Multiple Sclerosis

Which measure should the nurse prioritize when providing care for a patient with a diagnosis of multiple sclerosis (MS)? A. Vigilant infection control and adherence to standard precautions B. Careful monitoring of neurologic assessment and frequent reorientation C. Maintenance of calorie count and hourly I&O assessmebt D. Assessment of blood pressure and monitoring for orthostatic hypotension

A Infection control is a priority in the care of patients with MS because infection is the most common cause of an exacerbation of the disease. Decreases in cognitive function are less likely, and MS typically does not result in malnutrition, hypotension, or fluid volume excess or deficit.

Which action will the nurse plan to take for a 40-year-old patient with multiple sclerosis (MS) who has urinary retention caused by a flaccid bladder? a. Decrease the patient's evening fluid intake. b. Teach the patient how to use the Credé method. c. Suggest the use of adult incontinence briefs for nighttime only. d. Assist the patient to the commode every 2 hours during the day.

B. The Credé method can be used to improve bladder emptying. Decreasing fluid intake will not improve bladder emptying and may increase risk for urinary tract infection (UTI) and dehydration. The use of incontinence briefs and frequent toileting will not improve bladder emptying.

When establishing a diagnosis of multiple sclerosis (MS), about what diagnostic studies should the nurse teach the patient? Select all that apply. A. EEG B. Carotid duplex scan C. Evoked respnose testing D. CSF analysis E. CT scan

C, D, E There is no definitive diagnostic test for MS. CT scan, evoked response testing, cerebrospinal fluid analysis, and magnetic resonance imaging (MRI), along with the patient's history and physical examination, are used to establish a diagnosis for MS. EEG and carotid duplex scan are not used for diagnosing MS.

Which type of multiple sclerosis is characterized by a relapsing-remitting initial course followed by disease with or without relapses? A. Relapsing-remitting B. Primary-progressive C. Progressive-relapsing D. Secondary-progressive

D Secondary-progressive multiple sclerosis has a relapsing-remitting course that later becomes steadily progressive, with or without occasional relapses, minor remissions, and plateaus. Relapsing-remitting multiple sclerosis involves developing and resolving symptoms over a few weeks to months before the patient returns to the baseline. Primary-progressive multiple sclerosis involves steady and gradual neurologic dysfunction without remittance of the symptoms. Progressive-relapsing multiple sclerosis involves frequent relapses with a partial recovery, without the patient returning to the baseline.

The nurse caring for a patient with multiple sclerosis understands that the neuropathologic changes in multiple sclerosis include various processes. Arrange the processes in the order of occurrence. 1. The antigen-antibody reaction within the CNS activates the inflammatory response, causing demyelination of axons. 2. The underlying axon gets damaged, disrupting transmission of nerve impulses and loss of nerve function. 3. The activated T-cells in the systemic circulation migrate to the central nervous system (CNS), disrupting the blood-brain barrier. 4. The ongoing inflammation affects the nearby oligodendrocytes, and the myelin loses the ability to regenerate. 5. The inflammation subsides, and the glial scar tissue replaces the damaged tissue, forming hard, sclerotic plaques. 6. An environmental factor or virus triggers the activation of T-cells in genetically susceptible individuals.

6, 3, 1, 4, 2, 5 The primary neuropathologic condition is an autoimmune process orchestrated by activated T-cells. An environmental factor or virus in genetically susceptible individuals may initially trigger this process. The activated T-cells in the systemic circulation migrate to the CNS, disrupting the blood-brain barrier. Subsequent antigen-antibody reaction within the CNS activates the inflammatory response and leads to the demyelination of axons. Initially, attacks on the myelin sheaths of the neurons in the brain and the spinal cord result in damage to the myelin sheath. However, the nerve fiber is not affected. As ongoing inflammation occurs, the nearby oligodendrocytes are affected, and the myelin loses the ability to regenerate. Eventually damage occurs to the underlying axon. Nerve impulse transmission is disrupted, resulting in the permanent loss of nerve function. As inflammation subsides, glial scar tissue replaces the damaged tissue, leading to the formation of hard, sclerotic plaques.

A patient with multiple sclerosis has an exacerbation of sensory deficits. Which nursing diagnostic statement should be assigned highest priority? A. risk for injury B. acute confusion C. fluid volume deficit D. Ineffective thermoregulation

A In multiple sclerosis, one side is usually affected more than the other. Therefore the gait is unsteady, so the risk for falls is increased. Acute confusion may be a manifestation experienced by some patients later in the multiple sclerosis disease process. Deficient fluid volume and ineffective thermoregulation are not generally affected by multiple sclerosis. Visual disturbances and muscle spasticity may also contribute to the risk for injury.

Which disease exhibits Lhermitte's sign as a clinical manifestation? A. Multiple Sclerosis B. Myesthenia Gravis C. Lou Gehrig's Disease D. Huntington's Disease

A Lhermitte's sign is a transient sensory symptom manifested in the patients with multiple sclerosis. It is described as an electric shock radiating down the spine or into the limbs with flexion of the neck.

A 38-year-old woman has newly diagnosed multiple sclerosis (MS) and asks the nurse what is going to happen to her. What is the best response by the nurse? a. "You will have either periods of attacks and remissions or progression of nerve damage over time." b. "You need to plan for a continuous loss of movement, sensory functions, and mental capabilities." c. "You will most likely have a steady course of chronic progressive nerve damage that will change your personality." d. "It is common for people with MS to have an acute attack of weakness and then not to have any other symptoms for years."

