periods. D) Group activities together so care will not be interrupted.

Answer: C Explanation: Interventions to address the client's diagnosis of Fatigue include assessing the level of fatigue, arranging activities to include rest periods, and assisting the client to set 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.

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

Answer: C Explanation: There are four classifications of multiple sclerosis. The client has an exacerbation of symptoms and has a history of full recovery. This is classified as relapsing-remitting and is the most common type. Primary-progressive is a steady worsening of the disease with occasional minor recovery. Secondary-progressive begins as relapsing-remitting but the disease becomes worse between exacerbations. Progressive-relapsing is rare, with the disease progressing from the onset with periods of exacerbation.

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? Select all that apply. 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 the following is not a typical clinical manifestation of multiple sclerosis (MS)? 1.Double vision. 2.Sudden bursts of energy. 3.Weakness in the extremities. 4.Muscle tremors.

2 With MS, hyperexcitability and euphoria may occur, but because of muscle weakness, sudden bursts of energy are unlikely. Visual disturbances, weakness in the extremities, and loss of muscle tone and tremors are common symptoms of MS

The healthcare provider is planning care for a patient diagnosed with multiple sclerosis (MS). Which of the following is the priority intervention? 1) Advise the patient to drink liquids through a straw 2) Monitor the patient's temperature to avoid overheating 3) Teach the patient's family how to meet the patient's needs 4) Encourage bed rest in order to conserve strength

1 Problems related to dysphagia (such as aspiration) can be minimized if the patient drinks liquids through a straw. Sensitivity to heat is a concern with MS, but monitoring the patient's temperature is not necessary.

The nurse is admitting a client diagnosed with multiple sclerosis. Which clinical manifestation should the nurse assess?Select all that apply. 1. Muscle Weakness. 2. Lethargy. 3. Dysmetria. 4. Fatigue. 5. Dysphagia.

1,3,4,5 1.Muscle weakness is a hallmark symptom of MS. 3.Dysmetria is the inability to control muscular action characterized by overestimating or under estimating range of movement. 4.Fatigue is a symptom of MS. 5.Dysphagia, or difficulty swallowing, is associated with MS. 2. Lethargy is the state of prolonged sleepiness or serious drowsiness and is not associated with MS.

A client with multiple sclerosis (MS) lives with her daughter and 3-year-old granddaughter. The daughter asks the nurse what she can do at home to help her mother. Which of the following measures would be most beneficial? 1.Psychotherapy. 2.Regular exercise. 3.Day care for the granddaughter. 4.Weekly visits by another person with MS.

2 An individualized regular exercise program helps the client to relieve muscle spasms. The client can be trained to use unaffected muscles to promote coordination because MS is a progressive, debilitating condition. The data do not indicate that the client needs psychotherapy, day care for the granddaughter, or visits from other clients.

The nurse enters the room of a client diagnosed with acute exacerbation of multiple sclerosis and finds the client crying. Which statement is the most therapeutic response for the nurse to make? 1. "Why are you crying?The medication will help the disease." 2. "You seem upset. I will sit down and we can talk for awhile." 3. "Multiple sclerosis is a disease that has good times and bad times." 4. "I will have the chaplain come and stay with you for a while."

2 This is stating a fact and offering self. Both are therapeutic techniques for conversations. 1. "Why" is requesting an explanation, and the client does not owe the nurse an explanation. 3. The client did not ask about the nature of MS. The client needs to be able to verbalize feelings. 4. This is "passing the buck." Therapeutic communication is an integral part of nursing.

The nurse should conduct a focused assessment with the client with multiple sclerosis for risk of which of the following? Select all that apply. 1.Dehydration. 2.Falls. 3.Seizures. 4.Skin breakdown. 5.Fatigue.

2, 4, 5. The client with multiple sclerosis is at risk for falls due to muscle weakness, skin breakdown due to bowel and bladder incontinence, and fatigue. The client is not at risk for dehydration; seizures are not associated with myelin destruction

The home health nurse is caring for the client newly diagnosed with multiple sclerosis. Which client issue is of most importance? 1. The client refuses to have a gastrostomy feeding. 2. The client wants to discuss if she should tell her fiancé. 3. The client tells the nurse life is not worth living anymore .4. The client needs the flu and pneumonia vaccines.

3 A potential suicide statement is priority for the nurse when caring for the client with MS.

Which intervention should the nurse suggest to help a client with multiple sclerosis avoid episodes of urinary incontinence? 1.Limit fluid intake to 1,000 mL/day. 2.Insert an indwelling urinary catheter. 3.Establish a regular voiding schedule. 4.Administer prophylactic antibiotics, as prescribed.

