Chapter 63: Multiple Sclerosis

Question 1

A 29-year-old woman presents with fatigue, muscle weakness, and occasional blurred vision. Her medical history is unremarkable, but her symptoms have progressively worsened over the last six months. During the clinical discussion, the nurse recalls that multiple sclerosis (MS) is a chronic, progressive disorder. Which of the following additional findings would most strongly support a diagnosis of MS?

A. Symptoms resolve completely between episodes.
B. Demyelination of nerve fibers seen on MRI.
C. A family history of Parkinson’s disease.
D. Positive genetic marker HLA-B27.

Answer 1

B. Demyelination of nerve fibers seen on MRI.

Rationale: MS is characterized by disseminated demyelination of nerve fibers in the brain and spinal cord, which can be detected using MRI imaging. Symptom resolution between episodes (A) may occur in early MS but is nonspecific and does not confirm the diagnosis. A family history of Parkinson’s disease (C) and the HLA-B27 marker (D) are not directly associated with MS. The hallmark finding for MS diagnosis is evidence of CNS demyelination.

Question 2

A 35-year-old man is diagnosed with MS and asks the nurse about risk factors. The nurse explains that MS is a multifactorial disease. Which of the following factors is most likely associated with an increased risk of developing MS?

A. Diagnosis of MS in a sibling and low vitamin D levels
B. African descent and living near the equator
C. Frequent viral infections and living in tropical climates
D. High intake of vitamin D and a sedentary lifestyle

Answer 2

A. Diagnosis of MS in a sibling and low vitamin D levels

Rationale: MS is more prevalent in individuals with a family history of the disease, particularly first-degree relatives. Low levels of vitamin D are also associated with an increased risk of MS.

Question 3

A nurse is caring for a 50-year-old patient recently diagnosed with MS. Which statement made by the patient indicates an accurate understanding of the disease progression?

A. “This disease will definitely cause severe disability over time.”
B. “Symptoms will remain the same regardless of my age at diagnosis.”
C. “Since I am older, I am more likely to have a progressive form of MS.”
D. “MS always affects women more severely than men.”

Answer 3

C. “Since I am older, I am more likely to have a progressive form of MS.”

Rationale: Patients diagnosed at age 50 or older are more likely to have progressive forms of MS.

Question 4

A nurse is providing education to a patient recently diagnosed with MS. Which statement by the patient indicates the need for further teaching?

A. “This disease is more common in people of Northern European ancestry.”
B. “Maintaining good vitamin D levels may help reduce my risk of worsening MS.”
C. “MS is unpredictable, but it always causes severe permanent disability.”
D. “The symptoms of MS vary greatly between individuals.”

Answer 4

C. “MS is unpredictable, but it always causes severe permanent disability.”

Rationale: While MS is unpredictable and can lead to severe disability in some cases, many patients experience minimal permanent effects. The variability of symptoms and disease progression highlights the unique impact MS has on individuals.

Question 5

The nurse is assessing a 40-year-old patient who reports worsening fatigue, numbness in the legs, and muscle spasms. The nurse is aware that MS often has different prevalence rates in various regions. Based on this, which patient characteristic would align most with an increased risk of MS?

A. Living in a region closer to the equator
B. Having African American heritage
C. Living in northern latitudes
D. Being male and under age 20

Answer 5

C. Living in northern latitudes

Rationale: MS is more prevalent further from the equator, and the risk increases in northern latitudes. While MS affects people of all ethnic groups, it is most common in individuals of Northern European ancestry, not African descent (B). MS affects women more frequently than men, making D incorrect.

Question 6

A patient with multiple sclerosis asks the nurse about what causes the disease. Which response by the nurse is most accurate based on current evidence?

A. “Multiple sclerosis is caused by a specific viral infection that triggers inflammation in the central nervous system.”
B. “The exact cause of multiple sclerosis is unknown, but it likely involves both genetic and environmental factors.”
C. “Multiple sclerosis results from a single genetic mutation that leads to an autoimmune reaction.”
D. “Toxins in the environment are the primary cause of multiple sclerosis in genetically susceptible individuals.”

Answer 6

B. “The exact cause of multiple sclerosis is unknown, but it likely involves both genetic and environmental factors.”

Rationale: The cause of MS is not fully understood but is believed to involve a combination of genetic predisposition and environmental factors, including possible viral exposures. There is no single gene or specific virus directly identified as the sole cause, making A and C incorrect. Toxins (D) are not considered a primary factor in MS etiology.

Question 7

A nurse is explaining the role of T cells in the development of multiple sclerosis. Which of the following statements is correct?

A. T cells mistake myelin proteins for a viral antigen and initiate an inflammatory process.
B. T cells attack healthy CNS neurons directly, causing inflammation and axonal damage.
C. T cells cross the blood-brain barrier and immediately begin axonal repair.
D. T cells attack oligodendrocytes, leading to axonal regrowth.