A Most patients with multiple sclerosis (MS) have remissions and exacerbations of neurologic dysfunction or a relapsing-remitting initial course followed by progression with or without occasional relapses, minor remissions, and plateaus that progressively cause loss of motor, sensory, and cerebellar functions. Intellectual function generally remains intact but patients may experience anger, depression, or euphoria. A few people have chronic progressive deterioration and some may experience only occasional and mild symptoms for several years after onset.

The nurse is caring for a patient with multiple sclerosis in remission. What information should the nurse include when teaching the patient about advantages of exercise for multiple sclerosis? Select all that apply. A. Decreases spasticity B. Increases coordination C. Helps regain bladder control D. Delays demyelination process E. Restrains unaffected muscles to substitute for impaired ones

A, B, E Patients with multiple sclerosis in remission should be encouraged to exercise. Regular exercise can help to decrease spasticity, increase coordination, and retrain unaffected muscles to substitute for the impaired ones. The exercise does not help in regaining bladder control or delaying the demyelination process.

A patient with multiple sclerosis has been advised to use dalfampridine (Ampyra) to improve walking speed. What questions should the nurse ask the patient before administering the medication? Select all that apply. A. Do you have kidney disease? B. Does your work involve operating machinery? C. Do you have a history of any seizure disorder? D. Does any member of your family have diabetes? E. Have you been taking any over the counter medications?

A, C Dalfampridine is a selective potassium channel blocker and improves nerve conduction in damaged nerve segments. Because it is a potassium channel blocker, it should not be administered to patients with a history of seizure disorders or moderate to severe kidney disease. Therefore the nurse should ask the patient about any history of seizure disorders or kidney diseases. The factors of family history of diabetes, operating machines, or taking over-the-counter drugs are not relevant to dalfampridine use or nonuse.

The nurse is caring for a patient with a spastic bladder secondary to multiple sclerosis. What manifestations of spastic bladder should the nurse expect to find in the patient? Select all that apply. A. Bladder contractions are unchecked. B. The patient experiences urinary retention. C. The bladder has a small capacity for urine. D. The patient experiences incontinence and dribbling. E. There is no sensation of urge to void or no desire to void.

A, C, D A patient with spastic bladder may experience unchecked bladder contraction, and the bladder may have a small capacity for urine. Both of these factors may result in urine urgency and frequency and cause incontinence and dribbling. Sensation of an urge to void is present in patients with spastic bladder but absent in patients with flaccid bladder, who may have urinary retention due to a large bladder capacity for urine.

A patient with a suspected neurologic disorder has weakness of the limbs, blurred vision, patchy blindness, and bowel and bladder dysfunction. Which clinical findings would support the diagnosis of multiple sclerosis? Select all that apply. A. Presence of auditory and visual evoked potential B. Presence of IgM antibodies in CSF C. Presence of IgG antibodies in CSF D. Presence of an altered copy of the HTT gene on chromosome 4 E. Presence of inflammation, tissue breakdown, and atrophy of the spinal cord on the MRI

A, C, E There is no definitive diagnostic for multiple sclerosis. To diagnose MS, the factors considered are the history, clinical manifestations, and results of certain diagnostic tests. The presence of evoked potential in the visual, auditory, and somatosensory potential testing is a diagnostic test for multiple sclerosis. Many patients with multiple sclerosis have increased IgG antibodies in the cerebrospinal fluid, and the occurrence of IgG bands is seen in most. Patients with multiple sclerosis also show damage to the spinal cord such as inflammation, tissue breakdown, and atrophy of the spinal cord, which can be seen in the MRI. The presence of IgM antibodies in the cerebrospinal fluid is not a characteristic of multiple sclerosis. The presence of an altered copy of the HTT gene, located on chromosome 4, is a characteristic of Huntington's disease.

A 31-year-old woman who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. Which response by the nurse is accurate? a. "MS symptoms may be worse after the pregnancy." b. "Women with MS frequently have premature labor." c. "MS is associated with an increased risk for congenital defects." d. "Symptoms of MS are likely to become worse during pregnancy."

A. During the postpartum period, women with MS are at greater risk for exacerbation of symptoms. There is no increased risk for congenital defects in infants born of mothers with MS. Symptoms of MS may improve during pregnancy. Onset of labor is not affected by MS.

When obtaining a health history and physical assessment for a 36-year-old female patient with possible multiple sclerosis (MS), the nurse should A. assess for the presence of chest pain. B. inquire about urinary tract problems. C. inspect the skin for rashes or discoloration. D. ask the patient about any increase in libido.

B Urinary tract problems with incontinence or retention are common symptoms of MS. Chest pain and skin rashes are not symptoms of MS. A decrease in libido is common with MS.

Which information about a 60-year-old patient with MS indicates that the nurse should consult with the health care provider before giving the prescribed dose of dalfampridine (Ampyra)? a. The patient has relapsing-remitting MS. b. The patient walks a mile a day for exercise. c. The patient complains of pain with neck flexion. d. The patient has an increased serum creatinine level.

D. Dalfampridine should not be given to patients with impaired renal function. The other information will not impact whether the dalfampridine should be administered.