Med Surg 1 Chapter 43 Part 2

A patient diagnosed with multiple sclerosis has developed scotomas. What assessment finding is consistent with this finding?

Decreased peripheral vision Scotomas are changes in peripheral vision. Double vision is diplopia. Intention tremors are not scotomas. Involuntary eye movements are nystagmus.

What assessment findings does a nurse anticipate when caring for a patient with an acute exacerbation of multiple sclerosis? Select all that apply.

Fatigue and muscle spasm The patient with an acute exacerbation of multiple sclerosis will experience fatigue and muscle spasms. Hypertension is not a sign of an acute exacerbation. Loss of vision is not a sign of multiple sclerosis. Positive Babinski's reflex would be expected.

What does the nurse prioritize when caring for a patient diagnosed with multiple sclerosis who is experiencing hypalgesia?

Injury Risk A patient with multiple sclerosis who has hypalgesia has decreased sensitivity to pain, which increases the risk of injury. Pain is not as high a priority as injury risk. Reduced capacity for self-care is important but not priority. Likewise, lack of tolerance for activity is important but not priority.

Which statement about multiple sclerosis (MS) is correct?

It occurs more frequently among whites than other races. MS affects people of all races but does tend to occur more frequently among whites. Women are affected twice as often as men. Though MS may occur in people over 50 years, it usually affects people between 20 and 40 years of age. There is a higher incidence in the colder climates of the Northeastern states, the Great Lakes, and Pacific Northwestern states, as well as Canada.

Which disease is characterized by remissions and exacerbations of symptoms causing neurological disability?

MS Multiple sclerosis is an inflammatory disease of the brain and spinal cord that can cause neurological disabilities. This disease is characterized by remission and exacerbation of symptoms causing neurological disability. Spinal shock can occur after a spinal injury; it may not have remissions. Spinal cord tumors are not associated with remissions and exacerbations. Amyotrophic lateral sclerosis (ALS) is a lower and upper motor neuron disease; ALS is not characterized by a remission and exacerbation of symptoms.

What chemotherapy drug has been shown to effectively reduce neurologic disability in patients with multiple sclerosis?

Mitoxantrone Mitoxantrone is a chemotherapy drug that has been shown to be effective in reducing neurologic disability. Fingolimod was the first oral immunomodulator. Cyclosporine and methotrexate are immunosuppressants.

Which alternative therapy may lead to spasticity in patients with multiple sclerosis?

Positioning therapy Positioning therapy is ineffective in patients with multiple sclerosis because this therapy can lead to spasticity. Massage therapy helps relieve symptoms of spasticity. Reflexology and acupuncture are recommended to help decrease symptoms.

Which type of multiple sclerosis (MS) involves steady and gradual neurological deterioration without temporary diminution of the symptoms?

Primary progressive multiple sclerosis (PPMS Primary progressive multiple sclerosis involves steady and gradual neurological dysfunction without the remittance of the symptoms. Relapsing-remitting multiple sclerosis involves the development and resolution of symptoms within the span of a few weeks to a few months. After the resolution of symptoms, the patient returns to the baseline. Progressive relapsing multiple sclerosis involves frequent relapses with partial recovery without the patient returning to the baseline. Secondary progressive multiple sclerosis begins with a relapsing remitting course that later becomes steadily progressive.

A patient with bladder dysfunction has presented with five urinary tract infections in the last three months. The patient is using straight catheterization at home. What intervention should the nurse prepare to provide teaching on?

Prophylactic antibiotics The patient has already developed infections, so prophylactic antibiotics may decrease the incidence of infections. Bladder training is not indicated. Bladder pacemaker is not indicated for the reduction of infection. An indwelling urinary catheter will increase the risk of infection, not reduce it.

A patient diagnosed with multiple sclerosis reports fatigue and loss of interest in sexual activity. The patient expresses depression and frustration with the change in sexual desire. What intervention is most appropriate?

refer the patient to licensed therapist It is important to refer the patient to a licensed therapist to deal with a sexual dysfunction and depression. Discussing methods of conserving energy is important but not the priority. Offering information on treatments for sexual dysfunction should be done but is not the priority. Reviewing side effects of medications may be done but is not the priority.

What statement by the patient diagnosed with multiple sclerosis indicates a need for further teaching?

"If my muscles are feeling tired I will take a hot bath." Taking a hot bath is contraindicated in patients with multiple sclerosis; extreme heat will exacerbate the multiple sclerosis. Use of stress relief techniques is indicated. The patient should avoid people with infections. If the patient has diplopia, alternating an eyepatch from side to side is appropriate

The family member of a patient diagnosed with multiple sclerosis expresses concern over the patient's inappropriate behavior. What statement by the nurse is most appropriate?

"It is a good idea to develop a cue to let them know they're being inappropriate." Developing a cue to let the patient know she is behaving inappropriately is indicated. Avoiding social situations is not indicated. This behavior may be a permanent part of the disease; however, telling the family that this will likely get worse is not supporting the family. There are no medications to improve the behavioral changes related to MS

The nurse is teaching a patient newly diagnosed with multiple sclerosis (MS). Which statement by the patient indicates a correct understanding of the pathophysiology of the disease?

"Parts of my nervous system have plaques." MS is characterized by an inflammatory response that results in diffuse random or patchy areas of plaque in the white matter of the central nervous system. The patient with MS has no decrease in life expectancy. Frequent times of remission are common in patients with MS. There is no known cause for MS.

Which drug does the nurse expect to administer as part of the treatment plan for a patient with relapsing multiple sclerosis (MS)?

Immunomodulator Immunomodulators such as interferon-beta, synthetic proteins like glatiramer acetate, and monoclonal antibodies such as natalizumab are among the current drug therapies recommended for early and continuous treatment of relapsing types of MS. Penicillin-based antibiotics are used in the treatment of bacterial infections. Calcium channel blockers are commonly used in patients with hypertension and other cardiovascular issues. Antispasmodics are used to suppress muscle spasms.

A patient with multiple sclerosis will begin therapy with fingolimod. Which instruction does the nurse give the patient about this drug?

Monitor pulse daily The patient should be taught to monitor the pulse daily as the medication can cause bradycardia, especially within the first 6 hours of taking it. The drug does not cause elevated blood sugar, so monitoring of blood sugar is not required. The drug does not cause vertigo or flushing.

What teaching is priority for a patient taking dalfampridine?

Observe for seizure activity Dalfampridine has been shown to improve the ability of patients with multiple sclerosis to walk; however, it has a high incidence of seizures. There's no indication to check the pulse while on this medication. It does not carry the risk of bleeding. Dalfampridine does not increase the risk of visual disturbances.