Answer 7

A. T cells mistake myelin proteins for a viral antigen and initiate an inflammatory process.

Rationale: T cells are activated by environmental exposures, such as viral infections, and mistake myelin proteins for viral antigens. This misidentification initiates an inflammatory response, leading to demyelination and subsequent axonal damage.

Question 8

A nurse is teaching a newly diagnosed patient about the pathophysiology of multiple sclerosis. Which patient statement indicates understanding?

A. “Myelin sheaths are permanently destroyed early in the disease process.”
B. “The inflammatory process targets the blood-brain barrier, leaving myelin intact.”
C. “Demyelination slows nerve impulse transmission, causing my symptoms.”
D. “MS only affects the white matter of my brain and spinal cord.”

Answer 8

C. “Demyelination slows nerve impulse transmission, causing my symptoms.”

Rationale: MS causes chronic inflammation and demyelination, which disrupts nerve impulse transmission and leads to symptoms such as weakness or numbness. Early in the disease, myelin may regenerate (A). Both white and gray matter are affected in later stages of the disease (D), and inflammation directly targets myelin proteins, not just the blood-brain barrier (B).

Question 9

A 45-year-old patient with MS asks why their symptoms come and go. What is the best explanation by the nurse?

A. “The body repairs damaged myelin during periods of remission.”
B. “Symptoms return as the inflammatory process spreads throughout the entire CNS.”
C. “Temporary remissions occur because the axons in your CNS regenerate.”
D. “The disease affects your peripheral nerves, which can recover over time.”

Answer 9

A. “The body repairs damaged myelin during periods of remission.”

Rationale: During periods of remission, inflammation ceases, and oligodendrocytes may repair the damaged myelin, partially or fully restoring nerve impulse transmission. However, as the disease progresses, myelin regeneration becomes less effective. Axons in the CNS (not peripheral nerves) are permanently damaged in advanced MS, making C and D incorrect.

Question 10

A nurse is caring for a patient with late-stage multiple sclerosis. Which pathological finding is most consistent with disease progression?

A. Widespread axonal regeneration in the CNS
B. Formation of rigid plaques in the white matter
C. Complete restoration of myelin in affected areas
D. Persistent inflammation of the peripheral nervous system

Answer 10

B. Formation of rigid plaques in the white matter

Rationale: In late-stage MS, inflammation subsides and glial scar tissue replaces damaged tissue, leading to the formation of rigid plaques in the CNS white matter. Axonal regeneration (A) and complete myelin restoration (C) are not characteristic of advanced MS. The peripheral nervous system (D) is not directly affected in MS.

Question 11

A patient with MS is admitted with pneumonia. The nurse understands that the most likely contributing factor is:

A. Chronic inflammation of the respiratory tract.
B. Immune suppression caused by MS medications.
C. Complications of immobility due to disease progression.
D. Damage to respiratory neurons in the peripheral nervous system.

Answer 11

C. Complications of immobility due to disease progression.

Rationale: Pneumonia is a common cause of death in patients with MS due to immobility-related complications, such as decreased lung function and poor clearance of secretions. While immune suppression (B) can increase infection risk, it is not the primary factor in this case. MS primarily affects the CNS, not the peripheral nervous system (D).

Question 12

Which of the following best describes the role of gliosis in the pathophysiology of MS?

A. It promotes remyelination of damaged axons.
B. It stimulates the regeneration of oligodendrocytes.
C. It decreases plaque formation in white matter.
D. It marks the transition from inflammation to scar tissue formation.

Answer 12

D. It marks the transition from inflammation to scar tissue formation.

Rationale: Gliosis occurs as inflammation subsides, leading to scar tissue formation that replaces damaged myelin and axons. This contributes to plaque formation and progressive loss of nerve function.

Question 13

A nurse is reviewing the chart of a patient with MS. Which finding would indicate advanced disease progression?

A. Cerebral cortex atrophy noted on imaging
B. Remission of symptoms after an exacerbation
C. Increased regeneration of oligodendrocytes
D. Slowed but intact nerve impulse transmission

Answer 13

A. Cerebral cortex atrophy noted on imaging

Rationale: Cerebral cortex atrophy is associated with late-stage MS and indicates significant disease progression.

Question 14

A nurse is educating a student about MS pathology. Which of the following statements by the student requires correction?

A. “The immune system mistakenly attacks myelin proteins in the CNS.”
B. “Axonal damage in MS is permanent and contributes to disability.”
C. “Inflammation in MS occurs exclusively in the white matter of the brain.”
D. “T cells play a major role in the autoimmune process seen in MS.”

Answer 14

C. “Inflammation in MS occurs exclusively in the white matter of the brain.”

Rationale: MS affects both white and gray matter in the CNS. Statements A, B, and D are correct and consistent with the described pathophysiology of MS.