3 Maintaining a regular voiding pattern is the most appropriate measure to help the client avoid urinary incontinence. Fluid intake is not related to incontinence. Incontinence is related to the strength of the detrusor and urethral sphincter muscles. Inserting an indwelling catheter would be a treatment of last resort because of the increased risk of infection. If catheterization is required, intermittent self-catheterization is preferred because of its lower risk of infection. Antibiotics do not influence urinary incontinence.

When the nurse talks with a client with multiple sclerosis who has slurred speech, which nursing intervention is contraindicated? 1.Encouraging the client to speak slowly. 2.Encouraging the client to speak distinctly. 3.Asking the client to repeat indistinguishable words. 4.Asking the client to speak louder when tired.

4 Asking a client to speak louder even when tired may aggravate the problem. Asking the client to speak slowly and distinctly and to repeat hard-to-understand words helps the client to communicate effectively.

A client with multiple sclerosis (MS) is experiencing bowel incontinence and is starting a bowel retraining program. Which strategy is not appropriate? 1.Eating a diet high in fiber. 2.Setting a regular time for elimination. 3.Using an elevated toilet seat. 4.Limiting fluid intake to 1,000 mL/day.

4 Limiting fluid intake is likely to aggravate rather than relieve symptoms when a bowel retraining program is being implemented. Furthermore, water imbalance, as well as electrolyte imbalance, tends to aggravate the signs and symptoms of MS. A diet high in fiber helps keep bowel movements regular. Setting a regular time each day for elimination helps train the body to maintain a schedule. Using an elevated toilet seat facilitates transfer of the client from the wheelchair to the toilet or from a standing to a sitting position.

The right hand of a client with multiple sclerosis trembles severely whenever she attempts a voluntary action. She spills her coffee twice at lunch and cannot get her dress fastened securely. Which is the best legal documentation in nurses' notes of the chart for this client assessment? 1."Has an intention tremor of the right hand." 2."Right-hand tremor worsens with purposeful acts." 3."Needs assistance with dressing and eating due to severe trembling and clumsiness." 4."Slight shaking of right hand increases to severe tremor when client tries to button her clothes or drink from a cup.

4 The nurses' notes should be concise, objective, clearly stated, and relevant. This client trembles when she attempts voluntary actions, such as drinking a beverage or fastening clothing. This activity should be described exactly as it occurs so that others reading the note will have no doubt about the nurse's observation of the client's behavior. Identifying the "intentional" activity of daily living will help the interdisciplinary team individualize the client's plan of care. Clarifying what is meant by "worsening" with a purposeful act will facilitate the interrater reliability of the team. It is better to state what the client did than to give vague nursing orders in the nurses' notes.

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.

The male client diagnosed with multiple sclerosis states he has been investigating alternative therapies to treat his disease. Which intervention is most appropriate by the nurse? 1. Encourage the therapy if it is not contraindicated by the medical regimen. 2. Tell the client only the health-care provider should discuss this with him. 3. Ask how his significant other feels about this deviation from the medical regimen. 4. Suggest the client research an investigational therapy instead.

1 The nurse should listen without being judgmental about any alternative therapy the client is considering. Alternative therapies, such as massage and relaxation, are frequently beneficial and enhance the medical regimen.

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

Answer: A Explanation: Diazepam (Valium) is a muscle relaxant commonly used for clients with multiple sclerosis. Diazepam (Valium) 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

A nurse is caring for a client who has multiple sclerosis. Which of the following findings should the nurse expect? A. Fluctuations in blood pressure B. Loss of cognitive function C. Ineffective cough D. Drooping eye lids

B A. Fluctuations in blood pressure is a manifestation associated with amyotrophic lateral sclerosis. B. Loss of cognitive function is a manifestation associated with MS. C. Ineffective cough is a manifestation associated with amyotrophic lateral sclerosis. D. Drooping eyelids is a manifestation associated with myasthenia gravis

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? Select all that apply. 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.

A nurse is teaching a client who has multiple sclerosis and a new prescription for baclofen. Which of the following statements should the nurse include in the teaching? A. "This medication will help you with your tremors." B. "This medication will help you with your bladder function." C."This medication may cause your skin to bruise easily." D."This medication may cause your skin to appear yellow in color."

D A. Primidone and clonazepam are beta blockers given to clients who have MS to treat tremors. B. Propantheline is an anticholinergic medication that is given to clients who have MS to treat bladder dysfunction. C. Prednisone is a corticosteroid medication that is given to clients who have MS to treat inflammation. An adverse effect of this medication is bruising of the skin. D. CORRECT: Dantrolene and tizanidine are antispasmodic medications that are given to clients who have MS to treat muscle spasms. An adverse effect of this medication is a yellow appearance of the skin, also known as jaundice. The nurse should instruct the client to monitor for this finding, as this can be an indication of impaired liver function

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? Select all that apply. 1. "A hot bath in the evenings will help relax my muscles and relieve pain." 2. "I will avoid foods that are high in fiber to prevent problems with my bowels." 3. "It's important for me to inspect my skin daily make sure there aren't any injuries." 4. "Use of stress reduction strategies can decrease the severity of my symptoms."

