Nclex Review: MS

A patient diagnosed with multiple sclerosis (MS) tells the healthcare provider, "I'm not sure if I'll be able to exercise anymore." Which of these is the most appropriate response? 1) "Swimming or exercising in the water can be both enjoyable and beneficial." 2) "You should get a personal trainer to help you plan a fitness program." 3) "It's important for you to conserve your strength by not being too active." 4) "Exercise often causes a relapse of the disease, so it should be avoided."

1)

Which of these assessment findings should the healthcare provider expect to identify as an early clinical characteristic of multiple sclerosis (MS)? 1) Vision loss 2) Dementia 3) Muscle atrophy 4) Clonus

1)

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

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. and 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.

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

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

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? 1)"Are you feeling stronger and less fatigued today?" 2) "Has the stiffness in your muscles decreased?" 3) "Did you have a bowel movement this morning?" 4) "Have you been able to urinate without difficulty?"

2)

In a patient with MS, which of the following will the healthcare expect to identify? Select all that apply. 1) Flaccid paralysis 2) Nystagmus 3) Resting tremors 4) Scanning speech 5) Seizures

2) and 4) 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 (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

The nurse is reviewing the care plan of a client with Multiple Sclerosis. Which of the following nursing diagnoses should receive further validation? 1. Impaired mobility related to spasticity and fatigue. 2. Risk for falls related to muscle weakness and sensory loss. 3. Risk for seizures related to muscle tremors and loss of myelin. 4. Impaired skin integrity related bowel and bladder incontinence.

3

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 ordered.

3

A client with multiple sclerosis (MS) is experiencing bowel incontinence and is starting a bowel retraining program. Which strategy is inappropriate? 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

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

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)

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

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 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.

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

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.

Which of the following is not a realistic outcome to establish with a client who has multiple sclerosis (MS)? The client will: 1. Develop joint mobility. 2. Develop muscle strength. 3. Develop cognition. 4. Develop mood elevation.

3

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