Question 15

A patient with MS asks how the disease might affect life expectancy. The nurse explains:

A. “MS reduces life expectancy by about 20 years, mostly due to brain atrophy.”
B. “Life expectancy in MS is unaffected because it only affects nerve function, not other systems.”
C. “MS leads to death from exacerbations caused by inflammation in the CNS.”
D. “MS reduces life expectancy by about 7 years, often due to complications like pneumonia.”

Answer 15

D. “MS reduces life expectancy by about 7 years, often due to complications like pneumonia.”

Rationale: MS reduces life expectancy by approximately 7 years, often due to secondary complications like infections or immobility-related conditions (e.g., pneumonia).

Question 16

A nurse is assessing a patient with multiple sclerosis who reports experiencing an electric shock sensation traveling down the spine when flexing the neck. This symptom is best described as:

A. Dysarthria
B. Nystagmus
C. Lhermitte’s sign
D. Dysphagia

Answer 16

C. Lhermitte’s sign

Rationale: Lhermitte’s sign is a temporary sensory symptom in MS described as an electric shock sensation traveling down the spine or into the limbs with neck flexion.

Question 17

The nurse knows that a patient with multiple sclerosis may experience worsening fatigue. Which factor is most likely to contribute to this symptom?

A. Increased myelin regeneration
B. Hot and humid weather
C. Overuse of the affected muscles
D. Dehydration

Answer 17

B. Hot and humid weather

Rationale: Heat and humidity, along with deconditioning and medication side effects, are known to worsen fatigue in patients with MS. Myelin regeneration (A) does not cause fatigue, and overuse of muscles (C) is not a primary factor. Dehydration (D) may cause fatigue but is not specific to MS.

Question 18

A patient with MS reports bladder dysfunction characterized by urinary retention and no sensation to void. The nurse suspects:

A. Spastic bladder
B. Flaccid bladder
C. Overactive bladder
D. Stress incontinence

Answer 18

B. Flaccid bladder

Rationale: A flaccid bladder occurs when lesions affect the reflex arc controlling bladder function, leading to urinary retention, absent sensation to void, and no pressure or pain. Spastic bladder (A) causes urinary urgency and frequency. Overactive bladder (C) and stress incontinence (D) are not specific terms used to describe MS-related bladder dysfunction.

Question 19

Which of the following symptoms is most likely to be the first sign of multiple sclerosis?

A. Blurred or double vision
B. Severe fatigue
C. Dysphagia
D. Complete paralysis

Answer 19

A. Blurred or double vision

Rationale: Vision changes, such as blurred or double vision, red-green color distortion, or blindness in one eye, are often the first signs of MS. Severe fatigue and dysphagia occur later in the disease, while complete paralysis is a rare, advanced manifestation.

Question 20

A patient with MS reports an “MS hug.” The nurse explains that this symptom is caused by:

A. Inflammation of the spinal cord
B. Permanent nerve damage
C. Cerebellar dysfunction
D. Muscle spasms in the intercostal and abdominal muscles

Answer 20

D. Muscle spasms in the intercostal and abdominal muscles

Rationale: The “MS hug” is a term used to describe pain caused by muscle spasms in the intercostal and abdominal muscles. It is not directly caused by spinal cord inflammation, nerve damage, or cerebellar dysfunction.

Question 21

Which of the following cognitive symptoms is most commonly associated with MS?

A. Problems with multitasking and word finding
B. General intellectual decline
C. Loss of long-term memory
D. Complete loss of concentration

Answer 21

A. Problems with multitasking and word finding

Rationale: Cognitive issues in MS often include difficulties with multitasking, concentration, short-term memory, speed of processing, and word finding. General intellect remains unchanged, and long-term memory and complete concentration loss are not characteristic.

Question 22

A patient with MS presents with nystagmus, ataxia, and dysarthria. The nurse recognizes these as:

A. Signs of cerebellar involvement
B. Early signs of MS progression
C. Indicators of spinal cord damage
D. Symptoms related to peripheral neuropathy

Answer 22

A. Signs of cerebellar involvement

Rationale: Nystagmus, ataxia, and dysarthria are classic cerebellar signs in MS, indicating involvement of the cerebellum. These are not early signs (B) nor directly related to spinal cord damage (C) or peripheral neuropathy (D).

Question 23

A nurse is educating a patient with MS about their diagnosis. Which symptom is most likely to be reported as disabling?

A. Dysphagia
B. Fatigue
C. Tremors
D. Hearing loss

Answer 23

B. Fatigue

Rationale: Fatigue is often the most disabling symptom for patients with MS and can be severe. Dysphagia (A), tremors (C), and hearing loss (D) may occur but are less frequently described as disabling.

Question 24

The nurse is educating a patient with MS about sexual dysfunction. Which statement by the patient indicates a need for further teaching?