1,2 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.

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? Select all that apply. 1. "Drinking caffeinated beverages can help you empty your bladder completely." 2. "MS may cause the bladder to contract and empty more often than usual." 3. "You should not attempt to urinate until you feel that your bladder is full." 4. "Drink 1.5 - 2 liters of water each day so your urine isn't too concentrated." 5. "Drinking lots of citrus juices will decrease the amount of bacteria in your urinary tract." 6. "Patients with MS are at increased risk of developing urinary tract infections."

2, 4, 6 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.

The 45-year-old client is diagnosed with primary progressive multiple sclerosis and the nurse writes the nursing diagnosis "anticipatory grieving related to progressive loss." Which intervention should be implemented? 1. Consult the physical therapist for assistive devices for mobility. 2. Determine if the client has a legal power of attorney. 3. Ask if the client would like to talk to the hospital chaplain. 4. Discuss the client's wishes regarding end-of-life care.

4 The client should make personal choices about end-of-life issues while it is possible to do so. This client is progressing toward immobility and all the complications related to it. 1. The problem is grieving R/T loss of functioning. Assistive devices will not prevent loss of functioning and do not address grieving. 2. A legal power of attorney is for personal property and control of financial issues,which is not the focus of the nurse's care. A legal power of attorney for health care maybe appropriate. 3. The nurse should and must discuss end-of-life issues with the client and does not need to contact the hospital chaplain.

A nurse is beginning a physical assessment of a client who has a new diagnosis of multiple sclerosis. Which of the following findings should the nurse expect? Select all that apply. A. Areas of paresthesia B. Involuntary eye movements C. Alopecia D. Increased salivation E. Ataxia

A,B, E A. Areas of loss of skin sensation are a finding in a client who has MS. B. Nystagmus is a finding in a client who has MS. C. Hair loss is not a finding in a client who has MS. D. Dysphagia, swallowing difficulty, is a finding in a client who has MS. E. Ataxia occurs in the client who has MS as muscle weakness develops and there is loss of coordination

A client with multiple sclerosis (MS) is receiving baclofen (Lioresal). The nurse determines that the drug is effective when it achieves which of the following? 1.Induces sleep. 2.Stimulates the client's appetite. 3.Relieves muscular spasticity. 4.Reduces the urine bacterial count.

3 Baclofen is a centrally acting skeletal muscle relaxant that helps relieve the muscle spasms common in MS. Drowsiness is an adverse effect, and driving should be avoided if the medication produces a sedative effect. Baclofen does not stimulate the appetite or reduce bacteria in the urine.

The 30-year-old female client is admitted with complaints of numbness, tingling, a crawling sensation affecting the extremities, and double vision which has occurred two(2) times in the month. Which question is most important for the nurse to ask the client? 1. "Have you experienced any difficulty with your menstrual cycle?" 2. "Have you noticed a rash across the bridge of your nose?" 3. "Do you get tired easily and sometimes have problems swallowing?" 4. "Are you taking birth control pills to prevent conception?"

3. These are clinical manifestation of MS and can go un diagnosed for years be-cause of the remitting-relapsing nature of the disease. Fatigue and difficulty swallowing are other symptoms of MS. 1. MS does not affect the menstrual cycle. 2. A rash across the bridge of the nose suggests systemic lupus erythematosus 4. Taking birth control medications should not produce these symptoms or the pattern of occurrence.

When assessing a patient diagnosed with multiple sclerosis (MS), which of the following would require immediate action by the healthcare provider? 1) Fatigue and depression 2) Paresthesia and tremor 3) Nystagmus and diplopia 4) Dysphagia and congested cough

4 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.

A young adult client complains of blurred vision and muscle spasms that come and go over the past several months. On what information from the client's history should the nurse focus to help identify this help problem? A) Family history of Parkinson disease B) Family history of epilepsy C) Is an immigrant from Germany D) Has been depressed

Answer: C Explanation: Multiple sclerosis is primarily a disease of people of northern European ancestry. The onset of multiple sclerosis is usually between the ages of 20 and 50, with the peak at age 30. Family history of epilepsy, Parkinson disease, and depression are important items of the client's history but do not support a diagnosis of MS.