A. “Sexual dysfunction can be caused by spinal cord involvement.”
B. “Loss of sensation can affect my sexual response.”
C. “Emotional changes have no effect on my sexual response.”
D. “Hormonal changes during pregnancy may improve my symptoms.”

Answer 24

C. “Emotional changes have no effect on my sexual response.”

Rationale: Emotional changes, including depression and loss of self-esteem, can affect sexual response in patients with MS. Physiologic issues like spinal cord involvement (A), loss of sensation (B), and hormonal changes during pregnancy (D) are also factors.

Question 25

Which of the following is characteristic of spastic bladder in a patient with MS? A. Urinary retention without the urge to void B. Decreased urine production C. Painful bladder spasms with low urine output D. Involuntary bladder contractions causing urgency

Answer 25

D. Involuntary bladder contractions causing urgency Rationale: Spastic bladder in MS is caused by uninhibited bladder contractions, resulting in urinary urgency, frequency, dribbling, or incontinence. Urinary retention without urge is seen with a flaccid bladder. Decreased urine production and painful bladder spasms are not specific to spastic bladder.

Question 26

A nurse is assessing a patient with MS who has difficulty walking and standing. These symptoms are most likely caused by: A. Muscle weakness and coordination problems B. Cerebellar dysfunction and dysarthria C. Sensory deficits and nystagmus D. Paralysis of the lower extremities

Answer 26

A. Muscle weakness and coordination problems Rationale: Muscle weakness and coordination problems are common in MS and contribute to difficulty walking and standing. While cerebellar dysfunction (B) and sensory deficits (C) may occur, they are not the primary cause in this case. Paralysis (D) is less common and occurs in advanced disease.

Question 27

A patient with MS reports severe pain in the low thoracic region. The nurse identifies this symptom as most likely caused by: A. Peripheral nerve damage B. Inflammation of spinal meninges C. Muscle spasms in the thoracic area D. Demyelination of motor neurons

Answer 27

C. Muscle spasms in the thoracic area Rationale: Pain in the low thoracic region, commonly referred to as the “MS hug,” is caused by muscle spasms in the intercostal and abdominal muscles. It is not due to peripheral nerve damage (A), meningitis (B), or direct demyelination of motor neurons (D).

Question 28

Which of the following symptoms would most likely prompt early medical evaluation in a patient with MS? A. Blurred vision and eye pain B. Mild tremors C. Short-term memory loss D. Fatigue worsening with heat

Answer 28

A. Blurred vision and eye pain Rationale: Vision changes, such as blurred vision or pain, are often early symptoms of MS and may prompt a medical evaluation. Tremors (B), memory loss (C), and heat-related fatigue (D) are common but occur later or may not prompt early evaluation.

Question 29

A pregnant patient with MS is concerned about symptom changes. The nurse explains: A. “MS symptoms usually worsen during pregnancy due to hormonal changes.” B. “Pregnancy often leads to remission or improvement in MS symptoms.” C. “Pregnancy has no effect on MS symptoms or progression.” D. “Pregnancy increases the risk of permanent neurological damage.”

Answer 29

B. “Pregnancy often leads to remission or improvement in MS symptoms.” Rationale: Pregnancy often improves MS symptoms due to hormonal changes that modulate the immune system. Symptoms do not typically worsen (A) or increase the risk of permanent damage (D), and pregnancy has a significant impact on the disease (C).

Question 30

The nurse is assessing a patient with MS and notices dysphagia. This symptom is most likely due to: A. Cerebellar involvement B. Cognitive dysfunction C. Lesions in the reflex arc controlling swallowing D. Demyelination of cranial nerves

Answer 30

A. Cerebellar involvement Rationale: Dysphagia in MS is often caused by cerebellar dysfunction affecting coordination of swallowing muscles. It is not typically due to cognitive dysfunction (B), lesions in the reflex arc (C), or direct demyelination of cranial nerves (D).

Question 31

A nurse is explaining the diagnostic process of multiple sclerosis to a patient. Which diagnostic finding is most consistent with MS? A. Elevated immunoglobulin G and oligoclonal banding in cerebrospinal fluid B. Elevated white blood cell count and positive rheumatoid factor C. Increased nerve conduction velocity in evoked potential studies D. Normal MRI with contrast showing no plaques or atrophy

Answer 31

A. Elevated immunoglobulin G and oligoclonal banding in cerebrospinal fluid Rationale: CSF analysis in MS often shows elevated immunoglobulin G and the presence of oligoclonal banding, which indicate inflammation in the spinal fluid. White blood cell count (B) and rheumatoid factor are not specific to MS. Evoked potential studies (C) often show delayed, not increased, nerve conduction, and MRI findings (D) in MS typically show plaques, inflammation, and atrophy.

Question 32

Which of the following diagnostic criteria must be met to confirm a diagnosis of multiple sclerosis? A. Evidence of at least 3 inflammatory demyelinating lesions in the brain B. Two or more clinical attacks at least 2 weeks apart C. Evidence of inflammatory demyelinating lesions in at least 2 different CNS locations D. A positive evoked potential study and elevated WBC count

Answer 32

C. Evidence of inflammatory demyelinating lesions in at least 2 different CNS locations Rationale: MS diagnostic criteria include evidence of at least 2 inflammatory demyelinating lesions in at least 2 different CNS locations, along with 2 or more attacks occurring at different times (usually 1 month or more apart) and the exclusion of other diagnoses.

Question 33

A patient suspected of having MS undergoes an MRI with contrast. Which finding would most strongly support the diagnosis? A. Delayed evoked potential responses B. Brain and spinal cord plaques C. Increased intracranial pressure D. Decreased brain tissue perfusion

Answer 33

B. Brain and spinal cord plaques Rationale: An MRI with contrast in MS often shows plaques, inflammation, atrophy, and tissue destruction in the brain and spinal cord. While delayed evoked potential responses (A) and elevated CSF immunoglobulin G are supportive findings, plaques are a hallmark feature. Increased intracranial pressure (C) and decreased perfusion (D) are not associated with MS.

Question 34

A patient is being evaluated for MS after a single clinical attack. The healthcare provider explains that to meet diagnostic criteria, they must also confirm: A. A history of autoimmune diseases B. At least three delayed evoked potential responses C. Progressive symptoms over a 6-month period D. Presence of oligoclonal banding in the cerebrospinal fluid

Answer 34

D. Presence of oligoclonal banding in the cerebrospinal fluid Rationale: If only one clinical attack has occurred, the presence of oligoclonal banding in the CSF can confirm the inflammatory process consistent with MS. A history of autoimmune disease or progressive symptoms is not required for diagnosis. Delayed evoked potential responses are helpful but not diagnostic alone.

Question 35

The nurse is reviewing diagnostic test results for a patient with suspected MS. Delayed evoked potential responses most likely indicate: A. Decreased nerve conduction from demyelination B. Increased neural activity in the CNS C. Permanent nerve damage in the peripheral nervous system D. An acute inflammatory response in the CNS

Answer 35

A. Decreased nerve conduction from demyelination Rationale: Delayed evoked potential responses in MS result from decreased nerve conduction due to demyelination in the CNS. Increased neural activity (B) and peripheral nerve damage (C) are not characteristics of MS. While inflammation (D) may occur, delayed responses specifically reflect demyelination.

Question 36

A patient with multiple sclerosis asks about their treatment options. Which statement by the nurse best explains the primary goal of interprofessional care for MS? A. “The main goal is to cure the disease by targeting its underlying cause.” B. “Treatment is designed to slow disease progression and manage your specific symptoms.” C. “The focus is on reversing existing damage caused by demyelination.” D. “We aim to eliminate the inflammation to prevent future attacks completely.”

Answer 36

B. “Treatment is designed to slow disease progression and manage your specific symptoms.” Rationale: Since there is no cure for MS, the primary focus of interprofessional care is to tailor therapy to slow disease progression and provide symptomatic relief specific to the patient’s unique presentation.

Question 37

A patient with MS is being treated with a combination of therapies. The nurse explains that the individualized approach to care is necessary because: A. “Each case of MS is unique and requires tailored treatment for disease patterns and symptoms.” B. “Treatment must focus solely on managing cognitive impairments in MS.” C. “Research has identified specific treatments that cure MS in different patient groups.” D. “Symptom management is less important than targeting disease progression.”

Answer 37

A. “Each case of MS is unique and requires tailored treatment for disease patterns and symptoms.” Rationale: MS presents differently in each patient, so therapy must be tailored to address the disease pattern and individual symptoms effectively. There is no cure for MS, and care focuses on both symptom management and slowing progression.

Question 38

Which drug used for multiple sclerosis modifies the disease by preventing lymphocytes from reaching the central nervous system (CNS)? A. Fingolimod (Gilenya) B. Prednisone C. Dimethyl fumarate (Tecfidera) D. Ocrelizumab (Ocrevus)

Answer 38

A. Fingolimod (Gilenya) Rationale: Fingolimod works by preventing lymphocytes from reaching the CNS, reducing disease activity and subsequent damage. Prednisone is a corticosteroid for acute exacerbations, and dimethyl fumarate helps with inflammation and oxidative stress. Ocrelizumab is a monoclonal antibody for progressive forms of MS.

Question 39

A patient taking teriflunomide (Aubagio) asks about possible side effects. What is the nurse’s priority in patient education? A. The potential for liver toxicity B. Increased seizure risk C. Monitoring for chronic pain D. The risk of breast cancer

Answer 39

A. The potential for liver toxicity Rationale: Teriflunomide is an immunomodulatory agent with anti-inflammatory properties but can cause life-threatening liver toxicity. Monitoring liver function is a critical part of patient education.