The nurse writes the client problem of "altered sexual functioning" for a male client diagnosed with multiple sclerosis (MS). Which intervention should be implemented? 1. Encourage the couple to explore alternative ways of maintaining intimacy. 2. Make an appointment with a psychotherapist to counsel the couple. 3. Explain daily exercise will help increase libido and sexual arousal. 4. Discuss the importance of keeping physically calm during sexual intercourse.

1 This will assist the client and significant other to maintain a close relation-ship without putting undue pressure on the client. 2. This is a real physical problem, not a psychological one. 3. The problem is impotence, not libido 4. The problem is not psychosocial. It is aphysical problem, and staying calm willnot hel

Which of the following should the nurse include in the discharge plan for a client with multiple sclerosis who has an impaired peripheral sensation? Select all that apply. 1.Carefully test the temperature of bath water. 2.Avoid kitchen activities because of the risk of injury. 3.Avoid hot water bottles and heating pads. 4.Inspect the skin daily for injury or pressure points. 5.Wear warm clothing when outside in cold temperatures.

1,3,4,5 A client with impaired peripheral sensation does not feel pain as readily as someone whose sensation is unimpaired; therefore, water temperatures should be tested carefully. The client should be advised to avoid using hot water bottles or heating pads and to protect against cold temperatures. Because the client cannot rely on minor pain as an indicator of damaged skin or sore spots, the client should carefully inspect the skin daily to visualize any injuries that he cannot feel. The client should not be instructed to avoid kitchen activities out of fear of injury; independence and self-care are also important. However, the client should meet with an occupational therapist to learn about assistive devices and techniques that can reduce injuries, such as burns and cuts that are common in kitchen activities.

The client diagnosed with multiple sclerosis is scheduled for a magnetic resonanceimaging (MRI) scan of the head. Which information should the nurse teach the client about the test? 1. The client will have wires attached to the scalp and lights will flash off and on. 2. The machine will be loud and the client must not move the head during the test. 3. The client will drink a contrast medium 30 minutes to one (1) hour before the test. 4. The test will be repeated at intervals during a five (5)- to six (6)-hour period.

2 MRI scans require the client to lie still and not move the body; the client should be warned about the loud noise 1. This describes an evoked potential electroencephalogram (EEG). 3. The client does not drink any contrast medium. If contrast is used, it will be given IVP for a CT scan. 4. The test is performed at one time

The nurse is teaching a client with bladder dysfunction from multiple sclerosis (MS) about bladder training at home. Which instructions should the nurse include in the teaching plan? Select all that apply. 1.Restrict fluids to 1,000 mL/24 hours. 2.Drink 400 to 500 mL with each meal. 3.Drink fluids midmorning, midafternoon, and late afternoon. 4.Attempt to void at least every 2 hours. 5.Use intermittent catheterization as needed.

2, 3, 4, 5. Maintaining urinary function in a client with neurogenic bladder dysfunction from MS is an important goal. The client should ideally drink 400 to 500 mL with each meal; 200 mL midmorning, midafternoon, and late afternoon; and attempt to void at least every 2 hours to prevent infection and stone formation. The client may need to catheterize herself to drain residual urine in the bladder. Restricting fluids during the day will not produce sufficient urine. However, in bladder training for nighttime continence, the client may restrict fluids for 1 to 2 hours before going to bed. The client should drink at least 2,000 mL every 24 hours

Which of the following is not a realistic outcome to establish with a client who has multiple sclerosis (MS)? The client will develop: 1.Joint mobility. 2.Muscle strength. 3.Cognition. 4.Mood elevation.

3 MS is a progressive, chronic neurologic disease characterized by patchy demyelination throughout the central nervous system. This interferes with the transmission of electrical impulses from one nerve cell to the next. MS affects speech, coordination, and vision, but not cognition. Care for the client with MS is directed toward maintaining joint mobility, preventing deformities, maintaining muscle strength, rehabilitation, preventing and treating depression, and providing client motivation

The client diagnosed with an acute exacerbation of multiple sclerosis is placed on high-dose intravenous injections of corticosteroid medication. Which nursing intervention should be implemented? 1. Discuss discontinuing the proton pump inhibitor with the HCP. 2. Hold the medication until after all cultures have been obtained. 3. Monitor the client's serum blood glucose levels frequently .4. Provide supplemental dietary sodium with the client's meals.

3 Steroids interfere with glucose metabolism by blocking the action of insulin;therefore, the blood glucose levels should be monitored. 1. Steroid medications increase gastric acid;therefore, a proton pump inhibitor is an appropriate medication for the client. 2. Cultures are ordered prior to administer-ing antibiotics, not steroids. 4. Steroid medications cause the client to retain sodium; therefore, a low-sodiumdiet should be encouraged

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? Select all that apply. 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? Select all that apply. 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 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.

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.