Question 40

Which drug can improve walking speed in patients with MS but has a significant risk of seizures, particularly at higher doses? A. Amantadine B. Modafinil (Provigil) C. Dalfampridine (Ampyra) D. Bethanechol

Answer 40

C. Dalfampridine (Ampyra) Rationale: Dalfampridine is a selective potassium channel blocker that improves nerve conduction in damaged nerve segments, enhancing walking speed. However, it poses a risk of seizures, especially at higher doses.

Question 41

A patient with multiple sclerosis is experiencing fatigue. Which combination of medications might the nurse anticipate being prescribed? A. Amantadine, modafinil (Provigil), and fluoxetine (Prozac) B. Dimethyl fumarate (Tecfidera), dalfampridine (Ampyra), and prednisone C. Fingolimod (Gilenya), bethanechol, and modafinil (Provigil) D. Alemtuzumab (Lemtrada), natalizumab (Tysabri), and amantadine

Answer 41

A. Amantadine, modafinil (Provigil), and fluoxetine (Prozac) Rationale: These medications are commonly used to treat fatigue in patients with MS. Amantadine and modafinil promote alertness, while fluoxetine may help address fatigue associated with depression.

Question 42

Which statement about IV corticosteroids in MS treatment is correct? A. They reverse permanent neurologic impairment from MS exacerbations. B. They are effective in modifying disease progression. C. They reduce edema and acute inflammation during exacerbations. D. They prevent relapses when used as maintenance therapy.

Answer 42

C. They reduce edema and acute inflammation during exacerbations. Rationale: IV corticosteroids like prednisone reduce inflammation and edema at demyelination sites, accelerating recovery from acute exacerbations. However, they do not prevent relapses or reverse permanent damage.

Question 43

The nurse is reviewing a new order for cladribine (Mavenclad) for a patient with MS. Which adverse effect should the nurse prioritize monitoring for? A. Cognitive decline B. Cancer development C. Liver toxicity D. Seizure activity

Answer 43

B. Cancer development Rationale: Cladribine is a cytotoxic agent that increases the risk for cancer. Monitoring for signs of malignancy is a critical safety consideration.

Question 44

Which medication should the nurse question for a patient with MS who has a history of seizures? A. Oxybutynin B. Dalfampridine (Ampyra) C. Bethanechol D. Glatiramer acetate

Answer 44

B. Dalfampridine (Ampyra) Rationale: Dalfampridine increases the risk of seizures, particularly at higher doses, making it contraindicated in patients with a seizure history.

Question 45

A patient is prescribed glatiramer acetate (Copaxone) for MS. What should the nurse include in patient education? A. This drug may cause a fatal viral brain infection. B. It is taken orally in two annual cycles. C. It suppresses the immune system to prevent relapses. D. It reduces spasticity by relaxing the muscles.

Answer 45

C. It suppresses the immune system to prevent relapses. Rationale: Glatiramer acetate is an immunomodulator that suppresses immune activity, modifying disease progression and preventing relapses in MS.

Question 46

A patient with MS is experiencing bladder spasms. Which drug is likely to be prescribed? A. Oxybutynin B. Bethanechol C. Amantadine D. Teriflunomide

Answer 46

A. Oxybutynin Rationale: Oxybutynin is an anticholinergic used to treat bladder spasms, reducing urgency and incontinence commonly associated with MS.

Question 47

A patient receiving alemtuzumab (Lemtrada) asks why this medication was chosen. What is the best response by the nurse? A. “It is typically prescribed as a first-line therapy to prevent MS relapses.” B. “This drug is used when other treatments have not been effective.” C. “It helps repair myelin damage caused by MS.” D. “This medication reduces the risk of liver and kidney problems.”

Answer 47

B. “This drug is used when other treatments have not been effective.” Rationale: Alemtuzumab is a monoclonal antibody prescribed for active forms of MS after inadequate response to other treatments due to its significant side effects.

Question 48

Which drug for MS carries a risk of progressive multifocal leukoencephalopathy (PML)? A. Dimethyl fumarate (Tecfidera) B. Modafinil (Provigil) C. Dalfampridine (Ampyra) D. Amantadine

Answer 48

A. Dimethyl fumarate (Tecfidera) Rationale: Dimethyl fumarate increases the risk of PML, a rare but serious viral brain infection. Patients taking this medication require careful monitoring for neurological changes.

Question 49

A patient with MS is experiencing severe muscle spasticity. Which treatment option involves delivering medication directly into the spinal fluid? A. Baclofen administered via intrathecal pump B. Oral administration of onabotulinumtoxin A (Botox) C. Dorsal-column electrical stimulation D. Neurectomy

Answer 49

A. Baclofen administered via intrathecal pump Rationale: Intrathecal pumps deliver baclofen directly into the spinal fluid, providing targeted relief for severe muscle spasticity in patients with MS.

Question 50

Which type of exercise is especially beneficial for patients with MS who are not experiencing an exacerbation? A. Weightlifting B. High-impact aerobics C. Resistance training D. Water-based exercise

Answer 50

D. Water-based exercise Rationale: Water exercise is particularly beneficial for patients with MS because the buoyancy of water provides support, allowing for greater control and enabling activities that might be difficult on land.

Question 51

For a patient with MS experiencing unmanageable tremors, which advanced intervention might be considered? A. Onabotulinumtoxin A (Botox) injections B. Thalamotomy or deep brain stimulation (DBS) C. Physical therapy and stretching D. Rhizotomy

Answer 51

B. Thalamotomy or deep brain stimulation (DBS) Rationale: When tremors become unmanageable with medications, thalamotomy or DBS may be considered to target the area of the brain responsible for tremor control.

Question 52

Which benefit of physical therapy is most significant for a patient with MS experiencing spasticity and impaired motor coordination? A. Improving cognitive abilities B. Reducing the frequency of exacerbations C. Retraining unaffected muscles to compensate for impaired ones D. Preventing tremor progression

Answer 52

C. Retraining unaffected muscles to compensate for impaired ones Rationale: Physical therapy helps retrain unaffected muscles to compensate for impaired ones, improving coordination and decreasing spasticity in patients with MS.

Question 53

A patient with MS is considering surgical interventions for severe spasticity. Which procedure involves cutting nerve roots to relieve symptoms? A. Rhizotomy B. Cordotomy C. Neurectomy D. Dorsal-column electrical stimulation

Answer 53

A. Rhizotomy Rationale: Rhizotomy involves cutting nerve roots to relieve severe spasticity and pain, making it a surgical option for patients with MS when other treatments fail.

Question 54

Why is water-based exercise preferred for some patients with MS over other forms of exercise? A. It reduces the need for medication. B. It allows greater control and facilitates movements that may be difficult on land. C. It prevents exacerbations of MS symptoms. D. It is the only exercise that reduces spasticity.

Answer 54

B. It allows greater control and facilitates movements that may be difficult on land. Rationale: The buoyancy of water supports the body, enabling MS patients to perform movements that might be impossible on land, while also decreasing spasticity and improving coordination.

Question 55

Which factor should a nurse teach a patient with MS to avoid in order to reduce the risk of exacerbation? A. Fatigue and infection B. High-protein diet C. Sedentary lifestyle D. Overhydration

Answer 55

A. Fatigue and infection Rationale: Fatigue and infection are common triggers for MS exacerbations. Avoiding these can help reduce the likelihood of disease flare-ups.

Question 56

A patient with MS reports feeling overwhelmed by the diagnosis. What is the nurse’s priority action during the diagnostic phase? A. Provide resources about MS support groups. B. Reassure the patient that tests rule out other neurological disorders. C. Recommend exercise to reduce stress. D. Encourage the patient to minimize caffeine intake.

Answer 56

B. Reassure the patient that tests rule out other neurological disorders. Rationale: During the diagnostic phase, it is essential to address the patient’s anxiety by explaining that tests are performed to confirm the diagnosis and exclude other conditions.

Question 57

During an acute MS exacerbation, what is the nurse’s primary focus? A. Encouraging mobility to prevent muscle atrophy B. Preventing complications of immobility C. Teaching the patient to self-catheterize D. Preparing the patient for physical therapy

Answer 57

B. Preventing complications of immobility Rationale: Immobility during an acute exacerbation increases the risk of complications such as respiratory issues, pressure injuries, and UTIs. Preventing these complications is a priority.

Question 58

Which dietary recommendation should a nurse provide to a patient with MS experiencing constipation? A. Increase protein intake. B. Follow a low-sodium diet. C. Limit fluid intake. D. Consume a diet high in fiber.

Answer 58

D. Consume a diet high in fiber. Rationale: A diet high in fiber promotes regular bowel movements, which helps manage constipation commonly experienced by MS patients.

Question 59

What is a key teaching point for a patient with MS who lives in a warm climate? A. Avoid drinking cold fluids during the summer. B. Exercise outdoors during midday. C. Wear a cooling vest to help maintain function. D. Minimize water intake to reduce overheating.

Answer 59

C. Wear a cooling vest to help maintain function. Rationale: Overheating can worsen MS symptoms. Cooling vests can help regulate body temperature and maintain physical function in warm climates.

Question 60

Which statement by a patient with MS indicates a need for further teaching? A. “I will notify my HCP at the first signs of exacerbation.” B. “I should avoid extremes of heat and cold.” C. “It’s okay to skip doses of my medication when I feel fine.” D. “I need to eat a healthy, balanced diet.”

Answer 60

C. “It’s okay to skip doses of my medication when I feel fine.” Rationale: Patients must adhere to their medication regimen consistently to manage MS symptoms and prevent exacerbations, even if they feel well.

Question 61

A patient with MS reports worsening symptoms after childbirth. What should the nurse emphasize? A. Avoid live virus immunizations. B. Use cooling measures to manage symptoms. C. Monitor for signs of infection. D. Identify and avoid stressors.

Answer 61

D. Identify and avoid stressors. Rationale: Stress is a known trigger for MS exacerbations. After childbirth, identifying and managing stressors is critical to reducing symptom severity.

Question 62

What should the nurse emphasize to a patient with MS to reduce the risk of developing UTIs? A. Take tricyclic antidepressants as prescribed. B. Use self-catheterization if necessary. C. Increase caffeine intake to promote diuresis. D. Limit fluid intake to reduce bladder spasms.

Answer 62

B. Use self-catheterization if necessary. Rationale: Self-catheterization helps ensure complete bladder emptying, reducing the risk of urinary stasis and subsequent UTIs in patients with MS.

Question 63

What is the best approach for a nurse to address the emotional impact of MS on the patient and their caregiver? A. Provide a detailed disease progression timeline. B. Recommend avoiding discussions about future plans. C. Encourage the use of counseling or support groups. D. Focus on disease-modifying drug therapy.

Answer 63

C. Encourage the use of counseling or support groups. Rationale: Counseling and support groups provide emotional support, helping patients and caregivers cope with the unpredictability and lifestyle changes associated with MS.

Question 64

Why should a nurse advise a patient with MS to avoid extremes of heat and cold? A. To prevent worsening of symptoms B. To reduce the risk of fatigue C. To avoid triggering bladder spasms D. To improve blood circulation

Answer 64

A. To prevent worsening of symptoms Rationale: Extremes of temperature can exacerbate MS symptoms. Avoiding these extremes helps patients maintain better symptom control.

Question 65

onths and modafinil and dalfampridine daily. What assessment findings would indicate that the treatment plan was successful? (select all that apply) a. Blurred vision b. Improved walking c. Decreased fatigue d. No change in spasticity e. Reduced exacerbation frequency

Answer 65

b. Improved walking c. Decreased fatigue e. Reduced exacerbation frequency

Question 66

A woman who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. Which response would the nurse provide? a. “MS symptoms will be worse after the pregnancy.” b. “Symptoms of MS may improve during pregnancy.” c. “Women with MS frequently have premature labor.” d. “MS is associated with an increased risk for congenital defects.”

Answer 66

b. “Symptoms of MS may improve during pregnancy.” Rationale: Some women with MS have remission or an improvement in symptoms during pregnancy. Symptoms of MS may improve during pregnancy. There is no increased risk for congenital defects in infants born of mothers with MS. Onset of labor is not affected by MS. MS symptoms will not worsen after pregnancy.

Question 67

A patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate (Copaxone). Which information would the nurse include in patient teaching? a. Recommendation to drink at least 4 L of fluid daily b. Need to avoid driving or operating heavy machinery c. How to draw up and administer injections of the medication d. Use of contraceptive methods other than oral contraceptives

Answer 67

c. How to draw up and administer injections of the medication Rationale: Glatiramer acetate (Copaxone) is administered by self-injection. Oral contraceptives are an appropriate choice for birth control while taking Copaxone. There is no need to avoid driving or drink large fluid volumes when taking glatiramer.

Question 68

Which information about a patient with multiple sclerosis (MS) indicates that the nurse would consult with the health care provider before giving the prescribed dose of dalfampridine (Ampyra)? a. The patient reports pain with neck flexion. b. The patient walks a mile each day for exercise. c. The patient has epilepsy controlled by medication. d. The patient has the relapsing-remitting form of MS.

Answer 68

c. The patient has epilepsy controlled by medication. Rationale: Dalfampridine use may cause seizures, especially at higher doses, so it would be important to evaluate the risk of triggering seizures in someone known to have epilepsy. The other information will not impact whether the dalfampridine would be administered.

Question 69

Which action would the nurse plan to take for a patient with multiple sclerosis who has urinary retention caused by a flaccid bladder? a. Teach the patient how to self-catheterize. b. Encourage decreased evening fluid intake. c. Suggest the use of adult incontinence briefs. d. Assist the patient to the commode every 2 hours.

Answer 69

a. Teach the patient how to self-catheterize. Rationale: The patient may need to intermittently self-catheterize when urinary retention is not relieved by other means. Decreasing fluid intake will not improve bladder emptying and may increase risk for urinary tract infection and dehydration. The use of incontinence briefs and frequent toileting will not improve bladder emptying.